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Oral Surgery Coverage

Oral and maxillofacial surgery can correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the mouth.

A medical or dental benefits and insurance plan may cover oral surgery. Which plan covers it depends upon:

  • The treatment needed
  • How your medical or dental plan is designed

Coverage under your medical or dental plan

We define oral surgery in two ways:

  • Dental in nature, or
  • Medical in nature

Oral surgery that is medical in nature is typically covered by a medical plan. It involves:

  • Disease of the facial bones
  • Trauma to the soft and hard tissue structures of the face and oral cavity
  • Treatment of a jaw disorder commonly known as TMJ
  • Correcting facial deformities present at birth or later

Surgery that is dental in nature involves the teeth. Tooth surgery is typically covered by a dental plan.

Getting reimbursed
You will be reimbursed under the plan that considers oral surgery a covered service.

To verify how your surgery may be covered:

  • Get a pre-treatment estimate
  • Call the Customer Service number listed on you Aetna ID card
  • Ask for the Oral Surgery Center of Excellence

Get more information

 Dental benefits and dental insurance plans contain exclusions and limitations  (PDF) 

 

Legal Notices

This content is currently not available for California DMO members.

Dental benefits and insurance plans contain exclusions and limitations  (PDF).

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