Is gum grafting covered by dental or medical insurance

If you’re planning a major oral surgery (such as getting dental implants or needing your wisdom teeth removed) you may be wondering if it’s possible to get your medical insurance to cover your dental treatment. For people who don’t have great — or any — dental insurance coverage, this can be a huge factor in whether it’s possible to move forward with your treatment.

The short answer to this question is that yes, medical insurance will cover some types of oral surgeries, but not all of them. In most cases, the two plans will overlap one another, picking up various aspects of the line-item expenses and expecting the other policy to pay for the ones that are not covered.

Who Decides if My Oral Surgery Falls Under Medical or Dental Benefits?

Your medical insurance and dental insurance claims are filed with specific codes used to describe the service that is being rendered. Codes outline the type of oral surgery, how complicated it is, which tooth is involved, anesthesia/sedation, etc. The insurance policy will then dictate which codes are or are not covered.

The best way to find out if a specific procedure is covered by one of your plans is to work with a dentist or specialist (such as an oral surgeon) who has experience filing medical claims. Medical insurance claim processing is not the same as dental claims, so you need to work with someone who understands the process. A treatment coordinator will be able to get a breakdown of your benefits, so that your care plan outlines which services are covered, by whom they are covered, and an estimate of how much your insurance company will pay.

Once you have your written treatment plan in front of you, you’ll be able to see an estimate of which insurance plan pays for specific procedures and about how much will be left over for you to pay for out of pocket. Unfortunately, these are only estimates. Your dental or medical insurance may refuse to pay the claim, leaving you with the responsibility of covering that specific procedure.

When Sedation or Anesthesia is Involved

If you’re undergoing anesthesia or sedation for an oral surgery, you can usually expect either your medical or dental insurance to pay for it. General anesthesia, administered by a licensed anesthesiologist, may fall under the medical insurance category. Oral sedation or nitrous oxide (laughing gas) would typically be billed to your dental insurance.

Some types of oral surgery are performed in a hospital setting, because of the complexity of the treatment or type of anesthesia being used (such as intravenous, or IV.) When that’s the case, you need to make sure that your medical insurance will help pay, or you could be left with a hefty hospital bill.

Why are You Having the Surgery?

Depending on your situation, medical insurance may only cover your oral surgery if it’s deemed “medically necessary.” That is, you need it for the overall health and wellness of your body for everyday functioning. For instance, a complicated wisdom tooth surgery may require more than standard dental procedures to complete. Some medical conditions may entitle you to dental coverage under your health insurance.

Filing Claims for Medical or Dental Benefits

Some types of medical insurance policies require that your provider bill the dental insurance company first, and then once that claim is processed you can file a claim toward medical insurance.

Your dentist or oral surgeon will need to provide supportive data and clinical notes to support why a particular procedure needs to be completed a certain way. X-rays or even intraoral photographs may be necessary. Again, the person filing the medical claims needs to have a good understanding of medical coverage, as it is very different from using traditional dental insurance.

Other Ways to Save on Your Oral Surgery Bill

Having a medical claim denied is something that you obviously want to avoid. Instead of taking the chance at what-ifs, you might prefer to invest in a Cigna dental discount plan – also known as a dental savings plan – where you can save a flat percentage off any dental procedure (including oral surgeries like wisdom tooth extraction and implant placement.) Contact the professionals at CignaDentalPlans.com to find the Cigna dental plan that’s most affordable for your needs.

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As gums recede, they tend to cause more of your teeth to show, which will make you look older and a little less attractive. It also exposes the roots of your teeth, making them more susceptible to get cavities. Getting a gum graft to correct your gum problems can correct it, but you need to know some things about it before you make the decision.7 Things to know before considering a gum graft.

The Cause of Gum Recession

Although there are some other causes of receding gums, it is often caused by bacteria and inflammation that are destroying it. If you smoke, it will likely be even worse because the nicotine reduces the oxygen in your gums, which causes the cells in them to die faster.

The bacteria and inflammation will continue to destroy your gums. Normally, these bacteria cannot enter the gums, but by brushing too hard, or not providing good oral practices, they will find an entrance and get in. Once they do, the process is nearly unstoppable without the help of a dentist. Before long, the teeth will become loose and then may fall out.

Gum disease is also connected to other severe health problems which may include cardiovascular disease, stroke, heart attacks, cancer, diabetes, dementia, and many more. The sooner it is treated the better off you will be.

