The cost of treatment can also be an intimidating topic for patients considering jaw surgery. Many patients ask, “What dental procedures are covered by medical insurance?” or “Is oral surgery covered under medical insurance?” While it is not true for all oral surgical procedures, orthognathic surgery is covered by your medical insurance, not your dental insurance. Navigating your medical insurance can be an overwhelming task for many patients, but rest assured you will not have to face it alone. We will take care of all insurance paperwork that your insurance company will allow us to do. There are some steps that insurance companies attempt to make difficult and require the insured to take action. When that is the case we will explain the process and steps to you and help with questions that arise.
The first step we will take is to submit your case to the insurance company and explain that this is medically necessary to restore appropriate orofacial function derived from an underlying congenital or post-traumatic misalignment of the jaws. It is not a cosmetic or dental procedure as many medical insurance companies will attempt to claim to avoid paying. Next, while we are in network with many major medical insurance plans, if we are out of network with your medical insurance, we will work through a process called a “Gap Exception” in order to maximize your insurance coverage and make sure that your insurance company is paying their fair share. Finally, in the rare event where medical insurance coverage is denied or extremely poor, we can discuss a fixed rate cash option in a surgery center to make this an affordable option even when insurance coverage is not available.
To Summarize How Oral Surgery is Covered Under Medical Insurance
- Submit to medical insurance and advocate for approval on your behalf
- Submit for gap exception to make insurance pay their fair share
- If insurance coverage is unattainable or unaffordable, discuss cash option for treatment
Frequently Asked Questions
Most dental procedures are not covered by medical insurance, but fortunately for our patients orthognathic surgery is often an exception. We will work with you to help get oral surgery covered by your medical insurance if possible.
After the consultation, if you are interested in pursing a combined orthodontic and surgical treatment plan we will submit all relevant information to your insurance company within several days. Unfortunately, it typically takes 6 to 8 weeks to get a response from your insurance company regarding coverage status.
Sometimes insurance plans have specific exemptions regarding orthognathic surgery and we are not able to obtain an insurance approval. While this is uncommon, it does happen and we have solutions for patients. We offer a cash rate for surgery in an outpatient center. We use the same anesthesiologist, engineer, equipment, and surgical team, but we are able to control the cost at an outpatient center so we can define the cost beforehand. The hospital will not allow us to set a fixed surgical fee, so we need to use an outpatient center when this is the case to make this treatment affordable and accessible to patients and remove unanticipated costs.
While we are in network with many major medical insurance plans, if we are out of network with your medical insurance, we will work through a process called a “Gap Exception” in order to maximize your insurance coverage and make sure that your insurance company is paying their fair share.
Unfortunately, medical insurance does not cover most dental procedures. However, orthognathic surgery is often an exception. We will work with you to help get oral surgery covered by your medical insurance if possible.