Medical Insurance and Dental Trauma Procedures

Dentists can bill medical insurance companies so patients can receive coverage for procedures treating injuries caused by traumatic events. Dental trauma can be caused by many types of events, such as a car accident or sports incident. These events could lead to teeth that are chipped, fractured, dislodged, or knocked out. Treatments such as bone grafting, periodontal osseous surgery, or root canals that address these injuries may be covered under medical insurance policies. Dental practices should help patients receive coverage for these procedures.

Billing dental trauma procedures to medical insurance

However, billing these treatments to medical insurance involves many rules and caveats. According to Dentistry IQ, dentists “must first check to make sure the injury isn’t covered by auto, homeowners, or some other type of liability insurance.” If an injury is covered by liability insurance, dentists must bill that insurance before medical insurance. 

Dentists, including those referred by other dentists, should provide the whole treatment plan to get prior authorization from the medical insurance company. They may even need to provide a referral before a patient can receive medical coverage. They also need to indicate the date of the accident in the claim because some medical insurance companies may only provide coverage within a set timeframe. For instance, depending on their medical insurance policy, patients may only receive benefits for dental trauma procedures for the first 24 hours after an accident. In addition, dental practices need to check for a deductible or dollar maximum for dental trauma on the medical policy.  Dentists should provide much information about the accident and recommended procedures to get a better coverage estimate for their patients.

Dental practices must include all information medical insurance companies require on their claims. Once the claims are processed successfully, patients can receive coverage and pay less out-of-pocket for procedures that could fix teeth damaged by unfortunate events. Just as dentists collaborate with medical carriers, eAssist also collaborates with dentists assisting them with their billing needs. Schedule a consultation to find out more. 

Dr. James V. Anderson

CEO & Co-Founder, eAssist

Dr. James Anderson is a practicing dentist and the CEO and Co-Founder of eAssist Dental Solutions, the nation’s leading platform for dental billing. A serial entrepreneur, Dr. Anderson has built multiple successful ventures, including eAssist and nine dental practices in Utah, all driven by his mission to help dentists, their teams, and their patients achieve peace of mind. He co-founded eAssist in 2011 to give dental practice owners the ability to fully outsource their billing departments—a vision that now serves over 2,400 practices nationwide. Under his leadership, the company has formed strategic partnerships with the California Dental Association and Henry Schein, and earned a spot on the Inc. 5000 list for nine consecutive years. In 2020, Dr. Anderson was recognized as Entrepreneur of the Year by Business View Magazine and ranked among the top entrepreneurs in the country by Entrepreneur Magazine. He holds a B.S. in Finance from Brigham Young University, a D.M.D. from Oregon Health & Science University, and completed the three-year O.P.M. program at Harvard Business School. He also serves as Chairman of the Dental MBA Advisory Board at Roseman Dental School.