What is Medically Necessary Dentistry?

Dentists are doctors. As doctors, they provide treatments and procedures that restore, sustain, or improve your health. Even with this understanding, most dental procedures are not covered by medical insurance. Dental insurance fully covers cleanings, but typically pays only a portion of other procedures. And dental insurance may come with a low annual maximum benefit, which sometimes makes people uneasy when it comes to covering the costs of their dental procedure. Fortunately, if medical and dental issues are related, then both forms of insurance might come into play when covering dental costs. The challenge is figuring out what types of dental procedures are also considered a medical procedure.

Classifying Dental Procedures

How do you know when a procedure is strictly medical, strictly dental, or a combination of both? Here are some examples.

If you have a strong overbite, it could affect the way you live, so it needs to be addressed through dental procedures. That makes it a dental issue. Since it’s not directly endangering your health, it wouldn’t be considered a medical problem.

Diabetes is a medical condition that is not directly related to a person’s teeth and gums. Even though a patient’s dental health might be indirectly affected by diabetes, and vice versa, it’s still considered a medical condition, not a dental one.

A dental abscess typically involves severe infection. Therefore, it can lead to life-threatening complications. Therefore, this problem is potentially treated as both a medical and dental issue.

Basically, if a dental procedure is necessary to treat a diagnosed medical condition, most medical insurance companies cover it. Thus, here are four types of dental procedures that are sometimes billable as medical procedures.

  • Certain diagnostic procedures are considered medically necessary. This does not include your annual x-rays during dental exams, but may include a biopsy for oral cancer.
  • Non-surgical medical treatments – Non-surgical medical treatments may include things like nightguards, orthodontics for temporomandibular joint disorders, and sleep apnea appliances. Such dental treatments must be linked to a diagnosed medical condition to be covered by your medical insurance policy.
  • Surgical treatments are sometimes considered medical procedures. A good example could be removing impacted teeth before chemotherapy treatment, an organ transplant, or a heart bypass. Tissue grafting, some tooth extractions, or installing dental implants might be covered by your medical insurance, but it’s obviously important to verify this before scheduling any procedures.
  • Treatment of traumatic injuries – if your medical insurance covers traumatic injuries, then it will typically pay for dental procedures that repair damage to the mouth and jawbones. In the event of accident, payment may also be available from liability insurance.

We consider the circumstances to help you determine what type of insurance may pay for your dental procedures. Granted, the Placerville Dental Group is not an insurance company, but we know the importance of dentistry, especially when it’s medically necessary. If you have any questions about your procedure, please give us a call. We are happy to go over the details with you.


Submit a Comment

Your email address will not be published. Required fields are marked *