Is Orthodontic Surgery Covered by Insurance? Understanding Oral Surgery for Orthodontics

When orthodontic treatment alone cannot achieve the desired alignment of teeth and jaws, patients may be referred for oral surgery for orthodontics. Understanding whether insurance will cover such surgery can feel complicated. In this article we will explore how insurance coverage works for surgical aspects of orthodontic care, what factors influence coverage, and how patients at True North Oral Surgery & Implants can navigate the process.

What Is Oral Surgery for Orthodontics?

Oral surgery for orthodontics refers to surgical procedures that support, complement or enable orthodontic treatment. At True North Oral Surgery & Implants, these services may include exposing impacted teeth, removing bony or soft-tissue obstructions, assisting in impacted canine eruption, and coordinating with your orthodontist to ensure optimal alignment. These procedures play a key role when simply applying braces or aligners is not enough.

By undergoing such surgery, the orthodontic treatment can proceed more predictably, the mechanics may be simplified and long-term stability improved.

How Insurance Typically Handles Orthodontic-Related Surgery

Insurance coverage for orthodontic treatment and for oral surgery overlap but are not identical. Orthodontic treatment (braces, aligners) is often covered under a separate orthodontic benefit or rider, while surgical procedures may fall under the oral surgery or major dental benefit. Here are some main points:

• If the surgery is deemed medically necessary, such as to correct impacted teeth that pose a risk to other teeth or to remove obstacles preventing orthodontic correction, many insurers will consider coverage.
  
• If the treatment is purely cosmetic (for example, aligning teeth for aesthetic reasons without functional impairment) some plans may exclude it or classify it under “orthodontic only” coverage which may not include surgery.
  
• The nature of the procedure matters: A surgery to expose an impacted canine so orthodontics can bring it into place may get more favorable coverage than one done solely for aesthetic repositioning.
  
• Some plans require documentation, prior authorization and coordination between the orthodontist, surgeon and the insurance carrier.

Common Factors That Affect Coverage Decisions

Several important factors influence whether your plan will approve surgical orthodontic support. These include:

• Medical necessity: Insurance carriers evaluate whether the surgery addresses a functional problem (e.g., impacted tooth, jaw alignment issue) rather than purely cosmetic alignment.
• Documentation and imaging: Advanced imaging (3D scans, CBCT) and a consult-note from your orthodontist showing that surgery is required to support the orthodontic plan increase the chance of approval. True North uses advanced technology like CS 9600 CBCT machines for precise diagnosis.
• Benefit plan details: Some plans treat orthodontics separately, and may limit or exclude surgical components. Others combine dental and orthodontic benefits under one umbrella.
• Pre-authorization and timing: Submitting the surgical plan ahead of time, along with the orthodontic treatment plan, helps. If a plan is denied because of timing or missing documentation, you may need to appeal.
• Location of service and provider credentials: Board-certified oral surgeons and recognized dental practices tend to have smoother insurance coordination. True North emphasizes board-certified surgeons and advanced diagnostics.
• Patient’s age and condition: Some plans have age limits for orthodontic benefits. When the surgery is part of a broader orthodontic and surgical correction for alignment (especially in teens or young adults) coverage is more common.

How to Navigate the Process at True North Oral Surgery & Implants

At True North Oral Surgery & Implants the patient-journey for oral surgery for orthodontics can be managed effectively by following a few steps:

1. Initial Consult with the Orthodontist: Your orthodontist will assess if surgery is needed and will coordinate with the surgeon at True North.
2. Surgical Evaluation at True North: During your visit the team will conduct imaging, review your orthodontic treatment plan, discuss the surgical procedure and explain potential coverage/financial aspects.
3. Insurance Benefit Review: The office will verify your dental and orthodontic benefits, submit required documentation, and determine what portion your plan will cover or what you may owe. As noted on their website they assist with insurance verification.
4. Pre-Authorization Submission – A written surgical treatment plan with imaging and orthodontic coordination is submitted to the insurance carrier. REMOVE THIS ONE- THIS IS NOT ALWAYS POSSIBLE
5. Proceed with Treatment & Follow-Up – Once approved, the surgery is scheduled, and the orthodontic treatment proceeds in partnership with your orthodontist. Post-operative care and orthodontic follow-up are coordinated for best outcomes.
   
   

It is always wise to ask: “Does my plan differentiate between the surgical component and the orthodontic component?” and “What coverage applies to the surgical portion?” The team at True North can assist with these inquiries.

Key Take-aways and Next Steps

Understanding insurance coverage for surgical support of orthodontics can help you plan effectively. In summary:

• Surgery that supports orthodontic treatment may be covered if it is deemed medically necessary and properly documented.
  
• Coverage depends on your plan’s definition of orthodontic benefits and surgical dental benefits.
  
• Working with a board-certified team like True North Oral Surgery & Implants that uses advanced diagnostics and coordinates with your orthodontist improves your likelihood of a smooth insurance process.
  
• Early verification, imaging documentation and timely submission of prior authorization help prevent unexpected costs.
  

Frequently Asked Questions About Oral Surgery for Orthodontics

Does insurance always cover the surgical component when braces or aligners are involved?

No. Coverage varies widely. Some plans treat orthodontics separately and exclude surgeries, while others approve surgical procedures when they are part of a medically necessary plan. It depends on the specific benefit design and documentation.

What if my insurance denies the surgery as “cosmetic”?

You may appeal the decision by submitting an updated letter from your orthodontist and surgeon explaining why the surgery is required to achieve functional orthodontic correction. True North’s team can help with documentation and appeals.

We at True North Oral Surgery & Implants are committed to guiding you through every aspect of your care from initial consultation to insurance verification and surgical coordination. Contact us today to learn more and schedule an appointment.