My insurance company says they cover dental anesthesia. Can you bill just them (and not me)?
Unfortunately not. Please allow me to explain.
The experience of dental anesthesiologists nationwide consistently demonstrates that insurance companies will not actually fully cover the costs of dental anesthesia regardless of whatever impression you may receive from them prior to the procedure. I understand you may have called your insurance company and been reassured with clarity that dental anesthesia is covered by your policy. However, this is virtually certainly a misunderstanding.
When you call your insurance company, the person answering the phone almost certainly is not a dentist, physician, or any other kind of healthcare provider. That individual likely does not even understand what “dental anesthesia” exactly means. The insurance company representative is usually simply doing a generic search in the company’s documents, finds verbiage indicating that “sedation” or even “anesthesia” is covered, and then proceeds to assure you that your child’s dental anesthesia will be covered by your policy.
One source of misunderstanding in this situation is that the insurance company’s policy usually is referring to things such as oral sedation or local anesthesia performed by the dentist himself or herself. That is an entirely different situation than medical general anesthesia performed by a medical doctor–an entirely different individual than the dentist performing the dental procedure. Even in the rare situations in which your health insurance company actually will pay something for dental anesthesia, the amount it will pay is entirely unpredictable.
If you would like me to submit a claim for you on your behalf to your health (medical) insurance company after the procedure, I am willing to do so. Please be aware of what I explain on this page regarding your realistic chances at receiving reimbursement from your health insurance company. Payment in full will still need to be received on the day of service.
Amos Yang, MD 