Wednesday, June 15, 2022

Is Wisdom Teeth Surgery Covered By Medical Or Dental Insurance

Don't Miss

Would You Like To Schedule An Appointment With Us Today

Does insurance cover my wisdom teeth removal?

Whether you are in need of oral surgery for medical reasons, dental reasons or for both, we can get you scheduled in for a consultation appointment at a time that is convenient for you. Whenever there is a need for you to undergo a surgical process in order to improve your oral health, the more you learn about what happens during the surgical process, the more likely you will experience a successful outcome.

Request an appointment here: or call Palm Beach Dentistry at for an appointment in our Delray Beach office.

Check out what others are saying about our services on Yelp: Read our Yelp reviews.

Dental Procedures Medical Insurance May Pay:

  • Sleep apnea appliances
  • TMJ appliances and headache treatment
  • Oral infections, cysts, oral inflammation
  • Exams for services that are covered by medical insurance
  • Panorex x-rays for services covered by medical insurance
  • CBCT and tomography for services covered by medical insurance
  • Frenectomy/tongue ties for infants and children
  • Accidents to teeth
  • Mucositis and stomatitis .
  • Facial pain treatment
  • Dental implants and bone grafts
  • 3rd molars or wisdom teeth extraction
  • Biopsies
  • Clearance exams before chemotherapy or surgery
  • Botox Injections for bruxism and jaw pain
  • With all the opportunity there is to help patients who have medical-related symptoms, infection, obstructive sleep apnea, TMJ disorder, or oral surgeries, its essential for the dental office to have their ducks in a row to maximize medical insurance.

    Does Insurance Cover Oral And Maxillofacial Surgery

    We wishwe could say that oral and maxillofacial surgery is always covered by insurance,but sometimes, that isnt the case.

    Thesurgical procedures insurance plans cover vary by provider, and some pay only aportion of the oral surgery costs. In addition, some insurance companies havedifferent reimbursement rates for dental and medical procedures.

    Generally, oral and maxillofacial procedures that are medically necessary stand a strong chance of being covered. For surgeries that are considered elective, however, the opposite is true.

    Also Check: Can You Get Sr 22 Insurance Without A Car

    Our Partner Dentists Offer Affordable Wisdom Teeth Removal

    Our Kool Smiles Kids Club partner dentists have numerous locations across the nation and youll have easy access to affordable, painless wisdom teeth removal at most of them. Theyll first examine your childs oral cavity to see whether he/she needs a third molar removal, and then explain you the different options.

    Our partners stand for easy access to affordable oral healthcare in USA. You can always count on them to bring a smile to your face!

    Does Ohip Cover Dental

    Wisdom Teeth Removal and Medicare Coverage

    Generally speaking, OHIP does not cover dental care. The exceptions are complex jaw bone surgeries such as tumour removal, fracture repairs and jaw reconstruction. In extremely rare cases and with prior approval by OHIP, tooth removal may be covered under OHIP. Even though OHIP dental coverage is limited, there are 7 other programs in Ontario that do provide a wide range of dental services for free.

    Read Also: Travelocity Insurance

    What Are The Most Commonly Asked Questions

    No matter how old you are, when you learn youll have to have your molar teeth removed, you probably have a ton of questions including:

    • Will I be awake?
    • How long will the removal take?
    • Is the recovery painful?
    • Does health insurance cover the procedure?

    Anxiety about wisdom teeth removal and the length of time it will take you to recover is too much for some people to deal with. However, if you have a problem, the longer you wait, the worse the situation will get. Its better to talk to someone about it as soon as youre aware it might be a problem. That way youll know almost immediately whether or not youll need to go through with it.

    If youre worried about pain, you can opt to have a general anesthetic although some patients are comfortable with just a local anesthetic.

    Is Oral Surgery Covered By Medical Or Dental Insurance

    If youre planning a major oral surgery you may be wondering if its possible to get your medical insurance to cover your dental treatment. For people who dont have great or any dental insurance coverage, this can be a huge factor in whether its possible to move forward with your treatment.

