[Erica]

Has anyone sucessfully submitted dental work, particularly surgery or implants, as a medical claim?
Full story: Had 10+ extractions in December, now moving on to getting implants.

Looking at 8 posts, topped by 4 crowns, 2 bridges (10 teeth total, all molars essentially).

Even with “good” insurance, the cost is significant.

An acquaintance needs an implant, and is submitting costs not covered by dental insurance, to their health insurance.

It was his wife’s idea, she works at a non-profit helping folks with insurance claims, and has done it for others.

They are claiming it is medically necessary because he needs it in order to chew/eat.

I feel like I could easily make that case for myself, as I’m not able to chew anything without them.

The implants will provide direct, long term health benefits better nutrition, simply by having access to it.

Has anyone ever successfully submitted dental work for a medical claim? Or have any other creative options to help offset the costs?

Health insurance is Highmark if it makes a difference.

[Wiswell]

Since you have already had the extractions, it’s highly unlikely that you will prevail in a health insurance claim at this point.

But it never hurts to try.

I have spent the cost of several luxury cars on my mouth even with excellent dental insurance.

My medical condition caused my dental problems.

[Sarah]

My husband in getting hybrid implants. I’m surprised no one talked to you about that with the number of implants you are having done.

If you go out of country for the work and something goes wrong, no dentist in the US will

[Jennifer]

extremely unlikely it will work but good luck. dental stuff is excluded from medical and while benefit exclusion override can happen in rare circumstances (I got it for my young child who had expanding jaw cyst making jaw unstable) it needs to be done on the front end before the procedures.

you can still appeal but don’t expect much. getting full extractions and complete all on 4 dentures can be similar cost to what you are getting and would be cheaper in long run if still getting other routine dental work on those you have left

[Lori]

Unless it’s trauma related medical typically does not cover dental. Maybe if your teeth have caused you to lose a significant amount of weight do to being unable to eat, then you’d need a physician to attest to that.

[Chloe]

You can try but don’t get your hopes up. They can deny it and say that dentures would suffice.

You don’t “need” implants to eat.

[Rosemarie]

Read your medical coverage, it undoubtedly specifically says that they do not cover XYZ dental procedures. They all do.

If it doesn’t then their response would be that you could have got dentures so the expensive option you chose is “elective care” and/or cosmetic and not necessary.

[Katie]

Call your insurance company and ask. Most plans only cover dental accidents within 12 months, HOWEVER, many will cover facility bills and anesthesia associated with dental surgery, if the plan doesn’t specifically exclude.

[Kim]

I lost 7 teeth due to trauma. I’ve been fighting medical insurance for years. Still fighting. $0 paid by them, almost $50k by me.

People thinking this will be covered due to an accident/trauma are wrong in most cases.

I know I was shocked. They do not consider teeth as part of your body or necessary.

[Lynne]

It has to associated to an accident.
Keep in mind this was in 2007
My late husband was in a motorcycle accident. Not a bad one. But enough to lose 4 teeth.

Insurance covered all his dental work.
So as with everything

YMMV

[Elle]

If you have a malformed jaw which led to the demise of your teeth, yes. My sister and I had corrective surgery based on this and medical paid for braces before during and after.

In my sisters case, her lower jaw was set too far back and scraping away the tissue behind her upper teeth which would have led to loss of her teeth.

She was my dependant because our mom died when she was a child and Tricare health paid for all of it.

Need to get a consult with maxillofacial surgery to see if you can support your claim/ ase that it was a medical – health malformation.
You’d likely need to get surgical correction if jaw and then the implants.

Good luck

[Brittany]

You’ll need a medical diagnosis code from the dentist to make any sort of progress.

We had a tongue tie laser procedure for our kiddo covered by medical after lots of hoop jumping.

[Kerri]

My medical paid for my children’s wisdom teeth extraction. Might be worth a shot!

[Kerri]

I work in dental claims, I would call your insurance provider directly and ask what medical codes they specifically cover in the dental world as every insurance will vary wildly.

Then when you go to the dentist you can have them submit the dental claims using the medical codes if they cover at all.

It’s worth a shot

[Author]

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