wisdom teeth removal

[anniemae]

My teen needs her wisdom teeth out. I called the oral surgeon recommended by our dentist but they are not in network of our medical insurance. I thought it would be covered by dental insurance, which they do take and is in network. Does anyone know why it isn't covered by dental insurance only and why they need both medical and dental? I asked the woman I was talking to and she just kept saying it was not in network and they would not be able to bill the medical. Another dr. at the facility does take our insurance so I can book with that dr.

I called our medical insurance, but the wait time was really long so I plan to call again later today just to verify the dr. I wanted is not in network and to make sure the other dr at the facility is in network. Just wondering if anyone has had experience with wisdom teeth removal and how it was billed.

 

[mrodgers]

Because it's not a dental procedure. It's now a medical procedure and goes on your medical.

 

[AppleDumpling]

I had mine removed by an oral surgeon many years ago in my 20’s. It was paid partially by dental and partially by medical insurance.

It likely depends on the diagnosis, ie. severity of the tooth impaction (if it is deemed to be medically necessary), the specific procedure required, type of anesthesia, etc. and how it is coded. I would speak with both providers, find out exactly what benefits you have and get an estimate of how much is covered, and how much, if any, you will be expected to pay out of pocket.

 

[cvjw]

When my sons had their wisdom teeth out, our dental insurance only paid a part of the total cost and our health insurance paid for the anesthesia. We still had to pay a very large part of the bill.

 

[lanejudy]

Wisdom tooth (teeth) removal is sort of a hybrid procedure -- part dental part medical. If the teeth have fully erupted and simply need to be pulled, that would fall completely under dental. But as a teen most likely her teeth are impacted (still in the bone) and therefore the "surgical" part is considered medical with anesthesia, etc.

If you really prefer to use the out-of-network oral surgeon, find out if they offer any kind of payment plans. CareCredit is a common one but there are probably others.

 

[MrsCobraBubbles]

Some dental plans won't cover sedation and it has to billed medically, my son's wisdom tooth surgery had to be done in a hospital setting due to health issues and all those hospital services were billed medically though I believe the dentist's services were billed through our dental plan.

 

[LuvOrlando]

When we had it done some teeth were impacted & others were not. The impacted ones justified the coverage for sedation and all, but a few teeth were not at the tipping point to be justified by their rules so for those we were charged differently.

 

[Minnie1222]

I went through the wisdom teeth process with my kids and a cousin's kids and this is what I learned:

Some dental plans require the office to bill medical first, and will not pay unless they see some type of rejection letters from medical. Your surgeon can't bill medical if they don't work with your medical plan. Not all dental plans follow this ridiculous rule, but some do.

You should call your medical first to see if they have coverage for wisdom teeth removal in a private office, not at a hospital.
1. If they do: call each potential provider to make sure they're still in network. I found the list of providers on the website to be inaccurate.
2. If they don't: see if you can get a written proof to show your dental insurance.

 

[anniemae]

I went through the wisdom teeth process with my kids and a cousin's kids and this is what I learned:

Some dental plans require the office to bill medical first, and will not pay unless they see some type of rejection letters from medical. Your surgeon can't bill medical if they don't work with your medical plan. Not all dental plans follow this ridiculous rule, but some do.

You should call your medical first to see if they have coverage for wisdom teeth removal in a private office, not at a hospital.
1. If they do: call each potential provider to make sure they're still in network. I found the list of providers on the website to be inaccurate.
2. If they don't: see if you can get a written proof to show your dental insurance.

What is strange is that this practice has a few offices. The Dr we wanted also goes to another office over an hour and a half away that he would be considered in network. It's strange, he is in network at one office, but not the other.

 

[longboard55]

Dental insurance is not real insurance, more of a savings account. Unless the premium is very high, like something a union would provide, it is usually limited

 

[Minnie1222]

What is strange is that this practice has a few offices. The Dr we wanted also goes to another office over an hour and a half away that he would be considered in network. It's strange, he is in network at one office, but not the other.

I believe both the provider and the facility have to be in-network in order for claims to be processed smoothly.

 

[Minnie1222]

Were you told by your medical insurance that the provider was in-network? I would call his office directly to confirm. If they say they're not contracted then they're most likely not.

The list of providers on my insurance website is highly inaccurate. I was looking for a specialist (not oral surgery related), and found out some of the doctors have moved out-of-state or retired.

 

[mjkacmom]

Ended up paying around $3000 I think for each of us at the oral surgeon, twilight sedation. I don’t think dental or medical kicked in much if any.

 

[RangerPooh]

I'm thinking because an oral surgeon is a cross over between a dentist and medical physician. Where following their dental program they then specialize in surgery, crossing over into the medical field. This is only a guess based on the dental program at the university that I work for.

 

[anniemae]

Were you told by your medical insurance that the provider was in-network? I would call his office directly to confirm. If they say they're not contracted then they're most likely not.

The list of providers on my insurance website is highly inaccurate. I was looking for a specialist (not oral surgery related), and found out some of the doctors have moved out-of-state or retired.

The medical insurance told me that the provider is in network if we go to the office that is an hour and a half away. The office that is 10 minutes from our house is not in network with this dr. But, there is a dr. at the office that is 10 minutes away that is in network so we will use him.

 

[starry_solo]

When I had mine taken out (well, only one), my oral surgeon was a DDS and a MD. Went completely under (anesthesia) and woke up a half hour later (or so). I went through a dental school (no dental insurance) and didn't even think about seeing if my medical insurance would cover the anesthesia. But it only ended up being about $500 for the removal + anesthesia so it wasn't too bad.