Medical insurance reimbursement for All-on-4 cases has increased at record speed in the last few years.  If you’re placing bone grafts and implants or performing other surgeries, you may be wondering if it’s possible to get your patients’ medical insurance to cover this dental treatment. For people who don’t have great — or any — dental insurance coverage, this can be a significant factor in whether patients can move forward with treatment. According to Cigna and other carriers, some of these cases are eligible for coverage under their medical plan.

Can Both Medical and Dental be Billed for all-in-four cases?

According to a recent article by a major medical insurer, medical insurance covers some types of oral surgeries, sleep apnea appliances, and other services.  In most cases, the two plans, dental and medical, overlap one another, picking up various aspects of the line-item expenses and expecting the other policy to pay for services not covered.  For example, medical may cover the surgical portion, and the restorations are under the patient’s dental plan.

Who Determines if my Patient’s Oral Surgery Falls Under Medical Benefits? 

When you bill specific codes for extractions, bone grafts or implants, they are often flagged by dental insurance as “medical in nature.”  Medical diagnosis and procedure codes outline the type of oral surgery, how complicated it is, the area of the mouth and the use of anesthesia/sedation. The dental insurance policy dictates which codes that are not covered, at least until after billed to the patient’s medical carrier.  It’s increasingly common to see an explanation of benefits (EOB) with a statement like this: “Benefits could not be determined because of missing information.  This procedure may be covered under the enrollee’s medical carrier. Upon receipt of a new claim with either a copy of a finalized denial or payment from the medical carrier, we will process.”  In other words, dental wants medical to be billed first for a decision!

Essential Medical Billing and Coding Resources

The best way to find out if medical plans cover a specific procedure is to partner with a company specializing in continuing education (CE), dental to medical billing (cross-coding) software and other services for medical billing for dentists. Dental teams can readily master medical claims with some focused education.  With medical insurance kicking in to help with finances, more patients now have access to essential services such as All-on-4 implants, oral appliances for obstructive sleep apnea (OSA) temporomandibular joint (TMJ) appliances and other procedures that medical may cover.

Medical insurance claim processing is not the same as dental claims, so it’s essential to work with someone who understands the process and teaches the best protocols.  A treatment coordinator in an experienced dental office can get a breakdown of benefits so that patients understand which part of their care is covered by their medical benefits and which are covered by their dental insurance.  The dental office should be able to estimate which medical insurance covers surgical procedures and which restorative procedures are covered by dental.  Once the dental insurance coordinator bills some medical plans, the payment amounts for your locale are more apparent for subsequent cases.

Document All-on-4 Cases

Depending on the situation, medical insurance may cover All-on-4 procedures when medically necessary.” That is why the dental office needs to be trained to ask about various symptoms and chief complaints and to assign a diagnosis related to diminished function or conditions. Additionally, some medical conditions may entitle a patient to reimbursement under their health insurance.

Filing Claims for Medical Benefits in the Dental Office

As a dental practice, you can learn to provide specific documentation and clinical notes to support why a particular procedure is primarily a medical need.  When the dental provider and the person filing the medical claims have a good understanding of how to cross over to medical insurance processes, patients benefit.

With medical billing for All-on-4 cases, it’s what you do up front that counts and learning the processes are well worthwhile.  Once a dental practice learns the ropes of medical billing in dentistry, more and more patients can benefit from All-on-4 implants and other dental services that improve function and quality of life.

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