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Dental Claims - File w/Medical carrier first?


Guest dsw713
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Guest dsw713

I've been handling benefits for a long time and I've never heard of this but understand it is becoming more commonplace practice among dental carriers. When dependent kids are having their wisdom teeth extracted, dental carriers are now mandating that the claim is first filed with the medical carrier before they will consider it for payment? They want it to be paid first under the medical plan if applicable, or get denied for no coverage. I've come across 2 carriers -- DeltaDental and Humana -- that are now requiring this.

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Guest mcapuano
I've been handling benefits for a long time and I've never heard of this but understand it is becoming more commonplace practice among dental carriers. When dependent kids are having their wisdom teeth extracted, dental carriers are now mandating that the claim is first filed with the medical carrier before they will consider it for payment? They want it to be paid first under the medical plan if applicable, or get denied for no coverage. I've come across 2 carriers -- DeltaDental and Humana -- that are now requiring this.

dsw713,

Not surprising to hear. Medical plans have for quite some time now provided "some" level of coverage for the "extraction of wisdom teeth," but in my experience, I have found it limited to the extraction of "bony impacted teeth," and not just limited to the wisdom teeth. The dental carriers are proactively attempting to avoid having to pay claims of this nature when medical coverage is available, but more often than not - you'll find that the medical plan won't pay unless, again, the teeth are bony impacted. Does this help? Mark

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Guest samc6782

I didn't know that carriers who do not offer dental coverage were doing this too, but I expect this will become an issue for us.

Some carriers who do both medical and dental will not require it to go to medical first if medical is not provided by the same carrier. I don't know if that's true for real oral surgeries, but I've heard about some pretty basic procedures having to go through medical first (local anesthesia, extractions of erupted teeth) when the same carrier does medical and dental. This can result in some irate clients and employees who end up having to pay a lot more if it goes through medical first.

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