In most cases, health insurance plans will cover some important oral surgery procedures. We recommend that you talk to your dentist or the staff of a dental specialist's office to see if they have experience filing medical claims. Most common oral surgeries are covered, at least in part, by your dental insurance provider. However, this depends on the specific type of surgery you need, your dental plan and your level of coverage.
Surgical tooth extractions are considered to be dental in nature. They're generally covered by an Aetna dental plan. To see if your dental or medical plan can cover surgical extractions, call Member Services. As a courtesy to you, we will bill your insurance company and follow up on claims.
Keep us informed of any changes to your insurance plan. You are responsible for the fees charged by our office, regardless of your insurance coverage. Most insurance companies must respond to the claim within four to six weeks. Any remaining costs are your responsibility.
When you need a serious dental procedure, such as oral surgery, some of the costs may be covered by both your dental insurance plan and your health insurance plan. You, your employees and your agents are authorized to use the CPT only, as indicated in Aetna's clinical policy bulletins (CPB), solely for your personal use by participating directly in health care programs administered by Aetna, Inc. The Applied Behavior Analysis (ABA) Medical Needs Guide helps determine appropriate (medically necessary) levels and types of care for patients who need evaluation and treatment for behavioral health conditions. For example, the extraction of a medically necessary tooth, the extraction of the impacted teeth, and the extraction of the teeth before radiation therapy or an organ transplant may be billed to health insurance.
Since this particular case is related to trauma, your medical benefits are more likely to cover your oral surgery than not. Each benefit plan defines which services are covered, which are excluded, and which are subject to monetary or other limits. Dental insurance also typically has a low maximum annual benefit, so patients with complex problems can quickly exhaust their dental benefits for the year. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a doctor or other health professional.
As insurers become more concerned with systemic diseases and whole-body health, they are more likely to understand that dental offices play an important role in a patient's medical team. You can also talk directly with your health insurance provider to see if your procedure is covered, get an estimate of how much they'll pay, and get a better idea of the out-of-pocket costs you can expect. If liability insurance covers an injury, you must bill that insurance before you bill the health insurance. Another case in which health benefits help cover oral surgery is when there are atypical developmental problems or facial deformities.
While this is just an estimate, it can provide you with information about what types of oral surgery are covered by your exclusive plans. Oral surgeons and other dental specialists, as well as general dentists, can bill health insurance for certain procedures. For many oral surgeries and certain dental procedures, your health insurance may cover all or part of the health care bill. It will show you if a drug is covered or not, but the information about the levels may not be the same as that of your specific plan.
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