Is Dental Surgery Covered by Medical Insurance?

Understanding Dental Benefits in Medical Insurance Policies

A healthy and appealing smile can often be the first thing others notice about you, and preserving it requires proper dental care. To prevent and treat oral health issues, dental care involves more than just brushing and flossing—it also involves routine examinations, cleanings, and treatments.

However, dental care tends to take a backseat to maintaining our health. Additionally, given the high expense of dental care, it's critical to understand one's coverage status. Read ahead to learn about what types of dental care are covered by health insurance.

What Dental Treatments are Covered by Medical Insurance?

Certain essential dental procedures, like root canals, extractions, and fillings, can be covered by a health insurance plan. The following is a list of typical dental procedures and their coverage:

1. Routine Examinations

Good oral health requires routine dental examinations. You can keep an eye on your dental health with the help of several health insurance policies that offer yearly dental exams.

2. Fillings

Certain insurance plans may pay for fillings if you need them because of cavities. But there can be restrictions on coverage.

3. Scaling and Cleaning

Maintaining healthy teeth and preventing gum disease are benefits of professional cleanings. Verify whether dental cleanings are covered under your policy.

4. Tooth Extractions

Whether it is a basic tooth removal or a wisdom tooth extraction, compensation for extractions differs among plans.

5. Root Canal Treatment (RCT)

Root canal therapy is frequently required to preserve teeth that are severely damaged or diseased. It is important to confirm in advance whether a policy covers root canal therapy.

6. Orthodontic Treatments

Braces and other orthodontic procedures are typically not covered by ordinary health insurance. However, orthodontic coverage could be available through stand-alone dental insurance.

What are the Dental Exclusions to Be Aware of?

Coverage for dental treatments may have specific restrictions that prevent reimbursement for certain treatments. Here are the specific treatments which health insurance policies may not cover:

1. Cosmetic Dental Procedures

Health insurance does not provide coverage for treatments that solely focus on cosmetic tooth improvement, including whitening procedures, smile correction, and veneers. Medical organizations classify these treatments as electives since they do not qualify as essential medical procedures.

2. Pre-existing Dental Conditions

Insurance policies exclude coverage of previously diagnosed dental conditions that existed before a policyholder bought their plan. Unless they are included in the plan, coverage of particular dental procedures requires a waiting period of 1 to 3 years.

3. Not Meeting Hospitalization Criteria

Most health insurance policies activate claims only when the policyholder stays in a hospital for at least 24 continuous hours. The requirement for hospitalization during dental procedures can be met only when surgeries happen under general anaesthesia within a hospital environment.

What To Consider Before Buying Medical Insurance for Dental Coverage?

The process of understanding dental coverage from health insurance policies proves to be difficult. The following considerations will help you make the best possible decisions:

1. Choose the Right Policy with Dental Benefits

Health insurance providers now include dental riders together with OPD (Out-Patient Department) add-ons in their plans. The dental coverage under these plans includes minor surgical procedures, consultations, X-rays, and standard medical treatments. Review dental policies through different portals to determine which options exist.

2. Go for Corporate Health Plans If Available

Employed individuals should verify if their corporate health plan contains dental provisions that extend to standard dental treatments with immediate service availability. Health insurance plans provided by corporations commonly extend their coverage to include regular dental services while skipping waiting periods.

3. Invest in Standalone Dental Insurance

Although uncommon, some insurance companies have launched separate dental care policy options. These types of coverage include preventive care, restorative treatments, and surgical interventions.

4. Keep an Emergency Fund for Dental Expenses

The scarcity of detailed dental insurance policies makes it essential for everyone to establish savings for dental emergencies. This is especially true for those who experience occasional dental problems.

5. Consult Your Dentist and Insurer

Request your dentist to provide a detailed diagnosis and cost breakdown information before any dental procedure takes place. Show your insurance company the documentation to check both pre-approvals and eligibility. Getting this information ahead of time helps determine if the surgical procedure qualifies as medically necessary.

6. Understand the Claim Process

Understand your plan's extent of dental coverage. It may operate on a cashless basis or through reimbursement payments. The patient needs to keep all medical documents intact, from consultation notes to X-rays, hospital records, and billing statements.

Some health insurance policies provide additional riders that cover both minor and significant dental procedures, although not all policies may cover dental treatment. Thus, it is crucial to review your insurance to comprehend its limitations and coverage, including exclusions, sub-limits, and waiting periods.

At Star Health, we provide coverage for dental treatments and expenses under our Star Outpatient Care Insurance Policy. We offer hassle-free claim settlements with less turnaround time.