Will health insurance pay for wisdom teeth removal surgery?

Wisdom teeth are the third set of molars in the back of the human mouth. It’s the only round of tooth eruption that isn’t developed before a person is born.

For most people, these pesky molars are more trouble than they’re worth. Most people’s third molars don’t begin to erupt until their late teens and early 20s.

Since the last tooth eruption happens much later than any of human’s other teeth, in the formative years of a person’s life, they’re called wisdom teeth. Unfortunately, they don’t happen to be too full of wisdom.

Instead, they’re usually much more trouble than they’re worth and can actually be pretty painful too.

Read More: Types of Health Insurance Coverage

Adding to the headache of worrying about when a person’s mouth is going to experience the joy of this process, is trying to determine whether your health insurance will pay for all or any of the surgical removal.

To understand whether your health insurance may pay for part of all of this surgical removal, you need to know what these teeth are and why they need to be removed.

If you need your wisdom teeth removed and need better health insurance, enter your ZIP code above and compare at least three to four policies today!

How important are these particular molars?

So many people ask why we have wisdom teeth if we don’t need them? We may not need them now, but we did once upon a time. Our primitive ancestors required wisdom teeth to chew the raw meat, tree bark, roots, nuts, and leaves that were part of their everyday diet.

Advances in cooking and meal prep have made food much softer, which means the average person doesn’t need the third set of molars.

Today, the human brain is much larger than a caveman’s, which means there simply isn’t enough room in the human jaw for the third set of molars.

When there isn’t enough room for wisdom teeth to erupt through the gum, wisdom teeth can cause many health problems, including impactions, infections, and overcrowding.

To prevent these problems from becoming dental emergencies, many dentists will preemptively remove the third set of chompers. If left untreated, an impacted wisdom tooth can lead to serious health conditions, including death.

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What are the most commonly asked questions?

No matter how old you are, when you learn you’ll have to have your molar teeth removed, you probably have a ton of questions, including:

• Will I be awake?
• How long will the removal take?
• Is the recovery painful?
• Os wisdom teeth removal covered by insurance

Anxiety about wisdom teeth removal and the length of time it will take you to recover is too much for some people to deal with. However, if you have a issue, the longer you wait, the worse the situation will get. It’s better to talk to someone about it as soon as you’re aware it might be a problem. That way you’ll know almost immediately whether you’ll need to go through with it.

If you’re worried about pain, you can opt to have a general anesthetic – although some patients are comfortable with just a local anesthetic.

Is wisdom teeth removal covered by medical or dental insurance? Don’t worry, we’ll cover everything you need to know.

What’s the difference between general and local anesthetic?

A local anesthetic is injected into gum tissue as a numbing agent. The area around the tooth will be completely covered, and you won’t feel a thing.

Usually, a dentist would prefer to use a local anesthetic if only one tooth is affected, whereas if a patient is having all of their wisdom teeth removed at the same time, a dentist will likely recommend general anesthetic.

Some patients may opt for this type of anesthetic even if they are having only one or two out of the four possible molars removed. However, insurance companies do not often pay for elective general anesthetic.

How long does the removal process take?

In total, the procedure should take about an hour and thirty minutes. Recovery time is about two to three days to an entire week.

The length of time it will take you to recover is determined by how much swelling and discomfort you experience after the procedure. It’s also determined by how well you take care of your mouth. The last thing you want is an infection while you’re on the road to recovery. Your surgeon will tell you what your dental procedures should be during recovery. That way you’re not stuck living with even more pain.

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Does it all boil down to the money spent?

If it isn’t the fear of the procedure keeping you from going through with it, it may be the cost that’s preventing you.

The average cost for a wisdom tooth removal with local anesthetic ranges from $75 to $200; if all four wisdom teeth are removed, the cost can increase to $300-$800.

However, if there are any complications, the cost can increase drastically.

An impacted wisdom tooth is a more involved procedure. For one tooth, the cost ranges from $225 to $600. If you opt for general anesthesia, the cost of removal will increase by about $250 to $800.

It’s important to discuss with your dentist or oral surgeon whether your procedure is elective or medically necessary.

Does dental insurance cover wisdom teeth removal? Wisdom tooth removal, which is considered medically necessary, may be covered by dental insurance. However, most dental plans have an annual cap of $1,000 to $1,500. You’ll have to check with your provider on the coverage, but this can sometimes include the cost of sedation as well as the surgery itself. But what is medically necessary?

Does health insurance cover wisdom teeth removal?

In some situations, your health insurance may pay for wisdom tooth removal, even though it is considered dental surgery. Usually, the removal will be covered if it is deemed medically necessary. (For more information, read our “Is dental insurance considered health insurance?“).

For instance, if your wisdom teeth are partially or completely impacted on your gums, your health insurance may provide some payment.

The reason this type of removal is paid and others are not is because not treating the condition could lead to cysts, bone damage, infections, and even nerve damage.

While it’s very unlikely medical coverage will pay for any tooth removal, if your wisdom teeth are not impacted, it’s also important to call your health insurance to see if there are any benefits of going through with the pain of getting them removed. Oral surgeons will sometimes not suggest removal if your mouth can handle it.

When it comes to wisdom teeth removal insurance coverage, medical insurance may cover all or part of the cost if the procedure is deemed medically necessary. Dental insurance may also cover some of the cost of wisdom teeth removal.

If you’re in need of any sort of dental treatment, and you’re concerned that your medical insurance doesn’t offer this particular type of dental coverage, start looking around online.

Enter your ZIP code below and start comparison shopping today!

Case Studies: Health Insurance Coverage for Wisdom Teeth Removal Surgery

Case Study 1: Comprehensive Coverage

Sarah, a 25-year-old with a comprehensive health insurance plan, underwent wisdom teeth removal surgery. Her insurance provider covered the entire cost of the procedure, including pre-operative consultations, anesthesia, and post-operative care. Sarah only had to pay a small deductible, making the surgery affordable and accessible for her.

Case Study 2: Partial Coverage

John, a 30-year-old with basic health insurance, had his wisdom teeth removed. Although his insurance covered some costs like the surgeon’s fee and anesthesia, he had to pay a significant portion out of pocket. X-rays and prescription medication were not covered, adding to his financial burden.

Case Study 3: Limited Coverage

Megan, a 19-year-old under her parents’ health insurance plan, required wisdom teeth removal. Her insurance policy had limited dental coverage and considered the procedure as an elective treatment rather than a medical necessity. As a result, Megan’s insurance provider declined coverage for the surgery, leaving her responsible for the entire cost.

Case Study 4: Pre-authorization Denial

Alex, a 23-year-old, obtained pre-authorization from his health insurance company before undergoing wisdom teeth removal. However, following the surgery, he received a denial of coverage, citing a technicality in his policy regarding oral surgeries. Despite the pre-authorization, Alex had to bear the full financial burden of the procedure, as his insurance deemed it unnecessary.

Case Study 5: Alternative Coverage

Emily, a 35-year-old, had her wisdom teeth removal covered by a supplemental dental insurance plan. Despite limited dental coverage from her primary health insurance, she bought an additional dental policy that specifically covered oral surgeries. This extra plan relieved financial strain and enabled Emily to get the necessary treatment without significant out-of-pocket costs.

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