There’s no doubt that oral health impacts overall physical health. But that doesn’t guarantee the ease of how to bill medical insurance for dental procedures.
It’s a more complicated process than what’s implied with an off-the-cuff statement like, “Just charge it to medical…!” Even so, there are more dental procedures than you might be aware of that can actually be covered with a patient’s medical insurance.
Can Dental Work be Covered by Health Insurance?
Health insurance providers are discerning. And for good reason.
Dental to medical cross-coding can cause administrative headaches and gridlock access to necessary dental services. All in all your patient’s medical plan will in many cases augment their dental benefits.
Keep in mind that dental insurance is more easily positioned to cover preventative treatment. It’s essential to not raise red flags by trying to push through a procedure that’s on the borderline for allowable dental or medical coverage.
Stay within the boundaries allowed by your patient’s dental coverage while being aware of what their medical plan will allow for dental procedures. The end result is helping assure that your patients have access to dental care.
Do Medical Payors Reimburse for Dental Procedures?
The good news is that, yes, medical insurance will cover dental work. Health insurance will give some latitude for a dentist billing medical insurance.
Dental plans are equally specific about the dental procedures it will specifically cover. Knowing the overlap points between health insurance and the details of a dental claim are key.
Reimbursement success will often come down to the insurance company, dates of service, and the dental care you’re requesting payment for.
Are Dental Implants Covered by Medical Plans?
The big question patients ask – “Will health insurance cover implants?” Dental implant costs are substantial. And for the primary reason that they’re restoring an essential tooth root.
Your patient’s oral health cannot be placed at risk by dental insurance companies and their denial of coverage for dental implants. In some instances, replacing a tooth root falls under what is allowable by a patient’s medical plan.
It’s vital that you, as the dental provider, are specific in your examination and diagnosis regarding tooth replacement with implant treatment. Keep in mind that cut-and-dried cases where trauma or health related bone loss such as with certain cancers are easier for billing to your patient’s health insurance.
19 Dental Procedures Medical Insurance Might Pay
The better news is that there’s a list of allowable procedures that your patient’s medical insurance will cover. Keep the following list handy to give them hope especially when they lack dental insurance, when their dental coverage has lapsed, or when their dental insurance maximums have been reached.
1. Exams for services that are covered by medical insurance
Be specific. And make sure about the procedure’s necessity.
2. Panorex X-Rays
These are more thorough and increase diagnostic success.
3. Oral infections, cysts, and oral inflammation
Infection and its impact can be sourced outside of the mouth in some instances. Be thorough in your diagnosis and willing to refer if medical billing is an option.
4. CBCT (Cone Beam) and Tomography
Another thorough diagnostic tool that helps source the deeper cause of a patient’s oral health issue.
5. TMJ appliances and headache treatment
The systemic nature of this treatment helps with medical billing. Be clear in your diagnostic language.
6. Sleep apnea appliances (Dental Sleep Medicine)
Again, the systemic connection between the mouth, sinus, and breathing reflex helps categorize this as a….