This makes it necessary to treat gum disease prior to having a gum graft. Normally, you can remove gingivitis on your own, which is early gum disease, by brushing twice a day and flossing. Once it becomes periodontitis, non-surgical and surgical treatments may be necessary.

Benefits of Gum Grafts

Getting gum grafts can restore the way your gums look, giving you a healthy-looking smile. They will also protect your gums from bacteria and acid attacks. If your teeth had become sensitive because the roots were exposed and a cavity had started, the gum graft surgery should stop the sensitivity.

Before Gum Graft Surgery

You need to do very little prior to the surgery. You will have a consultation with the dentist so that you can provide some information. You will discuss which gum graft options are available, and which one you want. You will also discuss which type of anaesthesia you prefer. Most people get local anesthesia, but some people may prefer general anaesthesia. You will need to have transportation home since you likely will not be able to drive safely.

Three Gum Graft Options

There are three different ways that the dentist can provide you with a gum graft. They include:

Connective Tissue Grafts

This one obtains tissue from above your palate. First, a flap is cut into your palate. Then, some of the tissue above it is harvested to use as your new gum tissue. The flap is then stitched closed.

Free Gingival Grafts

This procedure is simpler than the above because it simply harvests tissue directly from your palate. It is used on patients where more gum tissue is needed to repair the gums.

Pedicle Grafts

In this grafting procedure, the dentist cuts your gums next to the vacant place, leaving one side still hinged. It is then pulled over to cover the empty space next to it and stitched in place.

Some claim that the above three procedures have a rather painful recovery time, but the pain is usually handled well with over-the-counter medications. Some people go back to work the next day, but most are likely to need two or three days. Since gums tend to heal rather fast, recovery time is normally completed within one-to-two weeks.

Pinhole Surgical Technique

This new procedure has several advantages over other procedures because it is much simpler and all your gums that need treatment can be completed in one appointment. Using the pinhole surgical technique, the dentist will make a small hole above the gums that need to be moved down, and then slides them into place. Collagen strips are then placed under the moved gums to help hold them in place and to encourage healing.

Follow the Instructions

When the surgeon has completed the surgery, you will be given a set of instructions to follow. In order to have faster healing, you will need to follow the instructions carefully.

Complications

Some complications are possible as a result of gum surgery. You may experience swollen gums, sensitive teeth, infection, and possibly teeth feeling looser – but this should only be temporary. There is also the possibility that the grafting could fail and may need to be redone.

Insurance

Your dental insurance plan will often cover gum graft surgery to help prevent or stop gum disease. It is not likely going to cover gum graft surgery for purely cosmetic purposes.

Dr. Kumar T. Vadivel, DDS

Dr. Kumar T. Vadivel, DDS, FDS RCS, MS, a Board Certified Periodontist, provides remedies for receding gums in his Carrollton, TX, and Grapevine, TX offices. Most dental insurance programs are accepted. For a consultation or information about periodontal treatment, you can contact his office today at (817) 756-8578.

How much will a gum tissue graft cost?

The average cost of gum tissue graft surgery ranges from $700 to $1,000. If gum contouring is performed to give the gums a more attractive appearance during the procedure the cost can climb to around $1,500.

How much does it cost to fix receding gum line?

Cost of Gum Graft Surgery The base cost of a gum graft can be between $600 and $1200 per tooth. A periodontist is a specialist so is likely to have a higher fee. Donor tissue is more expensive than tissue that is harvested from the roof of your mouth.

Are gums covered by insurance?

In its earliest stage, gingivitis, gum disease can be treated by simply brushing, flossing, and visiting your dentist for routine checkups and cleanings. These preventive visits are usually covered by your insurance plan.

Is gum grafting done by a dentist?

Gum grafting is a dental procedure performed by a periodontist (a gum specialist). It's the recommended course of treatment for receding gums to avoid exposing the teeth' root surface that leads to decay and sensitivity.

What type of service is a gum graft?

A gum graft is a type of dental surgery. It treats gum recession, a condition where your gums pull away from your teeth and expose the roots underneath. Exposed teeth roots increase your risk of tooth decay, sensitivity and bone loss around teeth.

Is gum graft surgery worth it?

While gum tissue grafts are effective at repairing gum recession and preventing further damage, there is no guarantee that gum problems won't develop again in the future. However, with regular dental checkups and careful dental care at home, serious damage requiring surgery can be prevented.