Dental insurance usually provides full coverage for cleanings, but only pays a portion of the cost of other treatments. Some of these treatments may be covered by medical insurance. Dentists can bill certain procedures to medical insurance so that their patients can get more coverage and lower out-of-pocket costs. With this additional coverage, patients may undergo procedures more willingly, resulting in higher income for the practice. Medical coverage for many dental procedures is available.
Dental treatment and medical necessity
Medical policies can contain benefits for many dental procedures based on their medical necessity criteria. Medical insurance would never pay for treatments for aesthetic reasons. Most of the time, it provides coverage to patients who need medically necessary procedures. To successfully bill claims to medical insurance for their patients, dentists usually record medical information about the patient, then provide risk assessments and diagnostic tests, and have the patient referred by a medical provider.
Dentists treat not only dental conditions but also medical conditions. For instance, they perform medical procedures that address pain or other issues that affect a patient’s daily life. Many procedures that dentists perform are covered by their patient’s medical insurance. For instance, patients can receive medical benefits for TMD orthotics and sleep apnea appliances. They can receive coverage for surgery on their teeth, such as extractions and dental implants. Medical insurance can also pay for restorative treatments that address problems that cause a loss of dental function and that impact a patient’s ability to live a healthy life. For example, medical policies may provide coverage for restorative treatments addressing teeth harmed by gastroesophageal reflux disease (GERD) or bulimia. They could pay for restorative or prosthetic treatments addressing dental damage from dry mouth caused by drugs prescribed for medical conditions like asthma. Medical coverage encompasses a wide variety of other procedures, such as CBCT (cone beam and tomography), infections, accidents, frenectomy, and Botox injections for bruxism and jaw pain.
While medical insurance policies cover many dental procedures, they still contain different benefits and exclusions. Consequently, dental practices and patients should verify if the policies provide medical coverage for their treatments. If you are struggling with insurance verification of any kind, consider partnering with eAssist. Our Success Consultants will verify all necessary details of your patient’s insurance coverage. To learn more schedule a consultation.
