Dental & Medical Insurance

office staff at front desk
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.  

Frequently Asked Questions

Why isn’t my consultation covered by my insurance?

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.

Why isn’t my panoramic x-ray covered by my insurance?

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.

How does my dental insurance benefit affect my cost of treatment?

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.

What are cash services?

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

Why are some services billed to medical vs. dental insurance?

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.

Does Medicare cover my dental procedure?

Medicare does NOT cover any dental related procedures unless you have a supplemental Medicare Dental plan, such as Humana or United Healthcare.

What are the differences between my medical and dental insurance coverage?

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.

What is and who needs a pre-authorization?

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.

How long does a pre-authorization take?

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.

Which insurance is billed for the following most common procedures?

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

  • Extractions that are not impacted
  • Tissue Grafts will primarily process through
  • Uncovering and Bracketing
  • Frenectomy and Operculectomy
  • Implants and bone grafting

Medical

  • TMJ
  • Sleep Apnea
  • Orthognathic
  • Biopsies
  • Impacted Wisdom Teeth
  • Facial Trauma

Why do we need a copy of your insurance card?

  • To verify subscriber and dependent name and spelling
  • Provides address of your insurance in order to bill treatment
  • Provides contact information to obtain your independent coverage
  • Provides your identification number and group number
  • Provides copays if applicable
  • Provides Deductibles
  • Provides Annual Maximums
  • Specifies if a pre-authorization is required

Your medical insurance has denied your orthognathic surgery, what now?

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!