Is Periodontics Covered Under Medical Or Dental Insurance?

Posted by PCE DENTAL IMPLANT CENTER Nov 10, 2019

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Getting specialized dental care can lead a lot of people to question whether their treatment is covered under medical insurance. After all, conditions like periodontal disease are scientifically proven to have a direct correlation with our overall health. Yet, most dental treatments only fall under dental insurance benefits, not medical. 

However, there are always exceptions! 

In general, periodontal disease treatments will almost always go back to your dental insurance benefits. This includes deep cleanings (scaling and root planing) or debridements, necessary X-rays for evaluation, etc. But when surgical interventions are necessary, there’s more wiggle room when it comes to attempting to file them toward your medical coverage. That doesn’t necessarily mean medical will cover them, but your insurance is less likely to deny the claim if our periodontist in Conroe can show that the procedure is medically necessary.

For example, if your periodontal treatments coincide with a type of oral surgery that is medically necessary (because of something like cancer, sleep apnea, a car wreck, etc.,) you could potentially make a claim to your medical insurance that the procedure be reimbursed by your traditional coverage. 

That’s not to say it will happen, but you can try. Just like oral surgery (such as wisdom tooth extractions, same day tooth extractions in Conroe, or sinus lift surgery) can be covered by your medical insurance, the periodontal procedure you’re getting might qualify as well. 

Estimating Your Insurance Coverage

In the best-case scenario, our periodontist in The Woodlands will gather both your dental and medical insurance information and file claims to the one that traditionally covers specific types of procedures. Usually, our financial coordinators will have worked with your same type of plan (under another patient) and can have a good idea as to whether or not the claim will be approved and reimbursed. If we know that it will be denied, we can try filing the claim towards your other coverage plan. 

When we tabulate your proposed treatment plan, we’ll apply the estimated coverage amounts (with either your dental insurance policy, medical coverage, or both) to the case. That way you’ll be able to see what is expected to be covered. 

Other Ways to Pay for Gum Disease Treatment

People who carry a Health Savings Account (HSA) or Flexible Spending Account (FSA) can use their balance towards either medical or dental procedures, regardless of whether they are for periodontal treatment or something else. If you know you’re planning to have gum disease treatments like LANAP or laser gum therapy in The Woodlands, be sure to bring a copy of your HSA/FSA card with you to your consultation appointment. 

The Truth About Dental Insurance

Although medical benefits have continued to rise with inflation rates and the cost of living, dental policies have remained stagnant since the 1970s and 80s. More measures are being taken to include basic medical care under conventional health policies, so that people have access to affordable treatments. 

For more information on quality, state-of-the-art gum treatments in Conroe, contact the office for a specialized consultation.

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