Cigna dental ppo wisdom tooth extraction cost

Here at Market Heights Family Dental, we’re committed to helping our patients in every way we can. If you have a Cigna dental insurance policy, you can get necessary preventive care at little to no out-of-pocket cost, and it may assist when your smile needs a bit of repair work. Contact our team so that we can help you understand and maximize your Cigna policy.

Cigna Coverage Availability & Fees

Cigna offers group plans that you must purchase through an employer as well as individual plans. Regardless of how you bought your coverage, it is likely a DPPO policy (sometimes simply called a PPO policy). This type of plan allows you to visit any licensed dentist and still use your benefits. However, visiting an in-network dentist helps you to keep out-of-pocket costs as low as possible.

Here is a general idea of the coverage you can expect when you visit an in-network practice:

• Preventive services, such as cleanings, exams, and routine X-rays: 100% covered with no deductible or waiting period.
• Basic restorative care, such as fillings and simple tooth extractions: 80% covered after a waiting period of six months.
• Major restorative care, such as root canal therapy and wisdom tooth extractions: 50% covered after a waiting period of 12 months.

Keep in mind that not all Cigna DPPO plans provide the above coverage. For example, they offer a policy that only covers preventive care and does not assist with even basic restorative services. If you have questions about how your plan works, you can log into Cigna’s online portal to learn more about it. Or you can rely on our team to help you understand your policy’s details.

Another important point to remember is that DPPO plans come with an annual maximum, which is the highest amount that Cigna will pay for approved services within a calendar year. Usually, this amount is $1,000 or $1,500. If you need a major service, we may be able to schedule it across multiple appointments between calendar years so you can take advantage of multiple annual maximums.

Meet Michelle, Our In-Office Insurance Pro

Michelle, our practice’s business assistant, is who you’ll work with when you’re seeking to get the most out of your Cigna policy. Not only will she verify your coverage and file your claims for you, but she’ll also strive to answer any questions you have about your coverage. She has over 10 years of experience in the field of dentistry, and she is eager to put her knowledge to work for you!

If you’re planning a major oral surgery (such as getting dental implants or needing your wisdom teeth removed) you may be wondering if it’s possible to get your medical insurance to cover your dental treatment. For people who don’t have great — or any — dental insurance coverage, this can be a huge factor in whether it’s possible to move forward with your treatment.

The short answer to this question is that yes, medical insurance will cover some types of oral surgeries, but not all of them. In most cases, the two plans will overlap one another, picking up various aspects of the line-item expenses and expecting the other policy to pay for the ones that are not covered. 

Who Decides if My Oral Surgery Falls Under Medical or Dental Benefits?

Your medical insurance and dental insurance claims are filed with specific codes used to describe the service that is being rendered. Codes outline the type of oral surgery, how complicated it is, which tooth is involved, anesthesia/sedation, etc. The insurance policy will then dictate which codes are or are not covered.

The best way to find out if a specific procedure is covered by one of your plans is to work with a dentist or specialist (such as an oral surgeon) who has experience filing medical claims. Medical insurance claim processing is not the same as dental claims, so you need to work with someone who understands the process. A treatment coordinator will be able to get a breakdown of your benefits, so that your care plan outlines which services are covered, by whom they are covered, and an estimate of how much your insurance company will pay.

Once you have your written treatment plan in front of you, you’ll be able to see an estimate of which insurance plan pays for specific procedures and about how much will be left over for you to pay for out of pocket. Unfortunately, these are only estimates. Your dental or medical insurance may refuse to pay the claim, leaving you with the responsibility of covering that specific procedure. 

When Sedation or Anesthesia is Involved

If you’re undergoing anesthesia or sedation for an oral surgery, you can usually expect either your medical or dental insurance to pay for it. General anesthesia, administered by a licensed anesthesiologist, may fall under the medical insurance category. Oral sedation or nitrous oxide (laughing gas) would typically be billed to your dental insurance.

Some types of oral surgery are performed in a hospital setting, because of the complexity of the treatment or type of anesthesia being used (such as intravenous, or IV.) When that’s the case, you need to make sure that your medical insurance will help pay, or you could be left with a hefty hospital bill. 

Why are You Having the Surgery?

Depending on your situation, medical insurance may only cover your oral surgery if it’s deemed “medically necessary.” That is, you need it for the overall health and wellness of your body for everyday functioning. For instance, a complicated wisdom tooth surgery may require more than standard dental procedures to complete. Some medical conditions may entitle you to dental coverage under your health insurance. 

Filing Claims for Medical or Dental Benefits 

Some types of medical insurance policies require that your provider bill the dental insurance company first, and then once that claim is processed you can file a claim toward medical insurance. 

Your dentist or oral surgeon will need to provide supportive data and clinical notes to support why a particular procedure needs to be completed a certain way. X-rays or even intraoral photographs may be necessary. Again, the person filing the medical claims needs to have a good understanding of medical coverage, as it is very different from using traditional dental insurance. 

Other Ways to Save on Your Oral Surgery Bill

Having a medical claim denied is something that you obviously want to avoid. Instead of taking the chance at what-ifs, you might prefer to invest in a Cigna dental discount plan – also known as a dental savings plan – where you can save a flat percentage off any dental procedure (including oral surgeries like wisdom tooth extraction and implant placement.) Contact the professionals at CignaDentalPlans.com to find the Cigna dental plan that’s most affordable for your needs.

Save 10% to 60%* at the Dentist!

With a Dental Savings Plan.

Start Saving Now

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