Hi Guest! I found the following language in Aetna”s medical policy titled: “Dental Services and Oral and Maxillofacial Surgery: Coverage Under Medical Plans”: It states: “The following dental services are considered not covered under the medical plan regardless of whether they accompany medically necessary reconstructive surgery: – Dental implants (except as specified in the certificate of coverage). Most medical plans do not cover the routine replacement of teeth via surgical placement of a dental implant body. In addition, any procedures (e.g., bone replacement graft,sinus lift surgery, soft tissue graft, and barrier membrane placement) considered as adjunctive procedures to the surgical placement of the dental implant body are also not covered. For those medical plans that do cover routine replacement of teeth by dental implants, the only procedure covered by the medical plan related to the dental implant is the surgical placement of the dental implant body (replacement of the missing root). The restorative procedure (replacement of the missing crown) is considered a dental expense; – Fluoride carrier.” However, if the reason for the sinus lift is not relating to implant placement, it would certainly be worth submitting a pre-authorization for review to your medical insurer. Hope this helps!
