Billing health insurance for dental procedures

chasgiv4

Guest
Messages
13
Best answers
0
If anyone has any info about this I am ALL EARS.

A former cancer patient is having major teeth problems due to chemo treatments from 5 years ago. Due to the fact that it was because of medical procedures I would assume that the health insurance would be required to cover any procedures that can be linked to chemo.

His teeth are cracking, and splitting and in an overall poor state. I'm not sure of the procedures he will need as I am not familiar on the dental spectrum of coding or reimbursement but I am not sure where else to go with this question. The market for this patient want's $1200 a month just for dental insurance because he owns a small business.

My questions are:
1. Is it possible to have the health insurance cover the dental procedures
2. If "yes" what needs to happen to ensure coverage?
3. What are the limitations to such a case?
4. Any other things not revealed by my questions?

Any help would be wonderful!

Thanks in advance.
 
Last edited:

CodingKing

True Blue
Messages
3,955
Best answers
1
When your teeth get that bad, dental insurance pretty much becomes useless due to limited dollar caps, waiting periods and low coverage for major procedures. When your premiums are close to or higher than the annual limit, its best just to go self pay.

Health insurance is very limited. If it was removal of teeth to prepare for radiation/chemo of the head is covered but not after the fact. There's many medical conditions that can wreak havoc on the mouth but it doesn't make the repairs covered under medical.

Aetna's policy may be a good read about what is and isn't typically covered under a medical insurance plan.

http://www.aetna.com/cpb/medical/data/1_99/0082.html

For example:
Removal of Impacted Teeth
Reconstruction of a dental ridge distorted as a result of removal of a tumor
Removal of broken teeth necessary to reduce a jaw fracture
 
Last edited:
Top