Wisdom teeth extraction is medical and not dental?

[Sherri]

I was suprised when my Dentist referred me to an oral surgeon for my son to be looked out since it seems like his wisdom teeth are impacted, and they told me to bring my medical insurance card not dental.
They said they would need a referal from our Doctor. No problem I got it, I just was suprised that it was medical and not Dental.

 

[honeymom]

Maybe it is medical in your state. In mine, it was dental. I had to pay for it.

 

[MushyMushy]

I think it's medical when they need to cut them out. I remember when I had mine done, I wanted IV sedation, and the only way it would be covered was if one of the teeth had to be cut out. One did, so it was covered under medical.

 

[Jennasis]

Hmmm..I had my wisdom teeth extracted by an oral surgeon because I wanted general anesthesia (no WAy was I going to be awake for that!). I had to pay out-of-pocket for the actual anesthesia because the dental insurance only covered local (I guess Blue Cross feels everyone should just suck it up and deal with the local only). I was never given the option of using medical insurance, just my dental. Sounds odd.

 

[believe]

Must be how your insurance sees it, mine saw it as dental and they were all cut out.

 

[Sherri]

I wonder if it has to do with him being a teenager and not an adult.
Not sure, but will bring along my dental card just in case.
When I called the primary Dr's office for the referal, I went through the whole thing, thinking I would have to explain, but they said they knew and they would do the referal.
We go on the 25th for the consult.

 

[mickeyfan2]

I think it depends on who does it. When DH had them out as an adult our medical insurance paid.

 

[RSoxFan]

It was medical for me because my top two were upside down and had grown into my sinuses (gross, huh?), so I guess they had to do a lot to get them out. I had to have it done in the hospital under general anesthesia. For my brother, only one was impacted, so they could do it in the office with novacaine, and that counted as dental. I guess it depends on how bad they are.

 

[Lars624]

Must be how your insurance sees it, mine saw it as dental and they were all cut out.

My teenage son is having his out 2/15, they are all impacted & our dental insurance is covering it.

 

[monarchsfan16]

I had mine out in June. Medical wouldn't cover any of it. Dental covered a portion of it (just the amount left in benefits for the fiscal year). Mine were impacted and were cut out by an oral surgeon.

 

[Missy Mouse]

I was suprised when my Dentist referred me to an oral surgeon for my son to be looked out since it seems like his wisdom teeth are impacted, and they told me to bring my medical insurance card not dental.
They said they would need a referal from our Doctor. No problem I got it, I just was suprised that it was medical and not Dental.

My DBF just had his wisdom teeth out and went through the same thing. He was thankful it ended up getting submitted through regular insurance because he ended up paying a lot less OOP ($325) than he would have if he had to go through his dental.

 

[miste76]

As a dentist, I have never sent a patient to get a referral from their MD for extraction of wisdom teeth - nor have I ever heard of it from colleagues. I can only imagine that it's done differently in different states.

 

[UnderTheMistletoe]

Hey Sherri!

I see you are in Chester County, PA. I grew up in Downingtown, PA. We currently live in Maryland and I had my wisdom teeth out the day before Thanksgiving. I can't tell you how close I was to going back home to have Dr. Famiglio remove them. I had oral surgery when I was young (7th or 8th grade) and he did an excellent job- only used local and was so gentle. I had a ton of complications with the wisdom teeth down here- missed an entire week of school.

I would highly, highly, highly recommend taking your child to see him! If they are all impacted and bony removals, then you want someone who is going to do a good job. I think Dr. Famiglio is in Exton these days- he used to be at the Brandywine Hospital Professional Building.

 

[Heidict]

I had my widsom teeth out when I was in my 20's. Due to the location of the teeth and the size of my jaw the oral surgeon felt more comfotable doing it in an out patient hospital setting.

Because it was done in the out patient portion of the hospital it went under medical.

Fine with me. I only had to pay a $5 copay instead of 20% of the bill.

 

[It's A Happy Day]

I believe (I could be wrong) but it depends on where you have them removed. If I had them taken out in the Dentists office it was considered Dental but if they were removed in a hospital day surgery setting (by an oral surgeon) it was considered Medical.

 

[cybrkitn]

Medical here in NY as well. Probably b/c it's surgery, which falls under medical At least that's what I'm guessing.

I just had my last two taken out a few months ago (not impacted, luckily) and had to be knocked out for it. I didn't want to be awake for that either due to my allergies/sinuses and TMJ.

 

[Sherri]

Hey Sherri!

I see you are in Chester County, PA. I grew up in Downingtown, PA. We currently live in Maryland and I had my wisdom teeth out the day before Thanksgiving. I can't tell you how close I was to going back home to have Dr. Famiglio remove them. I had oral surgery when I was young (7th or 8th grade) and he did an excellent job- only used local and was so gentle. I had a ton of complications with the wisdom teeth down here- missed an entire week of school.

I would highly, highly, highly recommend taking your child to see him! If they are all impacted and bony removals, then you want someone who is going to do a good job. I think Dr. Famiglio is in Exton these days- he used to be at the Brandywine Hospital Professional Building.

Thats so funny because my son is seeing Dr.Famiglio. I live in Downingtown (West Bradford). I'm glad to see that Dr.Famiglio comes highly recommended.

 

[bigbabyblues]

Two of mine were dental, one was medical. The one that ws impacted was medical because they had to cut the gum, or something like that. The other two were dental because it was just teeth pulling.

They billed my medical insurance for one and the dental for the other two. Talk about a mess to straighten out.

 

[HoneyPooh]

It all has to do with how exactly the tooth is in your mouth and insurance company billing codes. There is a code used for billing for each tooth extraction. The code will tell you which insurance will be billed. If you are referred to an oral surgeon you are more likely to have at least some of them be medical and that would be why your dentist referred you along because someone with more equipment and the ability to possibly put you under anesthesia needed to take care of you.

There are several codes for dental and medical wisdom teeth extractions(Example7230 and D7240 are for partial bony impactions and full bony impactions).

If they go under your dental you end up paying more (usually 20%) plus if you want anesthesia you pay out of pocket for that because dental only pays for anesthesia in very limited circumstances. Dental does not consider the severity of their codes to require you to be under for the extractions (pretty much they feel if you need to go under you must be a sissy and can pay for it yourself!).

If you have partially or fully impacted wisdom teeth it would go under your medical and you would need a referral and pay your co-pay and your insurance would normally pay for your anesthesia (their codes show enough severity to warrant anesthesia!). In some cases you could have a combination of dental and medical billing for the same surgery because each tooth had a different code some being medical and some being dental. X-rays are sent with the billing claims to prove to the insurance company why you chose each billing code (no fudging allowed, you would be surprised how many peopled asked us to do that).

Mostly the dental codes are for the wisdom teeth that just are not coming through the gums or are only slightly sideways and are considered relatively easy to extract. The medical codes are for the ones that are completely sidesways and upside down in there and are really some work to get out.

Ok, 3 years of Admin/billing for an oral surgeon is stuck in my head. I haven't used those codes in a year and I still remembered them

 

[Cindy B]

I had impacted wisdom teeth about two summers ago. I was referred to the oral surgeon from the dentist. Medical coverage covered it all! I think I paid a $20 copay or something like that... no dental at all.