No matter if it’s sharp and sudden or dull and constant, tooth pain is hard to ignore. It’s also often worrisome, as you wonder how much it will cost to fix the problem. The thing is, curing a toothache can be as simple as switching to a toothpaste for sensitive teeth, but it can also be much more serious and require oral surgery.

Oral and maxillofacial surgery treats complex dental problems and medical conditions related to the mouth, teeth, jaws and face. Just as the causes of tooth pain vary, so do oral and maxillofacial surgeries — from jawbone surgery, wisdom tooth extractions and dental implants to facial reconstructive and trauma surgeries.

If you’re facing oral surgery, before you proceed medically, it’s a good idea to review your Oral Surgery benefits on page 115 of the  2024 Plan Document.  The benefits apply to procedures such as impacted teeth/wisdom teeth or cutting procedures on the gums and mouth tissue. You’ll also want to review How to Maximize Oral Surgery Benefits and Coverage, so you make the most of your available coverage.

To receive your full benefits, your oral surgeon must be in-network with Delta Dental’s PPO or Premier network, since you automatically have access to both with the coverage provided by your agency. The difference between the two networks is in the deductible: PPO deductibles are $25/$75 and Premier deductibles are $50/$150.

You can find a Summary of Dental Benefits on page 22 of the Delta Dental Benefits Booklet. NOTE: Not all plans include Orthodontia Benefits, so check with your Health Benefits Coordinator if you’re not sure.

Follow the guidelines below when using your HMO or PPO oral surgery benefits.

HMO

• Request a referral for oral surgery through your Primary Care Physician medical group.
• Check that the referred oral surgeon is in-network with Delta Dental.
• Consult with your oral surgeon and request a predetermination of benefits from both Blue Cross and Blue Shield of Illinois (BCBSIL) HMO and Delta Dental.
• Review the predetermination with your oral surgeon to determine which benefit covers your claim and what your out-of-pocket cost will be.

PPO

• Choose a Delta Dental  in-network oral surgeon that’s also in-network with your BCBSIL PPO.
• Consult with your oral surgeon and request a predetermination of benefits from both BCBSIL and Delta Dental.
• Review the predetermination with your oral surgeon to determine which benefit covers your claim and what your out-of-pocket cost will be.

For questions about your oral surgery benefits, call PDRMA’s Health Program Team at 630.435.8998.