    The short answer to this question is that yes, medical insurance will cover some types of oral surgeries, but not all of them. In most cases, the two plans will overlap one another, picking up various aspects of the line-item expenses and expecting the other policy to pay for the ones that are not covered.

    Who Decides if My Oral Surgery Falls Under Medical or Dental Benefits?

    Your medical insurance and dental insurance claims are filed with specific codes used to describe the service that is being rendered. Codes outline the type of oral surgery, how complicated it is, which tooth is involved, anesthesia/sedation, etc. The insurance policy will then dictate which codes are or are not covered.

    Once you have your written treatment plan in front of you, youll be able to see an estimate of which insurance plan pays for specific procedures and about how much will be left over for you to pay for out of pocket. Unfortunately, these are only estimates. Your dental or medical insurance may refuse to pay the claim, leaving you with the responsibility of covering that specific procedure.

    When Sedation or Anesthesia is Involved

    Why are You Having the Surgery?

    Don’t Miss: Car Insurance Broken Window

    Dental Procedures Medical Insurance Might Pay

    The better news is that theres a list of allowable procedures that your patients medical insurance will cover. Keep the following list handy to give them hope especially when they lack dental insurance, when their dental coverage has lapsed, or when their dental insurance maximums have been reached.

    1. Exams for services that are covered by medical insurance

    Be specific. And make sure about the procedures necessity.

    2. Panorex X-Rays

    These are more thorough and increase diagnostic success.

    3. Oral infections, cysts, and oral inflammation

    Infection and its impact can be sourced outside of the mouth in some instances. Be thorough in your diagnosis and willing to refer if medical billing is an option.

    4. CBCT and Tomography

    Another thorough diagnostic tool that helps source the deeper cause of a patients oral health issue.

    5. TMJ appliances and headache treatment

    The systemic nature of this treatment helps with medical billing. Be clear in your diagnostic language.

    6. Sleep apnea appliances

    Again, the systemic connection between the mouth, sinus, and breathing reflex helps categorize this as a medical condition.

    7. Accidents to teeth

    Mouth trauma can require medical diagnosis alongside your dental diagnosis and related care.

    8. Mucosititis and stomatititis

    The systemic impact of treatments outside the mouth can produce oral health issues requiring medical attention and related coverage.

    9. Frenectomy for infants and children

    10. Dental implants and bone grafts

    12. Biopsies

    What Do I Do If I Can’t Afford A Dentist

    Does insurance cover jaw surgery?

    If you can not afford a dentist, first find out if you qualify for one of the 8 free dental care programs administered by the government: OHIP, OSDCP, HSO, ODSP, OW, IFHP, NIHB, and VAC. If you do not qualify for free dental care under one of these programs, then your next step in finding affordable dental care should be to understand the difference between dentist prices and dental costs,it will help you find a reasonably priced dentist.

    Read Also: Is Bonding Covered By Insurance

    Does It All Boil Down To The Money Spent

    If it isnt the fear of the procedure keeping you from going through with it, it may be the cost thats preventing you.

    The average cost for a wisdom tooth removal with local anesthetic ranges from $75 to $200 if all four wisdom teeth are removed, the cost can increase to $300-$800.

    However, if there are any complications, the cost can increase drastically.

    An impacted wisdom tooth is a more involved procedure. For one tooth, the cost ranges from $225 to $600. If you opt for general anesthesia, the cost for removal will increase about $250 to $800.

    Its important to discuss with your dentist or oral surgeon whether your procedure is elective or medically necessary.

    Wisdom tooth removal, which is considered medically necessary, may be covered by dental insurance. However, most dental plans have an annual cap of $1,000 to $1,500. Youll have to check with your provider on the coverage, but this can sometimes include the cost of sedation as well as the surgery itself. But what is medically necessary?

