Can We File Any Dental Procedure to Medical Insurance?

It is true that many services performed by licensed dentists may qualify for medical insurance.   Some of the newer policies that have arrived with the ACA have embedded dental coverage in the medical policy.  This often means that the procedure is to be billed to the medical first.  This is a policy driven requirement.  If the patient has a separate Medical and Dental policy, routine dental procedures are not billed to medical policies.  Dental implants, since they are not defined as routine care by the ADA Council on Dental Care Programs can be billed to medical policies after establishing “medical necessity” criteria.    

Again, clinical note taking should follow the S.O.A.P. format and any physician reports that will affect the diagnosis considered.  For instance if the medical condition includes atrophy of the jaw, or masticatory dysfunction( supported by valid ICD-10 diagnosis codes and CPT codes) that has clinical documentation demonstrating  the condition is causing medical problems for the patient, this supports a medical claim.

Patients often don’t understand the link between oral health problems and general health problems.  Not being able to eat for proper nutrition can have devastating effects on a person’s well-being.  In updating health history information in a dental office this is not often asked to the patient:  “Has your ability to bite or chew affected what you are choosing to eat?”

Because of more multidisciplinary treatment and the increasing possibility of being able to bill medical insurance policies more comprehensive health histories should be taken on patients that have medical health issues.

A claim supporting “medical necessity” should be part of the new thought processes for dental examinations today.