Will dental and oral surgery be covered by my private health insurance?
Dental and oral surgery is performed by certified dentists or oral surgery specialists in a private practice or hospital. This difference determines how much you’ll pay and any benefits you receive.
What benefits will I receive from my health fund?
You can expect to receive benefits towards your oral surgery procedure, based on the type of cover you have. Here’s an example of whether you are eligible for any benefits, pending your cover.
|Hospital Accommodation and Theatre Fees||Anaesthetist Fees and Other Medical Fees||Dental Fees from a General Dentist or Oral Surgery Specialist|
|Hospital Policy Only||Yes||Yes||No|
|General Treatment Policy Only||No||No||Yes|
|Hospital & General Treatment Policy||Yes||Yes||Yes|
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If you’re admitted to hospital to have any teeth removed under general anaesthetic, by an oral surgery specialist or general dentist, this will be considered an inpatient service, and you’ll need to have both Hospital and General Treatment (Extras) cover to receive maximum benefits. If you don’t have General Treatment cover and your teeth are removed as an outpatient, you’ll miss out on a benefit from your fund.
Find out more about Health Insurance for Dental and Oral Surgery
I’m having my wisdom teeth surgically extracted in the operator's private rooms as an outpatient. Am I covered?
Being an outpatient impacts your cost because your health fund may pay dental benefits under your General Treatment (Extras) cover, provided your level of cover includes benefits for tooth extraction. Any differences between the benefit amount paid by the fund and the fee quoted by your dentist or specialist will be at your own expense.
Surgically extracted teeth and your cover
If you have your teeth extracted, the procedure is usually considered to be major dental treatment, and you’ll need the correct cover to receive benefits. In some cases, a health fund may consider this to be General Dental (Extras) treatment and benefits will be paid.
Major Dental treatment usually has a waiting period of 12 months or more while General Dental treatment is 2 to 6 months.
What benefits am I entitled to for the cost of the general dentist’s or oral surgery specialist’s fees?
If you visit your dentist or oral surgery specialist and pay a General Treatment (Extras) cover, your respective health fund will pay certain benefits to you - given it includes surgical tooth extraction.
If your policy doesn’t cover the surgery and you go ahead with an operation in hospital, you’ll pay the full hospital fee, plus 25% of the Medicare schedule fee. You’ll also pay anything above the schedule fee for the costs of an anaesthetist.
What about the anaesthetist’s fees?
If you have appropriate Hospital cover, your fund will pay benefits towards the costs of the anaesthetist. Generally, you will receive 75% of the Medicare Schedule Fee from Medicare and the remaining 25% will be paid by your health fund.
If your anaesthetist charges above the Medicare Schedule Fee, you will need to pay what is called a gap, or the out of pocket amount toward those fees. Your general dentist or oral surgery specialist may be able to give you an indication of what the gap amount for the anaesthetist will be.
Before you go ahead with your hospital treatment you need to contact your health fund to confirm your level of cover. This will determine if there are any extra costs associated with your procedure, because not all hospital policies will cover all types of dental and oral surgery.
If your hospital policy doesn’t cover the type of surgery you need, then you should speak to your dentist or specialist about other options. If you don’t do this, you’ll be slapped with the full fee for the surgery, plus 25% of the Medicare schedule fee.
The cost of dental surgery in Australia is extremely expensive and for many of us on tight wages and mounting day-to-day expenses it can be more than difficult to find finances to pay for the medical procedure. Without adequate private health insurance policies, you will be out of pocket for the majority of the costs, because Medicare doesn’t cover a lot for dental work.
The average cost of having your wisdom tooth removed is between $130-$200 per tooth. This is for a basic extraction and can be performed by your dentist at their local clinic. A complex removal is $295-$400 per tooth. This is if you need a local anaesthetic in the chair. These situations will require a specialised wisdom tooth dentist. If you need sedatives or general anesthesia, then you would need to visit an oral surgeon. This can cost between $1500 to $3000.
Before you can start claiming benefits for your treatment, you must be in your fund for a set period of time. This is called a ‘waiting period’, and protects customers of the fund from people who look to join to claim for a policy before leaving soon after. This increases costs for people in that particular fund.
Here’s a list of industry standard waiting periods that you could experience for your Dental and Oral treatments.
- Major Dental. This is for specialist dentistry, which includes procedures like getting a crown or denture.
- Extraction of wisdom teeth by an oral surgeon.
- Periodontic surgical treatment. This is for procedures like root therapy and endodontic services.
There are a range of aspects that will impact the cost of your surgical procedure. These are:
- The type of extraction needed. Badly damaged teeth usually cost more to remove because they will need surgery. Simple extractions cost less.
- What your dentist chooses to charge. This is a major factor because it is up to your dentist to charge you what he feels fit.
- Do you need an oral surgeon. This will be far more expensive because a surgeon will require staff like nurses and could use anaesthetic.
- Do you have dental health insurance. if you have suitable cover you could receive benefits and your cost will be much less.
- Where do you live. Cost will vary depending on the state you receive treatment, which city you reside in and can also differ between metropolitan and rural areas where specialists are harder to come by, or demand is high.