    In Addition Dental Insurance Plans May Cover Some Or All Of The Costs Associated With These Procedures

    Does anthem health insurance cover wisdom teeth removal. What happens when you get your wisdom teeth out It varies according to each insurance plan and how much of a medical necessity removing your wisdom teeth is. Although this is a great option, most dental insurance plans have annual limits on how much they payout for all dental care .

    While some dental services may be discounted, dental implants are not listed as one of these services, and they. Teeth lost prior to this coverage. Dental insurance plans may also cover some or all the cost of such procedures.

    But the number one question we get asked is this: Get an expat quote today. Your health insurance plan may cover the cost of surgery if its considered medically necessary which is often the case if wisdom teeth are impacted or pose health problems.

    Most insurance companies cover 80 percent of wisdom tooth extraction costs. There are a variety of factors that will determine whether or not your insurance will cover the procedure. So what one persons blue cross might pay yours maynot.

    If the wisdom teeth are not impacted, then removal is not necessary. Wisdom teeth that are not impacted are rarely included and require a dental plan. Since you have not stated what part.

    The short answer is this it depends. Yes, but the exact benefit amounts vary depending on your plan. Here are four general guidelines to follow when determining if your wisdom tooth removal will be seen as medically necessary by your insurance.

    You May Like: Is American Income Life Insurance Good

    Is Wisdom Tooth Removal Effective

    Given the seriousness of this procedure, it is quite logical to wonder if the surgery is effective in the end. In the vast majority of cases, the removal leads to a much better overall quality of oral health, a reduction in pain, and a return of normal gum function. In many cases, wisdom teeth crowd the back teeth, causing much discomfort over time. Wisdom teeth removal can help alleviate this.

    In addition, any wisdom tooth that is impacted can cause severe problems down the road so it is best to have them removed by a trained surgeon. As the procedure can be expensive when paid out of pocket, it is helpful to first determine if your health insurance company provides coverage for the operation. There are quite a few policies that will certainly make accommodations for this medically necessary procedure.

    Wisdom tooth removal is also effective at reducing and eliminating the redness and swelling of the gum area caused by teeth that have only partially come in.

    As the tooth is not likely to come in any further, food and bacteria can get trapped underneath the gum area creating the potential for a host of serious problems down the road.

    It is important in such cases to have the wisdom teeth removed. Gum disease is a serious concern for individuals who have issues with their wisdom teeth, and removal is seen as an effective way of minimizing this risk. As wisdom teeth are difficult to clean, this situation is often compounded until they are removed altogether.

    Can Dental Work Be Covered By Health Insurance

    Dental Implants and Wisdom Teeth Removal Costs

    Health insurance providers are discerning. And for good reason.

    Dental to medical cross-coding can cause administrative headaches and gridlock access to necessary dental services. All in all your patients medical plan will in many cases augment their dental benefits.

    Keep in mind that dental insurance is more easily positioned to cover preventative treatment. Its essential to not raise red flags by trying to push through a procedure thats on the borderline for allowable dental or medical coverage.

    Stay within the boundaries allowed by your patients dental coverage while being aware of what their medical plan will allow for dental procedures. The end result is helping assure that your patients have access to dental care.

    Read Also: Car Insurance Replace Windshield

    How Important Are These Particular Molars

    So many people ask why we have wisdom teeth if we dont need them? We may not need them now, but we did once upon a time. Our primitive ancestors needed wisdom teeth to chew the raw meat, tree bark, roots, nuts, and leaves that were part of their everyday diet.

    Advances in cooking and meal prep have made food much softer, which means the average person doesnt need the third set of molars.

    Today, the human brain is much larger than a cavemans, which means there simply isnt enough room in the human jaw for the third set of molars.

    When there isnt enough room for wisdom teeth to erupt through the gum, wisdom teeth can cause many health problems including impactions, infections, and overcrowding.

