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How To Know When Health Insurance Will Cover An Oral ProcedureStay UpdatedSubscribe to the INSURICA blog and receive the latest news direct to your inbox. How To Know When Health Insurance Will Cover An Oral ProcedureHow to know when an oral procedure is actually a medical procedure and not dental. Your employees might be able to save money on dental work if they understand the difference between dental care and medical procedures performed in a dentist’s office. Most dental insurance covers routine cleanings at 100 percent. However, policies usually have a low annual maximum benefit and only pay a small fraction of the cost of other treatments. The good news is that health insurance might cover certain dental procedures. When health insurance pays for oral surgery it typically pays as the primary payer with no yearly maximum. Dental coverage coordinates benefits as the secondary payer. Employees who understand the difference between a dental and a medically necessary procedure can remind their provider to bill medical insurance when applicable so the patient can afford to get additional coverage. DENTAL CARE • Fillings to treat teeth for cavities or decay or to repair teeth that have fractures. MEDICAL PROCEDURES However, if a dentist treats a traumatic injury to a patient’s mouth, it is considered a medical treatment and is probably covered under medical insurance. Most medical insurance excludes payments for the routine care, treatment and replacement of teeth and related structures such as gums and jawbones. In addition, most health insurance policies exclude dentures, bridges, or crowns because these procedures are viewed as cosmetic, even when they restore function. Examples of medical procedures include: • Jaw surgery to correct sleep apnea or Temporomandibular Joint Disorders (TMJ); note that medical plans usually will not pay for orthodontic braces to
correct TMJ. Encourage your employees to talk to their broker for guidance and to find out how to get the most out of their dental and medical insurance policies. Copyright © 2021 Smarts Publishing
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