Oral surgeon - OHIP

[bubsicac]

Hello
I have been told i need to see an oral surgeon.
I also was told OHIP does not cover the cost and then i heard OHIP does cover.
Please can you tell me the correct answer so i can proceed.
With thanks

[SettlementOrgMod]

Hi there,

Thank you for sharing your question and situation with us, we appreciate your interest in this information.

You may find helpful information in the Settlement.Org article, does OHIP cover dental services?

OHIP may cover some dental surgery if it is at a hospital. Some dental surgeries need to be performed in a hospital because they are complex or you have a medical condition that needs monitoring during the procedure.
Dental care under OHIP is limited to oral surgery performed in a hospital and limited situations such as:

• fracture repair after an accident- tumour or cyst removal- surgeries correcting congenital issues- medically necessary tooth removal (prior approval by OHIP is required)
  Many employers and unions offer dental plans as part of a benefits package, but you can also buy an individual or family plan on your own. Dental plans help to pay for dental procedures such as cleaning teeth and gums, x-rays, filling cavities and removing wisdom teeth.

According to the Ontario Society of Oral and Maxillofacial Surgeons,

Oral & Maxillofacial Surgeons of Ontario will sometimes admit patients to hospital where services are covered by OHIP. Which services are they?

The Ministry of Health & Long Term Care of Ontario publishes a list of services that are covered under OHIP approximately every 10 years. In general, where an illness or disorder is being surgically corrected, and it would not normally be provided in an out-patient facility, and it would require an overnight stay in hospital then it is covered by OHIP. For instance, large tumors of the face, facial reconstruction, and infections that require hospitalizations.

OHIP does not provide coverage if a procedure is completed in an out-patient facility such as dental implants or wisdom tooth removal which are normally completed in a private Oral & Maxillofacial Surgery office.

There are certain hybrid situations, where a person would normally have a procedure completed in an out-patient facility but their health situation demands that it be completed in hospital. For instance, someone in long-term care with fragile health may need to be hospitalized for removal of multiple teeth. In this case, OHIP will cover the cost of hospitalization and anaesthesia but not necessarily the teeth*.

Wisdom teeth are not a scheduled benefit from OHIP. Where a patient’s health is too fragile to have the procedure in an out-patient facility, OHIP will cover the cost of hospitalization (‘OR time’ and any overnight stay), but not the cost of the professional services from the surgeon or the anaesthetist.

Some procedure are covered by OHIP but the ancillary services required to complete the surgery are not. Orthognathic surgery (surgical orthodontics) for instance, is covered under OHIP but the service to prepare the surgery, creation of the surgical stents, and special x-rays are not covered.

If you have questions about whether or not your surgery is OHIP eligible speak with your Oral & Maxillofacial Surgeon.

*In some cases a person’s health is fragile enough that removal of the teeth is medically necessary OHIP will provide special written approval. These circumstances are strictly regulated by the Ministry of Health, and require written prior approval from them to cover the cost of the dental professional services.

It may be best to contact the Ministry of Health and Long-Term Care for some information specific to your situation.

You can find some contact information here:

http://www.health.gov.on.ca/en/common/

Call ServiceOntario, INFOline at:
1-866-532-3161 (Toll-free)
In Toronto, (416) 314-5518
TTY 1-800-387-5559.
In Toronto, TTY 416-327-4282

Hours of operation: Monday to Friday, 8:30am - 5:00pm

If you find that this service is not covered, you may also find some helpful information in our Settlement.Org Where can I get dental care if I don’t have insurance? article. You can find more information on finding a dentist here as well.

Feel free to connect with 211 for a referral to low-cost/community (or urgent-care) dental services in Ontario. 211 Ontario is a free, confidential service. Their phone service is available 24 hours a day, 365 days a year. Here is a link to their live chat if you prefer to communicate online. Their live chat service is available Monday to Friday from 7am-9pm ET.

We hope this information is helpful. If you have any additional questions, please feel free to post them here.

Your Settlement.Org Team

[alexcray]

@bubsicac

Hello
I have been told i need to see an oral surgeon.
I also was told OHIP does not cover the cost and then i heard OHIP does cover.
Please can you tell me the correct answer so i can proceed.
With thanks

Hello,
I understand your concern about whether OHIP covers the cost of seeing an oral surgeon. Generally, OHIP (Ontario Health Insurance Plan) does not cover dental treatments or procedures unless they are performed in a hospital setting and are deemed medically necessary due to a serious medical condition.
However, there may be exceptions or specific circumstances where OHIP may provide coverage for oral surgery. It’s best to consult with your oral surgeon’s office or contact OHIP directly to inquire about coverage for your specific situation. They will be able to provide you with accurate information and guidance on how to proceed with your oral surgery.
I hope this helps, and I wish you the best with your upcoming appointment.