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  • Writer's pictureDanielle Brown

Billing Medical Insurance in Dentistry

More medical insurance companies recognize some dental procedures as medically necessary which means lower out-of-pocket expense for your patients and higher case acceptance for your practice.

Dentists may think that they are limited to only billing their patient’s dental insurance, but medical insurance also provides benefits that apply to oral care. Medical insurance covers a person's medically necessary treatment from head to toe, and dental benefits should be seen as a supplement to the medical insurance covering only the oral cavity. That means there is an overlap of coverage that the dental industry has an opportunity to access for their patients.

When we compare medical insurance benefits to dental benefits, it is easy to see the benefits of utilizing both coverages.

Medical Insurance has no annual maximum /Dental Insurance annual maximums have been approximately $1500 for 20 years

Medical Insurance has no frequency limitations on exams and diagnostic imaging related to the condition being treated /Dental Insurance has restrictive frequency limitations

Medical Insurance considers medical conditions that affect overall health/ Dental Insurance does not consider medical conditions, just the procedure itself.

Medical Insurance benefits increase case acceptance because of less out of pocket expense/ Dental Insurance limitations causes unaccepted treatment and further detriment to the patient, due to high out-of-pocket cost.

What services can we send to medical insurance and why:

Exams for services that are covered by medical insurance: Be specific and confirm medical necessity. Contact the Primary Care Physician to confirm the diagnosis code.

Panorex X-Rays, CBCT, Tomography: These are more thorough images and increase diagnostic success.

Oral infections, cysts, and oral inflammation: Infection and its impact can destroy bone and affect areas outside of the mouth in some instances. Consider the source of the infection or inflammation, and how it impacts your patient’s general health.

TMJ appliances and headache treatment: TMJ disorder symptoms can significantly impact a person who is otherwise healthy. Many sufferers experience chronic headaches or migraines, insomnia, and significant tooth wear.

Sleep apnea appliances (Dental Sleep Medicine): Untreated sleep apnea has been linked to high blood pressure, type 2 diabetes, liver problems and possibly even dementia.

Accidents to teeth: Any treatment of the teeth, supporting structures, and surrounding tissues that are damaged during a traumatic accident can be billed to medical insurance.

Mucosititis and stomatititis (from chemotherapy and other treatments): Ulcers may develop, increasing the risk for bleeding and infection. Dryness of the mouth can lead to bad breath as well as difficulty in speaking and tasting food. Pain and difficulty swallowing may limit food and water intake, leading to dehydration and weight loss

Frenectomy (tongue surgery) for infants and children: Left untreated, it can affect eating, speech, and breathing.

Dental implants and bone grafts: Dental implants and bone grafts can help rebuild bone structure, prevent bone loss and improve ability to chew and properly nourish the body.

Third molars or wisdom teeth extraction: Unerupted wisdom teeth can sometimes develop decay, cysts or neoplasms.

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

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.

Botox injections for bruxism and jaw pain: Medical coverage could apply to non-cosmetic cases. Botox has the ability to block receptors responsible for muscle contraction. The injections can relieve jaw tension and for many patients, eliminate headaches.

Congenital defects: Congenitally missing teeth and deformities in the growth of the bones in the head and face can restrict a patient’s ability to breathe, eat and speak. Medically necessary treatments could include dental, orthodontic or prosthodontic support.

Medical insurance companies are becoming increasingly aware that oral disease can complicate other medical conditions, such as heart disease, diabetes, digestive and nutrition problems.

When we educate our patients and help them realize the oral and systemic health benefits of their dental treatment and back that up with fighting for their medical benefits, we earn the trust of the patient and respect of the medical community. It is a Win for All!

Navigating Medical Insurance can be a big task. We are here to help.

Call or Text with questions or comments: 312-487-1161



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