For many years dental providers have known that oral procedures completed on medically compromised patients will allow them longer periods of health over the alternative of hospitalization and emergency room visits.
In the end, the question is always, “How do we determine if treatment falls under Medical Insurance or Dental Insurance?”
How to Determine if your Case Is Medical:
- What are the three S’s?
- Signs – Health history indicators, medications, disease or conditions.
- Symptoms – Infection, fever, bad taste in mouth, boneloss, swelling or inflammation, dry mouth, etiology.
- Significance of care – Increase health, potential health decline, practice protocol.
- Does this change the musculoskeletal function?
- Will you be improving their health because of treatment?
- Was this a result of an accident or incident?
- Is there a medical correlation from their disease or condition to a breakdown of the oral cavity?
Any coverage whether you obtain medical or dental benefits it is always determined by the condition that is being diagnosed and treated whether the service is provided by a dentist or a medical doctor.
When you are seeing a new patient or a new problem is it important to consult with the payer to determine coverage prior to treatment.
Each medical payer has established guidelines for care (here are a few):
Laurie Owens, CPB, CPC
Director of Medical Billing Education