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- If wisdom teeth removal is determined to be a medical necessity in your case, your existing health insurance provider may provide a certain level of benefits
- In terms of dental situations, medical necessity is taken to mean a range of mouth related issues including certain diseases, non-biting accidents, and treatments that are considered necessary to your well being
- The key to getting you claim paid is to justify the procedure as being medically necessary, so be sure to retain all documentation related to the wisdom teeth removal process
With the skyrocketing costs associated with many types of dental care, it is quite common for individuals to worry about their oral healthcare related emergencies.
While many people understand that cleanings and other routine types of oral maintenance must be paid out of pocket or with specific dental insurance, there are cases when major surgery is needed in the mouth region.
An example of this is when a person’s wisdom teeth have become impacted and need to be removed. In such cases, it is quite common to wonder if health insurance will provide coverage for this necessary operation.
These three areas will help you get your claim paid out if your health insurance provider does indeed provide benefit from medically necessary dental procedures.
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Situations Where Health Insurance Covers Oral Surgery
Wisdom teeth removal is considered a type of oral surgery. This is particularly true if one or more of the wisdom teeth have become impacted. In many cases, the patient will actually be put to sleep while the surgery takes place.
The procedure is typically done by a maxillofacial surgeon who specializes in the treatment of diseases, defects of the mouth, and injuries to the mouth, teeth, face, head, jaws, and neck regions of the body. The most commonly performed procedures in this genre include wisdom tooth extractions along with bone grafts and certain types of surgeries on the jaw.
Oral surgeries, such as those performed to remove wisdom teeth, are consider to be serious procedures that are necessary to ensure the continued wellbeing of the patient.
Because of this, it is quite likely that your health insurance will cover the operations providing it can be justified as being medically necessarily.
You will need to follow the recommendations of your dentist and any referrals to a surgeon, document everything, and then submit a claim to your insurance provider.
Why is wisdom teeth removal considered a medical necessity?
Many people go through their entire life without ever having to pay any attention to their wisdom teeth. However, countless others are forced to endure severe pain brought on by these four teeth as they erupt, impact with soft tissue, or become impacted by bone. When this happens, surgery is almost inevitable in order to alleviate the pain and corresponding medical issue that are almost certain to result of the wisdom teeth are not removed.
If the wisdom teeth are not impacted, then removal is not necessary. If you were to choose to have them removed anyway, the procedure would not be considered a medical necessity and coverage would likely not be extended to you by your health insurance provider.
Here are four general guidelines to follow when determining if your wisdom tooth removal will be seen as medically necessary by your insurance company.
- If a jaw is not large enough to accommodate the wisdom teeth, they may become impacted. When this happens, they are simply unable to break through the gums.
- Many people experience a situation where their wisdom teeth only partially break through the gums. This causes a small segment of gum tissue to grow over them, where food and germs are allowed to get trapped underneath. Swelling and a great deal of pain are the inevitable by-products of this.
- Infection and damage to surrounding teeth and bone can result from one or more of the wisdom teeth becoming impacted.
- One other serious problem can arise when wisdom teeth arrive in an awkward angle. This allows the top of the tooth to actually face forward, to the side, or backward. Removal of the teeth is the only possible remedy in this situation.
If any of these four situations are present, wisdom tooth removal is often viewed as medically necessary as it is the only way to correct the problem and to prevent future issues from arising in the future.
Is wisdom tooth removal effective?
Given the seriousness of this procedure, it is quite logical to wonder if the surgery is effective in the end. In the vast majority of cases, the removal leads to a much better overall quality of oral health, a reduction in pain, and a return of normal gum function. In many cases, wisdom teeth crowd the back teeth, causing much discomfort over time. Wisdom teeth removal can help alleviate this.
In addition, any wisdom tooth that is impacted can cause severe problems down the road so it is best to have them removed by a trained surgeon. As the procedure can be expensive when paid out of pocket, it is helpful to first determine if your health insurance company provides coverage for the operation. There are quite a few policies that will certainly make accommodations for this medically necessary procedure.
Wisdom tooth removal is also effective at reducing and eliminating the redness and swelling of the gum area caused by teeth that have only partially come in.
As the tooth is not likely to come in any further, food and bacteria can get trapped underneath the gum area creating the potential for a host of serious problems down the road.
It is important in such cases to have the wisdom teeth removed. Gum disease is a serious concern for individuals who have issues with their wisdom teeth, and removal is seen as an effective way of minimizing this risk. As wisdom teeth are difficult to clean, this situation is often compounded until they are removed altogether.
The Aftermath of Wisdom Tooth Removal
Once you do have one or more of your wisdom teeth removed, there are some things that you should be aware of. These are summarized below.
- You may experience some pain and swelling in the gum are where each tooth was removed
- Bleeding in the mouth will continue for up to 24 hours. If it continues past that point, you will want to contact your medical professional
- You may experience some difficulty in opening your jaw, and pain may occur as well
- Your gums may be slow to heal
- Existing dental work may be damaged, and such damage will likely not be covered under your health insurance policy. Dental insurance may be necessary.
- Dry sockets may result, which is a painful inflammation of the area where the teeth were removed
- Your mouth be numb for quite some time after the local anesthetic wears off because of an injury or inflammation to the jaw region
Any of these situations may result from wisdom teeth removal, which is another reason why the procedure is considered to be a medical necessity. Compare health insurance policies to determine which one is best for your current and future medical needs.
Things To Think About
As you consider the possibility of having one or more of your wisdom teeth removed, there are some things that you will want to consider. Remember that you might never have any problems with your wisdom teeth.
While some people opt to have them removed anyway just to head off any possibility of a future issue, health insurance will almost certainly not provide coverage in such situations. There are also very few risks associated with have your wisdom teeth taken out, but as with any surgical procedures, the possibility of complications is always there.
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