When Does Health Insurance Cover Dental Work?

In the event of a medical emergency that affects your mouth, the idea of getting necessary care can be stressful, especially if you do not have dental insurance. Fortunately, there are some cases in which your health insurance pays for dental work. Understanding your coverage and knowing whether a service is billed to dental, or health insurance can help you estimate your cost-sharing responsibility.

Health Insurance or Dental Insurance: Which One Pays the Bill?

In most cases, dental insurance pays for routine care such as annual x-rays, cleanings and exams, as well as procedures such as fillings, crowns and bridges. Some plans also provide coverage for orthodontia, which may include braces and implants.

While dental insurance covers most treatments related to the teeth, there are some cases in which your health insurance company foots the bill. If a treatment is medically necessary, the dentist or oral surgeon may file the claim with your health insurance. For example, if you experience trauma to the mouth during an auto accident, injury, or act of violence, your health insurance most likely pays for the treatment.

Determining Whether a Service is a Dental or Medical Procedure

Health insurance pays for certain medical conditions and treatments such as temporomandibular joint (TMJ) and radiation therapy for oral cancer. It also usually pays to treat damage caused by trauma to the mouth, such as an injury or accident. The exception to this is if you experienced that trauma in a car accident. In this case, your auto insurance policy may pay for treatment as the primary insurance, and your health insurance would be secondary. Who pay’s what would depend on the coverages you have on each of your policies.

What Will You Pay for Dental Work?

Your cost-sharing responsibilities depend largely on the type of insurance paying for your treatment. If you experienced trauma from a car accident and your auto insurance policy’s medical coverage is paying, you may not have to pay anything out of pocket. If your medical insurance is covering a procedure or if the procedure is filed with your dental insurance company, you may have to pay a deductible plus coinsurance (a percentage of the treatment’s cost) or a copayment (a set dollar amount).

To ensure the best coverage for a procedure, it is important to make sure you see an in-network provider. Don’t ask your dentist, “do you take this plan” because they will most likely say yes. It’s rather best if you ask “are you contracted with this insurance company?” It’s also best to look online or call the insurance company to find out if that particular dentist is a contracted provider of your plan. Determining which dentists and oral surgeons are within your network can be challenging if you do not know how a procedure will be filed, but a health insurance agent can help you review your coverage and make informed decisions regarding the provider you choose.

Nevada Insurance Enrollment Is Here to Help

Understanding how a treatment is covered can be confusing, but knowing which insurance policy pays can help you estimate your cost-sharing responsibilities. At Nevada Insurance Enrollment, we can help you review your coverage and determine how a covered treatment is paid. Our licensed health insurance agents can also assist you in finding the robust coverage you need to protect yourself financially when the unexpected happens.