Medical Insurance and Dental Trauma Procedures

Medical Insurance and Dental Trauma Procedures

Dentists can bill medical insurance companies so that patients could receive coverage for procedures treating injuries caused by traumatic events (“Most Medical Insurances Cover Dental Work as a Result of Trauma”). Dental trauma, usually classified “as a ‘non-biting injury to a sound natural tooth’” by health insurance companies, can be caused by many types of events, such as a car accident or an incident in sports (“Medical Filing Tips for Dental Accident Claims” 2013; “Most Medical Insurances Cover Dental Work as a Result of Trauma”). These events could lead to “[chipped] or fractured teeth,” “[dislodged] teeth,” “[knocked-out] teeth,” and “[root] fractures” (“Most Medical Insurances Cover Dental Work as a Result of Trauma”). Treatments, such as restorative care, surgery, dental implants, root canals, bone grafting, crowns, periodontal osseous surgery, TMD surgery, laser procedures, etc. that address these injuries are included as benefits in most medical insurance policies (“Most Medical Insurances Cover Dental Work as a Result of Trauma”; Zahrebelny 2003). Dental practices should help patients receive coverage for these procedures.

However, billing these treatments to medical insurance involve many rules and caveats. According to Christine Taxin, “the founder and president of Links2Success,” dentists “must first check to make sure the injury isn’t covered by auto, homeowners, or some other type of liability insurance. If an injury is covered by liability insurance, [dentists] must bill that insurance before [they] bill medical insurance” (Taxin 2016). Furthermore, medical insurance companies usually provide coverage for teeth that were healthy and undamaged before the accident (“Medical Filing Tips for Dental Accident Claims” 2013). Dentists, including those referred by other dentists, should provide the whole treatment plan in order to get prior authorization from the medical insurance company (“Medical Filing Tips for Dental Accident Claims” 2013). Dentists may even need to provide “a primary care physician’s referral for trauma” before a patient could receive medical coverage (“Medical Filing Tips for Dental Accident Claims” 2013). Dentists also need to indicate the date of the accident in the claim because some medical insurance companies may only provide coverage within a set timeframe (“Medical Filing Tips for Dental Accident Claims” 2013). For instance, depending on their medical insurance policy, patient can receive benefits for dental trauma procedures “for the first 24 hours after an accident” (“Medical Filing Tips for Dental Accident Claims” 2013). Along with that, dental practices need to check for “a deductible and/or dollar limit for dental trauma on the medical policy. Some medical policies set dollar limits on the amount of dental trauma benefits available per year or per tooth” (“Medical Filing Tips for Dental Accident Claims” 2013). Dentists should provide much information about the accident and recommended procedures in order to get a better coverage estimate for their patients (“Medical Filing Tips for Dental Accident Claims” 2013).

Dental practices must include every information that medical insurance companies require on their claims. Once the claims are processed successfully, patients can receive coverage and pay less out-of-pocket for procedures that could fix teeth damaged by unfortunate events.

Works Cited

“Medical Filing Tips for Dental Accident Claims.” Pediatric Dentistry Today 49, no. 5 (2013).
http://www.pediatricdentistrytoday.org/2013/september/xlix/5/news/article/285/.
“Most Medical Insurances Cover Dental Work as a Result of Trauma.” Advanced Dental &
Implant Care. Accessed January 24, 2019. https://www.adicalgonquin.com/blog/most-medical-insurances-cover-dental-work-as-a-result-of-trauma.
Taxin, Christine. “What makes it medical? A basic guide to medical vs. dental procedures.”
DentistryiQ, June 22, 2016. https://www.dentistryiq.com/articles/2016/06/what-makes-it-medical-a-basic-guide-to-medical-vs-dental-procedures.html.
Zahrebelny, Olya. “Billing patient medical plans: There’s nothing illegal about it!” Dental
Economics, June 1, 2003. https://www.dentaleconomics.com/articles/print/volume-93/issue-6/features/billing-patient-medical-plans-theres-nothing-illegal-about-it.html.
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