We wish we could say that oral and maxillofacial surgery is always covered by insurance, but sometimes, that isn’t the case.
The surgical procedures insurance plans cover vary by provider, and some pay only a portion of the oral surgery costs. In addition, some insurance companies have different reimbursement rates for dental and medical procedures.
Generally, oral and maxillofacial procedures that are medically necessary stand a strong chance of being covered. For surgeries that are considered elective, however, the opposite is true.
Oral Surgery Procedures Most Insurance Plans Cover
Certain oral and maxillofacial procedures are performed to correct medical problems that threaten a patient’s health. Some or all of the costs of these surgeries are typically covered by insurance. Examples include:
- Surgery to remove tumors or cysts in the cheeks, jaws or oral cavity
- Procedures to correct a congenital birth defect or facial deformity
- Treatment to address structural abnormalities in the jawbone
- Facial surgery to repair injuries due to physical trauma
Oral Surgery Procedures with Out-of-Pocket Costs
For elective procedures — basically any cosmetic oral surgery — patients typically have to pay for themselves. Most insurance providers do not cover the costs of procedures such as:
- Tooth extraction, including wisdom teeth removal
- Dental implant placement
- Bone grafting and other pre-prosthetic procedures
- Treatment for obstructive sleep apnea (OSA)
- Procedures to treat temporomandibular joint (TMJ) disorder
Some insurance plans may agree to cover some or all the costs for some of these oral surgery procedures if other non-invasive treatments have failed. For instance, patients with sleep apnea may be able to get coverage for surgical treatment if use of a CPAP machine has proven ineffective.
Options for Patients Who Have to Pay for Oral Surgery
If your insurance provider refuses to cover the oral and maxillofacial procedure you need, speak to the financial staff at your oral surgeon’s office.
Certain procedures may come with discounts for paying in cash, and you may be able to make arrangements for financing.
You can also look into the idea of enrolling in a dental discount plan. Those have monthly fees, but some plans offer significant savings. Depending upon the type of surgical treatment you need, you could cut your costs by thousands of dollars.
Do you need oral surgery? Are you concerned about the costs?
If you’re in the greater east central Indiana area, turn to the professional team at Richmond Oral and Maxillofacial Surgery. We understand the complexities of insurance coverage, and our staff can handle the claims process for you. And if your procedure isn’t covered, we can point you toward a dental discount plan or assist you in applying for financing.
Rest assured, Richmond Oral and Maxillofacial Surgery will work to help you find an affordable payment solution. To discuss your options for covering the costs of oral and maxillofacial surgery, contact us today.