Aetna Oral Surgery Center of Excellence

To check coverage or get more information, call Aetna at 1-800-531-7895 (TTY: 711).

Sometimes, it’s confusing to know whether oral surgery procedures fall under your dental or medical benefits. No need to worry — we’re here to help you figure it all out. Oral and maxillofacial surgery (oral surgery) is a branch of dental medicine. It provides surgical treatment for diseases, disorders, deformities and injuries to the bones of the face, jaw, teeth and mouth.

Dental: Any surgical procedure that’s directly related to the teeth.

Medical: Any surgical procedure that’s directly related to:

• The treatment of disease of the facial bones

• Trauma to the soft and hard tissue structures of the face and oral cavity

• The treatment of temporomandibular joint disorder (TMJ)

• The correction of facial abnormalities that were present at birth (congenital) or developed later

• How do I know if my medical or dental plan covers oral surgery?

  • This depends on the procedures involved and your benefits plan. There are many different ways that oral surgery can be covered. So it’s a good idea to get an estimate before any procedure.

• Where can my health professional and I find a list of the oral surgery procedure codes that are “dental in nature” and “medical in nature”?

  • You can find information at aetnadental.com. Select “Aetna Dental FAQs.” Or toggle back to “Claims information” and choose “Understanding oral surgery benefits.”

• Do I have to get treatment from an oral surgeon, or can my general dentist provide the services I need?

  • Under certain plans, an oral surgeon or a licensed general dentist may provide services. First, find out if your medical or dental plan covers the services. Then, get treatment from the appropriate professional.

    Keep in mind that going to network providers may help lower your costs.

• How will you pay my oral surgery claim if my health care professional is in both networks?

  • Aetna will pay under the plan in which we consider the oral surgery procedure a covered service.

• Can I go to a network dental specialist even if my procedures are payable under my medical plan?

  • Yes, for certain medical plans. Your network dentist’s contracted rates will apply, subject to medical coinsurance or copays.

• Are surgical extractions, like removal of impacted teeth, covered under my dental plan?

  • Aetna typically cover these procedures under our medical plans, including HMO. (HMO covers bony impactions only). But based on your benefits plan, you may have coverage under your dental plan, if no medical benefits are available.