Wisdom tooth extraction can be frightening for many teenagers but, even more frightening , can the cost associated with a wisdom tooth extraction. As a parent, you may be confused as to what is covered by your dental plan and what is not covered – an important piece of information to clarify well before the oral surgery date.
Wisdom tooth extraction is normally covered as a Class II dental procedure under most dental health plans. If your dental plan is a DMO, or dental managed plan, or a PPO, the Class II benefits for dental coverage are typically the same – 20% coinsurance, subject to your deductible, and paid at U&C – usual and customary charges.
The cost associated with wisdom tooth extraction can be absurdly expensive when you are faced with dental policy coverage limits and the decision to use a dentist, or oral surgeon, which is in-network versus one out-of-network. Normally, your dental plan will cover the full 80 percent expense of your wisdom tooth extraction if you are using an oral surgeon that is within their dental health network. Even at this rate, the 20 percent out of pocket can be costly.
The out of network oral surgeon will be far more costly for you. Because the dental plan will only pay the amount up to what they consider to be “usual and customary” charges, if the oral surgeon charges a much higher rate than the in-network counterparts, your out-of-pocket expense will be the full amount over U & C, plus the 20 percent standard out of pocket, plus and deductible, if not yet met.
Further expenses may include any charges that exceed your overall dental policy limits. With many dental plans providing only a $2,000 to $2,500 policy limit on Class II services, one oral surgery procedure may completely wipe out your entire dental plan in a year.
Many dental insurance providers opt to exclude themselves from in-network services because they understand that being an out-of-network provider can be far more lucrative to their business. Being unclear about the out-of-pocket expenses can lead to a large oral surgery bill for you and, ultimately, this may cause more pain than the surgery itself. If you are considering oral surgery, such as the extraction of wisdom teeth, consider your cost options and consult opinions from both oral surgeons that are in-network as well as those out-of-network. Obtaining a pricing estimate before surgery, and weighing those costs against your oral surgery needs, should help in determining what oral surgeon should be used and how it will be covered.
Sources: Journal of American Dental Association, 2002: 76-79.