    To prevent these problems from becoming overwhelming, many dentists will preemptively remove the third set of chompers. If left untreated, an impacted wisdom tooth can lead to serious health conditions including death.

    Compare Insurance Providers Rates to Save Up to 75%

    Secured with SHA-256 Encryption

    Things To Think About

    As you consider the possibility of having one or more of your wisdom teeth removed, there are some things that you will want to consider. Remember that you might never have any problems with your wisdom teeth.

    While some people opt to have them removed anyway just to head off any possibility of a future issue, health insurance will almost certainly not provide coverage in such situations. There are also very few risks associated with have your wisdom teeth taken out, but as with any surgical procedures, the possibility of complications is always there.

    Read Also: Banfield Active Care Plus Cost

    Is Oral Surgery Considered A Medical Or Dental Procedure

    Thinking oral surgery is in your future? While it makes sense that oral surgeries are performed as dental procedures, many people do not realize that oral surgeries are also performed for medical reasons. So how can you tell the difference between the two types of procedures? Read on to learn more about when oral surgery is considered to be a medical procedure and when it is considered to be a dental procedure.

    Does Dental Insurance Cover Wisdom Tooth Removal

    Patient Walk-through of Wisdom Teeth Extraction | Boston Children’s Hospital

    Insurance coverage for wisdom teeth removal depends on your dental insurance plan. Most insurance companies cover 80 percent of wisdom tooth extraction costs.

    Although this is a great option, most dental insurance plans have annual limits on how much they payout for all dental care . Many people split the procedure into two years to get more coverage.

    NewMouth recommends

    Find Out

    Don’t Miss: Does Car Insurance Cover Broken Window

    Does Dental Insurance Cover Wisdom Teeth Removal Yes

    How much does it cost to get wisdom teeth removed when you have insurance? Well, that will depend on the plan youve signed up for, as well as how complicated the extraction will be.

    With a comprehensive dental plan, you can dramatically reduce what youre required to pay out of pocket, even when you consider premiums, deductibles, coinsurance, and copays.

    Whether your insurance covers 50% of the cost or as much as 80%, you can save a lot of money, especially if the procedure will cost you hundreds or thousands of dollars!


    • Remember, you might be able to save some money if you have more than one problematic wisdom tooth extracted during the same appointment.
    • If your insurance has an annual maximum and you need more than one wisdom tooth removed, you might be able to do one at a time over the course of two years to remain within coverage limits, and to save the most money possible.

    Are Wisdom Teeth Covered Under Medical Or Dental Insurance

      In some cases, your health insurance plan may cover the cost of surgery if it is medically necessary which is often the case if wisdom teeth are impacted or pose a health risk. In addition, dental insurance plans may cover some or all of the costs associated with these procedures.

      Also Check: Securedent Implant System

      Why It Is Done

      A wisdom tooth is extracted to correct an actual problem or to prevent problems that may come up in the future. Some of the problems that can occur when wisdom teeth come in are:

      • Your jaw may not be large enough for them, and they may become impacted and unable to break through your gums.
      • Your wisdom teeth may break partway through your gums, causing a flap of gum tissue to grow over them. Food and germs can get trapped under the flap and cause your gums to become red, swollen, and painful. These are signs of infection.
      • More serious problems can develop from impacted teeth, such as infection, damage to other teeth and bone, or a cyst.
      • One or more of your wisdom teeth may come in at an awkward angle, with the top of the tooth facing forward, backward, or to either side.

      Does Private Health Insurance Cover Wisdom Teeth Removal

      Does Insurance Cover Wisdom Teeth / Wisdom Teeth Removal ...

      How much does insurance usually cover for wisdom teeth removal? Your health insurance plan may cover the cost of surgery if its considered medically necessary which is often the case if wisdom teeth are impacted or pose health problems.

      Wisdom Teeth Removal Dr Alistairs Comprehensive Guide

      Read Also: Is Teeth Bonding Covered By Insurance

      More articles

      Popular Articles