Dental Insurance for Oral Surgery: A Guide to Coverage and Costs

Many people are surprised to learn that dental insurance often covers a significant portion of oral surgery costs, but the extent of coverage varies widely depending on the type of procedure and the insurance plan.

Typically, dental insurance plans cover 50% to 80% of oral surgery costs, with some plans covering up to 100% for certain procedures.

Some common oral surgeries that are often covered by dental insurance include wisdom teeth removal, dental implant placement, and bone grafting.

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Most medical insurance providers will cover oral surgery procedures that are medically necessary, meaning they're required for your overall health and wellness. This is in addition to your dental insurance coverage.

Some common oral surgeries that are covered by medical insurance include surgical treatments for complex tooth removals, soft and hard tissue biopsies, and correction of facial deformities.

Your dental insurance provider may also cover some oral surgery procedures, depending on your plan and level of coverage. This includes most common oral surgeries, such as wisdom tooth extractions and dental implants.

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Medical insurance may pick up the cost for medically-related oral surgery procedures, such as diagnosis, treatment, or prevention of a medically-related oral condition.

Here are some examples of dental procedures that may be billed as medically-related dental procedures by your insurance provider:

It's essential to understand the terms of your coverage, including any deductibles or percentage payments, to figure out your insurance coverage.

Understanding how insurance works can be a daunting task, but it's essential to navigate the world of dental insurance for oral surgery. Most common oral surgeries are covered, at least in part, by your dental insurance provider.

Your specific insurance policy terms determine which codes are and aren't covered and at what percentage. This is why it's crucial to review your policy before undergoing any oral surgery.

By purchasing a dental insurance plan, you enter into a contract with the company, which agrees to pay certain amounts for certain procedures. You assume responsibility for what they do not cover.

Different plans approach coverage in different ways, with some requiring you to reach a deductible before paying anything, while others pay a percentage immediately. Understanding the different terms associated with your insurance plan can help you figure out your coverage.

Here's a breakdown of the types of procedures that may be covered by medical insurers:

Your medical insurance may also pick up the cost in full or part for medically-related oral surgery procedures, depending on your plan, medical health status, and the type and degree of difficulty of the surgery.

Oral surgery can be a complex and costly process, but understanding your options can help you make informed decisions about your care. Certain oral and maxillofacial procedures are performed to correct medical problems that threaten a patient's health, and some or all of the costs of these surgeries are typically covered by insurance.

If you're facing a medical emergency, surgery to remove tumors or cysts in the cheeks, jaws, or oral cavity may be necessary. Insurance usually covers some or all of the costs for procedures like this.

Insurance providers typically don't cover elective procedures, which are basically any cosmetic oral surgery. This means that patients usually have to pay for themselves for procedures like tooth extraction, including wisdom teeth removal.

Some insurance plans may cover the costs of certain oral surgery procedures if other non-invasive treatments have failed. For instance, patients with sleep apnea may be able to get coverage for surgical treatment if use of a CPAP machine has proven ineffective.

Here are some examples of oral surgery procedures that are not typically covered by insurance:

Oral surgery procedures can be a bit confusing when it comes to insurance coverage. Some procedures are covered by insurance, while others you'll have to pay for yourself.

Certain oral and maxillofacial procedures are performed to correct medical problems that threaten a patient's health. These procedures are typically covered by insurance, including surgery to remove tumors or cysts in the cheeks, jaws or oral cavity.

Procedures to correct a congenital birth defect or facial deformity are also usually covered. Additionally, treatment to address structural abnormalities in the jawbone is often covered by insurance.

Facial surgery to repair injuries due to physical trauma is also typically covered. However, it's essential to check with your insurance provider to confirm coverage for your specific procedure.

Some oral surgery procedures have out-of-pocket costs, including tooth extraction, dental implant placement, bone grafting, and treatment for obstructive sleep apnea (OSA). These procedures are usually considered elective and are not covered by insurance.

Here's a breakdown of some oral surgery procedures and their typical insurance coverage: