Diplomate


Member


Member

Insurance FAQ's

Will my insurance cover the anesthesia services?
Each policy varies in the type of benefits as well as the amount covered. Some policies may not have any anesthesia coverage, while others may cover anesthesia services up to 100%. To find out what your benefits allow, you must contact your insurance company. OADC staff will assist you in providing the information you might need for an insurance pre-determination.
When I file a claim, do I submit it to the medical or dental plan?
It varies. Some dental plans might give you coverage, but the total benefits amount may not be large enough to cover both the dental treatment and the anesthesia services. It is important for you to know the maximum allowable per year in your dental plan. Medical insurance policies might cover anesthesia services for dental procedures, especially in children under age 6, or due to “medical necessity” e.g. trauma, extreme anxiety, mentally challenged, autism, infection, or other reasons. Consult with your medical insurance carrier for details of your benefits.
If my medical insurance covers anesthesia only if it is done in a hospital or surgical center - is this my only option?
No. You must know the percentage of the total hospitalization fees the insurance covers. It is not unusual to have hospitalization bills ranging from $10,000.00 to $15,000.00 for same-day surgery. If the policy does not cover 100% of the bill, you may still be responsible for an amount that EXCEEDS the TOTAL office-based anesthesia fees. In many situations, if coverage is not 100% for in-hospital anesthesia services, office-based anesthesia would provide a BETTER OPTION. Some policies may cover 100% of the hospitalization bill only if the procedure is done in a specific hospital within their network. Make sure that your Dentist/Surgeon is on staff at that hospital otherwise he/she cannot provide the treatment for you or your family member there.

Remember Dental fees are always going to be separate from your Anesthesia fees

Will I have to fill out my own claims?

OADC staff will fill out all the paperwork necessary to help you file the claim. You need to specify whether you will submit the claim to Medical or Dental since the procedure codes are different and are not interchangeable. You will then receive a copy of the claim to sign and submit to your insurance provider for re-imbursement. We are committed to assist you in every way possible to provide the necessary information for your insurance needs.