Oral surgery is often necessary for both medical and dental reasons, from removing impacted teeth to treating jaw disorders. If you’re a UnitedHealthcare member, you might be wondering whether your insurance plan will help cover these procedures. In this article, we’ll explore what UnitedHealthcare typically covers when it comes to oral surgery, and provide answers to related questions that people frequently ask.
What Is Oral Surgery?
Oral surgery includes procedures performed by a dentist or oral surgeon to treat various conditions affecting the mouth, jaw, and facial structures. Common oral surgeries include:
- Wisdom tooth extraction (especially impacted teeth)
- Jaw realignment surgery (orthognathic surgery)
- Treatment of facial trauma
- Dental implant placement
- Biopsies and removal of cysts or tumors
- TMJ disorder treatment
Whether or not these procedures are covered depends on the reason for the surgery and the details of your insurance plan.
Does UnitedHealthcare Cover Oral Surgery?
Yes, UnitedHealthcare does cover oral surgery, but coverage depends on several factors, including the type of plan (medical vs. dental), the medical necessity of the procedure, and your specific policy.
Here’s how it typically works:
- Medically Necessary Oral Surgery: If the procedure is considered medically necessary (e.g., removal of impacted wisdom teeth, jaw surgery for TMJ disorder, or treatment of facial injuries), it is usually covered under your UnitedHealthcare medical insurance.
- Dental-Related Oral Surgery: If the surgery is purely dental in nature (like tooth extraction for orthodontic reasons), it may only be covered if you have a UnitedHealthcare dental insurance plan that includes oral surgery.
It’s crucial to verify with UnitedHealthcare whether the procedure requires prior authorization or a referral.
What Type of Insurance Covers Oral Surgery?
Oral surgery may be covered by:
- Medical insurance: When the surgery is for medical reasons (e.g., facial injury, tumors, infections).
- Dental insurance: When the surgery is purely dental (e.g., non-impacted tooth extraction, implant placement).
- Dual coverage: Some procedures may involve both plans. For example, tooth removal due to a medical condition may start with medical coverage and shift to dental.
What Does UnitedHealthcare Not Cover?
UnitedHealthcare typically does not cover procedures that are:
- Cosmetic in nature (e.g., aesthetic jaw alignment without medical need)
- Elective and non-medically necessary
- Not approved or recommended by a licensed professional
- Performed by out-of-network providers (unless your plan allows it)
Always review your Summary of Benefits and Coverage (SBC) to understand specific exclusions.
Does Medicare Cover Oral Surgery to Remove Teeth?
Traditional Medicare (Part A and B) does not cover routine dental care or tooth extractions. However, it may cover oral surgery if it is part of a covered procedure — for example, removing teeth before radiation therapy for jaw cancer.
If you have a Medicare Advantage Plan (like those offered by UnitedHealthcare), you may have expanded dental benefits that include oral surgery.
How Do You Know If Your Insurance Covers Dental?
To find out if your UnitedHealthcare plan includes dental benefits:
- Check your insurance card – It may list “dental” as a component.
- Log into your UnitedHealthcare account on their member portal.
- Call customer service and ask about dental or oral surgery coverage.
- Review your plan documents, such as your Evidence of Coverage (EOC) or Summary Plan Description (SPD).
Final Thoughts
So, does UnitedHealthcare cover oral surgery? The answer is yes — but the extent of the coverage depends on the type of surgery, the reason for it, and your plan type. If you’re planning to undergo oral surgery, always confirm with UnitedHealthcare and your provider to ensure you understand your benefits and avoid unexpected costs.
