Health Insurance Waiting Period

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I have 4x partially erupted impacted wisdom teeth. My health insurance policy covers 50% of routine dental fees. Based on reading threads on here, I think that consultations for wisdom teeth removal would fall into this category, but I will have 100% coverage for the operation as it will need to take place in a hospital and not a regular dental practice. Is this assumption correct?

My main concern is the waiting period of 5 years. As this is my first health insurance policy, does this mean that I must wait 5 years as the impacted wisdom teeth pre-date the inception of the policy earlier this year?

Oral Surgeon

Dante Colossal Notch wrote: »

I have 4x partially erupted impacted wisdom teeth. My health insurance policy covers 50% of routine dental fees. Based on reading threads on here, I think that consultations for wisdom teeth removal would fall into this category, but I will have 100% coverage for the operation as it will need to take place in a hospital and not a regular dental practice. Is this assumption correct?

My main concern is the waiting period of 5 years. As this is my first health insurance policy, does this mean that I must wait 5 years as the impacted wisdom teeth pre-date the inception of the policy earlier this year?

Having four partially erupted teeth in itself is not a "pre-existing condition".
It is only considered a "pre-existing condition" (requiring a 5 year wait) if they were either causing you problems prior to being insured or if you were told by a dentist/oral surgeon that they needed removal prior to being insured....

Tons of people have impacted wisdom teeth, just having them prior to insurance does not exclude you from cover.... You would wait 6 month before the cover for this kicks in though...

This is not routine dental care so that side of things won't help...
Regular medical insurance plans cover the removal of impacted teeth (not all teeth- just impacted/ partially erupted ones). The insurance code for this is 2981. There is no requirement to have this done in a hospital to be covered- I preform thousands of procedures per year through insurance in my private clinic.
Private clinics, private hospitals or public hospitals may charge a day case or technical charge to you in the region of €100-€200 or so.... in addition to what the medical insurance company may pay them. Private consultations and xrays are extra too (€150 approx) and may or may not be reimbursed to you by your insurer depending on your plan.....

The history of your case is important as waiting 5 years is likely not in your best interests and you may be covered sooner....

at9qu5vp0wcix7

Oral Surgeon wrote: »

Having four partially erupted teeth in itself is not a "pre-existing condition".
It is only considered a "pre-existing condition" (requiring a 5 year wait) if they were either causing you problems prior to being insured or if you were told by a dentist/oral surgeon that they needed removal prior to being insured....

Tons of people have impacted wisdom teeth, just having them prior to insurance does not exclude you from cover.... You would wait 6 month before the cover for this kicks in though...

This is not routine dental care so that side of things won't help...
Regular medical insurance plans cover the removal of impacted teeth (not all teeth- just impacted/ partially erupted ones). The insurance code for this is 2981. There is no requirement to have this done in a hospital to be covered- I preform thousands of procedures per year through insurance in my private clinic.
Private clinics, private hospitals or public hospitals may charge a day case or technical charge to you in the region of €100-€200 or so.... in addition to what the medical insurance company may pay them. Private consultations and xrays are extra too (€150 approx) and may or may not be reimbursed to you by your insurer depending on your plan.....

The history of your case is important as waiting 5 years is likely not in your best interests and you may be covered sooner....

Thank you for the detailed response. It may be possible that I was told as a teenager that they must be removed - would a dental consultant be able to verify if this is the case? Ultimately, who makes the call if it is considered to be pre-existing?

Oral Surgeon

Dante Colossal Notch wrote: »

Thank you for the detailed response. It may be possible that I was told as a teenager that they must be removed - would a dental consultant be able to verify if this is the case? Ultimately, who makes the call if it is considered to be pre-existing?

Yeah I often say to 15 year olds that the wisdom teeth look a bit off angle and that they may need removal in future.... The key words here are MAY NEED REMOVAL. That is not a firm diagnosis or history of illness...

If you see an oral surgeon who is percertified to provide these treatments, he/she will determine if the treatment is needed. they will ask when you first had issues or were first aware of the need to remove. A vague recollection of a dentist commenting on them does not count. Provided you had insurance before the knowledge (or recorded knowledge) of needing them removed then you should be covered. There is an initial 6 month period between taking insurance and having treatment you can have the consultation in this time though.
The oral surgeon will give you the codes to check with your insurer and they will confirm that you are covered...
Once treatment is complete, the insurer pays the oral surgeon.

All of this is open to audit by the insurance company and they can request the oral surgeons records, your general dentist records and the referral letter to see if this was a pre existing and known about condition. Provided there is none of the above all should be ok....