Yes, you heard me right! 

Medical insurance benefits for dental procedures.  Our insurance billing used to be simple.  Dentists performed dental procedures and billed dental insurance.  Then along came accident related claims requiring dental practices to bill dental procedures to other non-dental insurance carriers.  Most were forgiving enough to go ahead and accept ADA codes and assist in translating them to the required medical and ICD diagnostic codes. 

As times have changed, it became evident that dental offices needed to bill medical insurance for dental procedures, especially by oral and maxillofacial surgeons, in order to get reimbursed by insurance.  However, many general practices aren’t tapping into the opportunity to get the insurance reimbursement from a patient’s medical carrier.  And as we will see in our near future, the implementation of the Coordinated Care Organizations will increase the need for dental practices to have the ability to cross-code their dental procedures.  

As we are continually educated on the systemic link to dentistry, we are seeing the billing to medical carriers more frequently in the dental field, by all types of dental practices, not just specialty offices.  Many dental practices are billing medical for periodontal procedures, surgical procedures, biopsies, TMJ, Sleep Apnea appliances, oral conditions caused by congenital defects, cancer, Sjorgren’s Syndrome, bulimia, etc. 

Additionally, patients with medical conditions such as diabetes, heart disease, pregnancy, Parkinson’s disease, dry mouth, etc. could be considered for medical reimbursement.

Your practice can assist your patients in being able to afford their dental care by seeking reimbursement by their medical plans.  This can result in more treatment acceptance and patients speaking highly of your dental practice and therefore becomes a marketing tool.  

The challenge in billing medical insurance for dental procedures hovers over us like a dark cloud – “How do I correctly bill a medical plan when we use a different set of codes?”  I can assure you that many dental practices have learned how to cross code effectively and are receiving successfully paid EOB’s.  In order to obtain reimbursement from a medical plan, a practice needs to know how to complete the CMS-1500 medical claim form, select the ICD diagnostic codes, and translate the ADA codes to the medical procedure codes. 

At DMC we are consulting with insurers and working on developing a solution for our clients that will provide a separate medical insurance module to facilitate the billing to the medical as well as dental carriers. 

Additionally, we are looking to provide computer assisted cross-coding for the ICD diagnostic and the medical procedure codes to ADA codes.

Although we would like to collect our fees in full before delivering a ‘new tooth’, I know that each of us has entered the field of dentistry because we care for people.  We are not simply mechanics that can hold the keys until the patient pays, but we are dental professionals that desire our patients to be well taken care of. 

And if billing a patient’s medical insurance assists them in getting the care that they need, well, I am willing to face the challenge, how about you?