At Oral & Maxillofacial Surgeons of Utah, we want you to be able to maximize your insurance benefits. We work hand-in-hand with you to help guide you and provide assistance in working with your insurance company. If you have questions about covered procedures, please contact your insurance provider or call our office for assistance. We are happy to help navigate provider questions with you.

Please bring your dental and medical insurance cards with you to the consultation.

Disclaimer: Insurance denials are usually not a determination of medical necessity. Rather, they are typically associated with what services your plan determines as a covered benefit.

Consultations have a frequency with most insurances. This means you are allowed 1 consultation every 6 months or 2 consultations per year, depending on your insurance. Call your insurance to check your plan frequencies. When you go into your dentist for a cleaning, that uses a consultation as well.

Panoramic x-rays have a frequency similar to consultations. The most common frequencies are 1 every 3 years or 1 every 5 years. This does not mean you do not need a new x-ray; it simply means you have reached your benefit limit for that service right now. In order for our doctors to provide the best care for you, a panoramic x-ray no older than a year is required.

You are responsible for any services not covered by your dental or medical insurance. You are responsible for your deductible, your coinsurance (Percentage after insurance pays), as well as anything above your annual benefit being exhausted.

These are services that do not have dental or medical codes available for insurance coverage. Therefore, they are the patient’s responsibility.

Services related to teeth, gums, or implants, are typically billed to dental insurance, unless the dental insurance requests the medical to be billed. Medical billing will consist of Biopsy, Orthognathic, Trauma, TMJ, Sleep Apnea, and Accident services.

Dental insurance coverage has a small deductible, while medical insurance has a much larger deductible.

Medical insurance covers at 100% after your annual maximum has been met. In contrast, dental benefits provide no coverage after your annual maximum has been met.

These insurances cover different services even though you are coming to an Oral Surgeon who is performing surgery.

A pre-authorization is an insurance approval required for services to be rendered and covered.

Pre-authorization is a requirement from your insurance carrier, not from the treating provider.

A pre-authorization can take up to 90 days to be completed by the insurance company, received back in our office, and processed for the patient.

Wisdom teeth extractions are billed to both medical and dental insurance if the teeth are impacted, however this is specific to your insurance plan coverage.

Dental

Medical

If services are denied by your insurance, you are responsible for the entire treatment. If your insurance benefit booklet lists coverage for this service, please contact your insurance to complete an appeal.

We are here to help! Please call for more information about financing your oral health needs in our office!