02 Jan Medical Coverage for Many Dental Procedures
Dental insurance can limit coverage with annual maximums and usually provides full coverage for cleanings, “but only pays a small fraction of the cost of other treatments” (Taxin 2016). Although some patients cannot afford certain treatments or decide to deny them due to little to no dental coverage, they can look to medical insurance. Dentists can bill certain procedures to medical insurance so that their patients can get more coverage and lower out-of-pocket costs (“Billing Medical Insurance for Dental Services” 2016). With more coverage, patients could undergo procedures more willingly, resulting in higher income for the practice (Taxin 2013b; Tuller 2018). Medical insurance policies can provide coverage to a variety of procedures.
The policies can contain benefits for many dental procedures based on their criteria of medical necessity. Medical insurance would never pay for treatments for aesthetic reasons (“When Are Restorative Dental Treatments Medically Necessary?” 2018). Most of the time, it provides coverage to patients that needs medically necessary procedures (Nierman 2018). To successfully bill claims to medical insurance for their patients, dentists usually record medical information about the patient, then “[provide] risk assessments,” “[provide] diagnostic tests,” and “[have] the patient referred by a medical provider” (Taxin 2013a). Dentists treat not only dental conditions, but also medical conditions (Taxin 2016). For instance, they perform medical procedures that addresses “pain or other issues that result in the loss of function in a patient’s daily life…” (Taxin 2016). Many procedures that dentists can perform in their practice can be covered by the patient’s medical insurance (Taxin 2016). For instance, patients can receive medical benefits for “TMD orthotics and sleep apnea appliances…” (Taxin 2013a). They could receive coverage for surgery on their teeth, such as extractions “before radiation therapy or an organ transplant” and dental implants (Taxin 2016). Medical insurance can also pay for restorative treatments that “[addresses] problems that cause a loss of dental function and that impact a patient’s ability to live a healthy life” (“When Are Restorative Dental Treatments Medically Necessary?” 2018). For example, medical policies may provide coverage for restorative treatments addressing teeth harmed by Gastro-esophageal Reflux Disease (GERD) or Bulimia (“When Are Restorative Dental Treatments Medically Necessary?” 2018). They could pay for restorative or prosthetic treatments addressing “dental damage from dry mouth caused by drugs prescribed for medical conditions,” such as asthma, allergies, Parkinson’s, etc. (“When Are Restorative Dental Treatments Medically Necessary?” 2018). Medical coverage encompasses a wide variety of other procedures, such as “CBCT (cone beam) and tomography,” “[oral] infections, cysts, oral inflammation,” “[accidents] to teeth,” “[frenectomy]/tongue tie for infants and children,” “Botox Injections for bruxism and jaw pain,” and much more (Nierman 2018).
While medical insurance policies can cover many dental procedures, the policies can still contain different types of benefits and exclusions (Nierman 2018). Consequently, dental practices and patients should verify if the policies provide medical coverage for their treatments.