When Doesn’t Health Insurance Cover Dental Work?


When Doesn’t Health Insurance Cover Dental Work?

 

While certain types of dentistry do fall under your health insurance plan (like those involving hospitalization or sedation,) the rest of your dental work may not be covered unless it’s medically necessary or due to an injury, such as an automobile accident. How can you know what’s covered or what isn’t?

If it’s Supposed to be Covered by Your Dental Policy 

Certain types of dental treatments fall under medical, or both medical and dental insurance policies. It’s when your treatment is strictly dental, that you should expect your medical carrier to not get involved. Only in limited circumstances do the two overlap each other.

If the dental procedure does fall under medical coverage (such as an oral surgery procedure, like wisdom teeth removal,) your policy may require that the claims be submitted to the dental insurance company first. Then once your benefits are paid out, you may be able to file the remaining portion toward your medical coverage for an additional partial reimbursement.

Your medical insurance company expects the dental company to pay up…and if you have coverage under two different companies, it can turn into a game of each one pointing fingers at each other, so that one doesn’t get stuck with a bill that they don’t want to pay. After all, they’re out there to make a profit, too. 

Before You’ve Paid Your Co-Pay, Deductible, or Met Your Waiting Period

No matter how much your dental treatment or oral surgery costs, you still have to pay for your deductible at the time of service, before your insurance claim to be filed. Otherwise, it constitutes as insurance fraud and you (and your dentist) could get into serious legal trouble.

Before you can take advantage of your medical insurance policy, you have to be sure that A) your deductible has been met, and B) you’ve paid your co-pay for the specific type of treatment that’s involved.

What about waiting periods? While waiting periods are common in dental insurance policies (when you need a crown or other major dental treatment) they aren’t as common with medical coverage. Your treatment coordinator will break down your benefits for you so that you have a more specific understanding about if a specific type of treatment needs to be delayed. 

If the Claim Wasn’t Submitted Properly

To get your dental treatment covered by a health insurance policy, you need to be sure that the claims are filed properly. Unfortunately, the majority of dental offices do not work directly with medical insurance companies, as they rarely cover most dental procedures. You’ll want to be sure that the person filing your insurance claim understands medical coding and the unique forms involved. Otherwise, the claim will automatically be rejected (leaving you with the bill.)

Not When It’s Routine

A toothache may cause you a lot of pain and sleepless nights, but unfortunately, your medical insurance doesn’t think it’s their job to help you fix it. Instead, you need to rely on your dental coverage to help you reduce the cost of getting your tooth filled by your dentist. But when you have poor or no dental coverage, you may have to pay out of pocket anyway, simply due to waiting periods.

Alternatives to Using Medical Insurance to Pay for Dental Procedures

Instead of hoping, wishing, and crossing your fingers about medical insurance covering dental care, you might want to consider enrolling in a discount dental plan. At CignaDentalPlans.com we can help you find the best dental discount plan to cover your oral health needs. Talk with one of our savings specialists today together started.

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