Does Insurance Cover Tongue Tie Surgery and How It Works

Tongue tie surgery, also known as a frenotomy, is a relatively simple procedure that can make a big difference in a person's life.

Most insurance plans cover tongue tie surgery, but the extent of coverage varies depending on the insurance provider and the individual's policy.

Typically, insurance companies consider tongue tie surgery a medically necessary procedure, especially if it's performed on a baby or toddler to help with breastfeeding or speech development.

Insurance coverage for tongue tie surgery may require a doctor's referral or a pre-authorization from the insurance company.

Insurance coverage for tongue tie surgery can be a bit confusing, but I'll break it down for you.

If you're an adult with Ankyloglossia, your insurance should cover the procedure if it's related to symptoms like feeding, eating, swallowing, or speech difficulties. This is considered a medically essential treatment.

For Medicare, the story is different. It won't cover the procedure if it's related to an excluded service, such as mouth preparation for dentures.

Most dental insurance policies, however, view a frenectomy as a cosmetic procedure and may not cover it. A few policies might cover up to 50% of the cost, but it's best to check with your insurer.

If you're a baby, the good news is that most commercial medical insurance will cover tongue tie release surgery, even if it's performed by a dentist.

Tongue-tie surgery is a relatively straightforward process. Most commercial medical insurance covers the treatment for tongue tie release.

Dr. Ghaheri, an ENT surgeon, confirms that many insurances will pay for the treatment if it's done by an MD, NP, DO, or PA-C.

If your baby has tongue-tie and is feeding okay, you may choose to wait and see if their lingual frenulum stretches on its own.

However, if tongue-tie causes problems with eating, speech, or social interactions, the doctor may release the tissue through a procedure called a frenotomy or a frenuloplasty.

The cost of a frenectomy can vary significantly, ranging from $500 to $1,500, depending on the clinic, anesthesia, and additional treatments required.

A typical frenotomy, a common treatment for infant ankyloglossia, costs around $850, according to an analysis of frenectomies performed at The Children's Hospital of Philadelphia in 2014.

Post-operative care fees, such as antibiotic therapy, may be incurred, adding to the overall cost of the procedure.

Painkillers may be required to control suffering during the healing process, which can be an extra expense.

Most dental insurance policies cover a frenectomy surgery, but some may only pay up to 50% of the cost, so it's essential to contact your insurer to find out if your plan covers the procedure.

Here are some ways to save money on a frenectomy:

A short, thick, or tight band of tissue (the lingual frenulum) can tether the tip of the tongue to the floor of the mouth, limiting its range of motion.

This condition, known as ankyloglossia, can interfere with breastfeeding and bottle feeding, making it difficult for a baby to stick out their tongue.

Tongue-tie can also affect how a child eats, speaks, and swallows.

In some cases, a simple surgical procedure called tongue tie treatment may be needed to correct the issue.

Breastfeeding issues can be a sign of tongue-tie, but it's not the only symptom.