What Dental Claims Are Covered by Medical Insurance?

Not all dental procedures can be billed to medical insurance, but some may have a better chance of success when submitted as medical, rather than dental, claims. Check out this quick guide to which dental treatments are covered by medical insurance!

Why Medical Insurance Doesn’t Include All Dental Claims

Even though oral health and physical health are linked, dental care is not usually included in medical insurance coverage. Few health insurance plans are required to provide dental coverage, so most opt not to. The reasons behind this may surprise you!

One theory to explain this stems from the way dental care was seen in the past. Historically, dental care was separate from medical care because its treatments were comparatively barbaric. No one visited a dentist for cleanings or preventative care—instead, barbers would pull teeth without the aid of Novocain when people came in for a shave. Some believe that dental care’s former reputation as a less-than-scientific method factors into the way it’s regarded by health insurance today.

Insurance coverage of dental treatments may also be limited because many of those treatments are cosmetic (think braces or teeth whitening), and therefore classified as “not medically necessary.” If you try submitting a claim for teeth cleaning to your health insurance company, chances are you’ll receive a denial for lack of medical necessity. The dental services that have a higher likelihood of being covered are integral to maintaining your physical health.


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Dental Services Your Health Insurance May Cover

The following are dental procedures that are sometimes covered by medical insurance. To be sure that your plan covers these services, check with your insurance provider.

  • Sleep Apnea Treatment. Many health insurance plans cover sleep apnea treatment, whether that’s a procedure, dental intervention, or a CPAP machine. You might see your dentist about sleep apnea, but since the condition can pose risks to your physical health, your medical insurance should kick in to cover treatment.
  • TMJ Treatment. Temporomandibular joint disorders fall under the umbrellas of both medical and dental issues. Some states mandate that medical insurance cover treatment for TMJ disorders, and some do not. It will be hard to find a plan that covers TMJ care in a state where it’s not mandated, so you may still get a dental claim denied for TMJ treatment.
  • Oral Infections. Once a dental problem evolves into an infection, it becomes a medical problem. That’s why the diagnosing and treatment of oral infections should be covered by your health insurance.
  • Dental Trauma. If you’ve had an accident that caused trauma to your teeth and landed you in the ER, for example, your treatment has a good chance of being covered by health insurance.
  • Dental Implants. Getting a dental claim covered for implants is possible if you and your dentist can prove that the dental implants are medically necessary. Some insurance plans still claim that dental implants are purely for cosmetic purposes, so check with your insurance provider before making any assumptions.
  • Wisdom Teeth Extraction. Medical insurance covers wisdom teeth extraction when it’s crucial to your overall health. If your wisdom teeth are impacted (stuck under your gums), for example, your medical insurance should cover the procedure. If there are no issues with your wisdom teeth, medical insurance will deem extraction not medically necessary.
  • Dental Care for Children. The Affordable Care Act mandates that children’s dental care be covered by medical insurance, so marketplace plans should include treatment for your children.
  • Oral Surgery. If oral surgery is medically necessary, your medical insurance will foot the bill. Oral surgeries that require the use of anesthesia are often the type covered by insurance.

What to Do When Insurance Denies Your Dental Claim

The reality is that denied dental claims can happen when you least expect them. If you have both medical and dental insurance plans, you may submit the same claim to your dental insurance and see what happens. Since dental insurance coverage is so limited, however, you may still end up owing a large sum. Plus, what happens if you don’t have dental insurance to fall back on?

When you’ve received a dental denied claim from your medical insurance, the first step is to start the appeal process. The problem with the appeal process is that it’s complicated—there are certain steps you must follow that may not be clear, you need to fight your way through your insurance plan’s phone tree (which you may not have the time or patience to do), and your insurance provider may still stick by their original decision after all that time and effort. But how do you know when you have the right to insurance coverage for dental claims, and how do you push for coverage or a lower bill?

You turn to a professional service, like aJust.

Why Trust aJust With Your Dental Bills

Unfortunately, navigating dental coverage in the US is like walking blindfolded through a maze. You feel disoriented by the often-illogical health insurance system, then you receive a denied claim and your path to good health and a stable financial situation is blocked. When you turn to aJust you can take off the blindfold and step out of the maze, letting professionals complete it on your behalf instead.

So, give aJust the chance to take over your dental bill negotiations. Using insurance expertise, they’ll guide you toward a better solution that doesn’t zap your time or money.

Reach out today to learn more, or start by filling out this quick form.