Will Health Insurance Cover Wisdom Teeth Removal?

Without dental insurance, the cost of removing wisdom teeth is anywhere between $200 and $1,000 per tooth. Will health insurance cover wisdom teeth removal? If you have dental insurance, will it cover it?

Keep reading to find out the answers.

Will Health Insurance Cover Wisdom Teeth Removal? 

The short answer is, “yes.” Your health insurance may cover this type of oral surgery. The general rule of health insurers when it comes to coverage is — if the treatment is medically necessary, then it’s covered. 

If your health insurance includes dental coverage, which plan will cover the oral surgery cost?

Read: Will Health Insurance Cover Breast Reduction Surgery?

Does Wisdom Teeth Removal Fall Under Medical or Dental Coverage? 

Medical and dental insurance claims are filed by your health insurers with certain codes. The codes will describe the service received.

The codes describe the type of dental surgery, its complexity, the tooth involved, anesthesia, etc.

Your policy will dictate which items are covered and not covered.

To know whether or not your health insurance will cover this procedure, you need to work with your dentist or oral surgeon who has years of experience in filing medical claims.

Remember processing medical insurance claims is different dental claims processing. Thus, you must work with someone who knows the process. 

You may work with a treatment coordinator to give you a breakdown of your benefits. In that way, you will know which services are covered, the estimated cost your insurer will pay for, etc.

When you have the written treatment plan, you can see an estimate of which plan pays for certain procedures and the amount left over for you to pay for.

Remember, though, that the plan includes estimates. It’s not an assurance that your health insurance will pay for it. There’s a huge chance that the insurers will refuse to pay the claim. 

If it refuses to pay for the cost, you’ll be left with covering the wisdom teeth removal cost.

On the other hand, if you have a separate dental insurance policy, you may ask if it covers wisdom teeth removal?

Read: When Health Insurance Doesn’t Pay?

Does Dental Coverage Include Wisdom Teeth Removal? 

Many dental insurance plans include wisdom teeth extractions. This type of insurance can cover a portion of the overall cost of this procedure.

The coverage depends on a lot of things. You should talk to your oral surgeon so he/she can submit a pre-authorization letter to your insurer before undergoing this procedure.

Pre-authorization will help you know whether or not the procedure is covered by your policy and how much is left for you to pay out of pocket.

Factors that Affect the Cost of Wisdom Teeth Removal 

Type of extraction

The cost is less if the tooth has fully erupted in the mouth. The reason for this is that it takes less time to extract your erupted wisdom tooth because it doesn’t require surgical drills and medical dressings. These items can easily add to the overall cost of the procedure.

Anesthesia

General anesthesia is more expensive because it needs additional equipment and training for the oral surgeon. Furthermore, sedation adds to the overall cost because of the equipment required to monitor and administer you while you’re under.

Training of the Dentist 

You can lower the overall cost of the procedure if your general dentist can do it. Having your wisdom teeth removed by an oral surgeon can be more expensive because of the surgeon’s years of specialized training.

Furthermore, oral surgeons have a nurse anesthesiologist and specialized equipment for the procedure that you can rarely find in a general dental office.

This extra equipment and staff can easily add up to the cost.

If your general dentist can’t perform this job, then you’ll need an oral surgeon for this procedure. Make sure that the surgeon is part of your plan’s network.

The Cost of Wisdom Teeth Extraction with Dental Insurance 

Your policy can pay 50% to 80% of the dentist’s or oral surgeon’s fees. This procedure is also subject to co-pays and deductibles. 

The insurance may impose yearly limits on the amount it pays for each year for wisdom teeth extractions. For instance, if your policy has a limit of $1,000 but your total bill or this procedure is $3,000, then the limit is met. You won’t have benefits left for the remaining months.

If you just obtained your dental insurance policy, take note of its waiting period. You may have to wait a few weeks before you can schedule your wisdom teeth extraction.

Conclusion 

Will health insurance cover wisdom teeth removal? If it’s medically necessary, then it is covered. The amount covered will also depend on your policy.

Are you looking for health insurance for your parents? Read here to find out more about purchasing health insurance for senior citizens.