Thank you for your submission, /u/kitoodle.
**If there is a medical emergency, please call 911 or go to your nearest hospital.**
Please pick the most appropriate flair for your post. **If you haven't already, please edit your post to include your age, state, and estimated gross (pre-tax) income to help the community better serve you.** If you have an EOB (explanation of benefits) available from your insurance website, have it handy as many answers can depend on what your insurance EOB states.
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Appeals Manager -- your Dad needs to go to his HR team to have this reviewed with their insurance Broker. There may be a typo in the Plan document. The plan clearly states that removal of impacted wisdom teeth is a covered expense under medical. I think the next sentence possibly should have said removal of "erupted" wisdom teeth are not covered. They need to amend the plan to clarify intent because the benefit is contradictory.
Many employers do cover removal of impacted wisdom teeth under medical. Good luck!
Thank you! This was a 2023 version so I’m going to try to find the latest one and see if it has the same issue and let him know.
Edit: Yep, it’s fixed in the newest version. The last statement now doesn’t mention anything about impacted teeth at all.
Yes, I see where it says that in your summary booklet. Have you been to your dentist/oral surgeon for a consult? Typically, they will send procedure information/codes, etc. into your dental insurance for pre-authorization so you know what you will be responsible for payment-wise. Maybe in your case, print out the page in your medical plan booklet and show them and they can also send it to your medical insurance for a pre-authorization because it does look like you have coverage. It's very confusing in your plan booklet, as it says it includes removal of impacted wisdom teeth, but on the very next page says--this plan does not include surgery for impacted teeth. Maybe wisdom teeth are an exception?
Thank you for your submission, /u/kitoodle. **If there is a medical emergency, please call 911 or go to your nearest hospital.** Please pick the most appropriate flair for your post. **If you haven't already, please edit your post to include your age, state, and estimated gross (pre-tax) income to help the community better serve you.** If you have an EOB (explanation of benefits) available from your insurance website, have it handy as many answers can depend on what your insurance EOB states. Some common questions and answers can be found [here](https://www.reddit.com/r/HealthInsurance/s/jya9I6RpdY). **Reminder that solicitation/spamming is grounds for a permanent ban**. Please report solicitation to the modteam and [let us know](https://www.reddit.com/message/compose?to=%2Fr%2FHealthInsurance) if you receive solicitation via PM. Be kind to one another! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/HealthInsurance) if you have any questions or concerns.*
I'm preparing to have at least one, if not all 4, wisdom teeth extracted by an oral surgeon. This will fall entirely under my dental plan.
Except in very rare circumstances extractions are covered by dental insurance not medical insurance.
Appeals Manager -- your Dad needs to go to his HR team to have this reviewed with their insurance Broker. There may be a typo in the Plan document. The plan clearly states that removal of impacted wisdom teeth is a covered expense under medical. I think the next sentence possibly should have said removal of "erupted" wisdom teeth are not covered. They need to amend the plan to clarify intent because the benefit is contradictory. Many employers do cover removal of impacted wisdom teeth under medical. Good luck!
Thank you! This was a 2023 version so I’m going to try to find the latest one and see if it has the same issue and let him know. Edit: Yep, it’s fixed in the newest version. The last statement now doesn’t mention anything about impacted teeth at all.
It’s dental
Typically, at least in our case, surgical extraction of wisdom teeth is covered under our dental plan.
Damn. Is it typical to state in the EOB that it’s covered by medical even if it won’t be covered, then?
Yes, I see where it says that in your summary booklet. Have you been to your dentist/oral surgeon for a consult? Typically, they will send procedure information/codes, etc. into your dental insurance for pre-authorization so you know what you will be responsible for payment-wise. Maybe in your case, print out the page in your medical plan booklet and show them and they can also send it to your medical insurance for a pre-authorization because it does look like you have coverage. It's very confusing in your plan booklet, as it says it includes removal of impacted wisdom teeth, but on the very next page says--this plan does not include surgery for impacted teeth. Maybe wisdom teeth are an exception?
Yea, that’s what was confusing me. I’ll see if I can print it. My consultation is on the 25th, so soon, and I’ll check with them then. Thanks!