JEFFREY A. KIMELMAN DMD PC

WHAT YOU SHOULD KNOW ABOUT INSURANCE AND ORAL SURGERY

Many surgical procedures are considered medical in nature and are covered services under your MEDICAL OR HEALTH INSURANCE
Some medical insurances will cover consultations and x-rays even though they may not cover the surgery.
Utilizing your medical and dental insurance may result in no out of pocket expense for you. Even your deductibles may be covered.
It is very important the oral surgeon check your insurance for you as well because properly coded claims may be covered by both.

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Insurances have become increasingly more complex as employers try to find the least expensive plan and insurance companies try to include as many loopholes as possible to avoid paying a claim.

THINGS TO CONSIDER

Coordination of benefits
Which insurance pays first – medical or dental? Who is primary for children? What about divorced parents?
Are there “non-duplication of benefits” clauses? Even though there may be additional plans they may not pay even if the first plan pays nothing.
Does your insurance plan run calendar year or anniversary year?
Are some procedures, such as anesthesia, covered in the hospital and not covered in the office?
Can you save money by staggering your surgery?
Does your specialist participate in many or most insurance plans? In other words, is the surgeon willing to accept a lower amount from some than you pay because he participates with so many different plans?
Is it fair that the surgeon is willing to accept less payment for the same surgery from one insurance company yet charge you more?

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