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How to Bill Medical Insurance for Dental Procedures

By Planet DDS
March 4, 2020

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 medical condition.

7. Accidents to teeth

Mouth trauma can require medical diagnosis alongside your dental diagnosis and related care.

8. Mucosititis and stomatititis (from chemotherapy and other treatments)

The systemic impact of treatments outside the mouth can produce oral health issues requiring medical attention and related coverage.

9. Frenectomy (tongue surgery) for infants and children

The surgical detail places this within a medical category of treatment.

10. Dental implants and bone grafts

The reason for implant placement and necessary bone build up can add support to a medical claim.

11. Third molars or wisdom teeth extraction

The impact of these specific teeth on overall general health can lead to a medical insurance allowance in some cases.

12. Biopsies

Diagnostic details can reveal a risk to your patient’s oral and general health.

13. Clearance exams before chemotherapy or surgery

A dental issue can delay other medical treatment. The necessity and cost of an oral health examination can be covered in these instances.

14. Facial pain treatment

Not all facial pain is sourced in the mouth. Though it’s impact on your patient’s oral health could prompt medical coverage.

15. Botox injections for bruxism and jaw pain

Medical coverage could apply to non-cosmetic cases. Again, the diagnostic details are essential.

16. Congenital defects

Oral health problems that are triggered by other general health deficiencies could be filed under your patient’s medical insurance.

17. Emergency trauma procedures

Trauma that requires immediate medical attention and that involves the mouth or head would be an acceptable medical coverage issue.

18. Treatment related to inflammation and infection

The source of the infection or inflammation is to be considered. And how it impacts your patient’s general health.

19. Exams for oro-facial medical problems

The impact of oral and facial issues on general health is key to coverage for related exams.

Which Form Is Needed when Submitting Claims to a Medical Payor?

Accuracy in claim submission is vital whether using electronic claims submission or submitting manual claims. Required claim forms provide some primary guidance when submitting a claim to a health insurance company.

The explanation of benefits (EOB) your patient receives should outline coverage details. This information helps determine the procedure’s medical necessity prior to coverage approval.

What are the Advantages to Dental Providers and Patients?

All things considered the value of insurance coverage is how it eases the financial burden for patients. They will occasionally pay more for a certain procedure but their overall health quality is the core benefit.

It’s to your advantage as a dental provider to explain what they’re allowed to bill to dental and help them maximize their annual dental insurance benefits.

When necessary some coverage allows for auxiliary services that improve their oral and general health such as tobacco and nutritional counseling. Bottom-line is helping your patients get the most benefit from their dental and medical coverage.

With the Right System You Can Help Your Patients Get the Most from Their Insurance Coverage

Your patient relationships will improve as you become their advocate for maximizing their insurance provisions. Planet DDS’s Denticon Dental Practice Management Software helps you standardize those systems that help you assist your patients with their insurance benefits.

Observe how one dental practice is utilizes the Denticon Dental Dashboard, Dental Bookkeeping, and Dental Charting Software System to centralize tasks (including insurance reimbursements) and grow their practice.

An Inside Look at How Denticon Can Help Your Dental Practice Standardize, Centralize, and Grow

Contact us for more information about how Denticon can streamline your systems that help you manage all aspects of your dental practice – including insurance.