Dental and Medical Coverage for Periodontal Disease

People with periodontal disease must go to a hygienist, dentist, or periodontist, all of whom could address their disease before it worsens. According to Michael Roizen, MD, “Periodontal (gum) disease is a bacterial infection of the gums… Early in the infection, periodontal disease is called gingivitis; later on, as the infection gets worse, it is called periodontitis.” As the disease develops and goes throughout the mouth the gum and jawbones continue to deteriorate to the point that the patient’s teeth fall out. This disease is also connected to medical conditions, such as heart attacks, type 2 diabetes, and strokes. The price of treating the disease varies based on the severity of the gum infection. People who need treatment for periodontal disease can utilize their dental and medical insurance.

Dental coverage for periodontal disease

Dental insurance can cover some treatments for periodontal disease. They may have to pay a deductible or complete a waiting period before receiving coverage for this care.  Dental insurance can have different types of benefits for people, such as coverage for scaling and root planing, perio maintenance, or surgical periodontal treatment. Most plans may categorize periodontal surgical services under a separate periodontal maximum, which could limit coverage. PPO dental plans may provide partial coverage for deep cleanings and laser gum disease treatment. Also, while beneficiaries can receive coverage for medically necessary deep cleaning and surgical procedures, they will not receive coverage if they undergo these procedures for cosmetic reasons.

Medical coverage for periodontal disease

Medical insurance can also cover some treatments for periodontal disease and conditions related to the disease. While medical insurance policies usually do not cover procedures related to periodontics, they may pay for the perio examination and treatment if the patient is undergoing a different surgical procedure included in the plan. Some policies provide partial coverage for gum surgery if they consider it a medical procedure. In addition, a periodontal, or gum, abscess can stem from periodontitis disease, a deep periodontal pocket, or a weak immune system. Dentists can bill the non-surgical medical treatment, “curettage of periodontal abscesses,” to medical insurance.

Both dental and medical insurance can include benefits for treating periodontal disease. Coverage from both sources can help people pay for their treatments. If you need assistance billing periodontal treatment or any other dental procedures, consider partnering with eAssist. Our Sucess Consultants are dental billing experts and will correctly bill any treatment you provide. To learn more, schedule a free consultation here.