Salt Lake City, UT asked in Health Care Law for Utah

Q: Does your insurance pay if you're referred from a Dr or is it special thing that insurance won't go through the Dr?

If you get referred to a dental surgeon for wisdom teeth because they are wrapped around nerves or veins, would insurance pay for it?

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1 Lawyer Answer
Tim Akpinar
Tim Akpinar
  • Little Neck, NY

A: A Utah attorney could advise best, but your question remains open for two weeks. Insurance practices are generally governed by state law. But in general nationwide, it can be a matter of demonstrating to the carrier the need for the referral based on "medical necessity." It sounds like your matter may have involved a level of complexity or risk that your dentist determined to be better suited for an oral surgeon to handle. It's difficult to answer your question "yes" or "no." It could be up to the carrier, and how well you coordinate between the offices of the dentist and the oral surgeon to present evidence that it's medically necessary for the procedure to be handled by an oral surgeon. You could ask the carrier what they would need to consider authorization, such as a letter of necessity, imaging studies, short narrative, etc. Good luck

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