The Sacramento Dentistry Group is pleased to bring our Guardian Insurance patients the information that wisdom teeth extractions are now once again automatically covered for sedation or general anesthesia, if your dentist deems it necessary. When dealing with impacted teeth, the availability of some form of sedation is best for the patient, as the procedure is much more complicated than simply “pulling” a tooth. Therefore, this change back to a preferred practice is beneficial for our clients and their families.
Why the Policy Change?
According to the American Dental Association, at some point the executives at Guardian decided that all claims for the use of sedation or anesthesia during third molar extractions would be reviewed for “medical necessity.” This meant that Guardian might pay for all or part of a patient’s sedation, or they might not pay for any of it, depending on whether Guardian decided that it was medically necessary. The only problem with this position is the difficulty in describing a patient’s mental state via an x-ray! Dental office anxiety is a major reason why people delay important oral procedures and should certainly be considered as a basis for administering anesthesia or sedation, not just the relative difficulty of extracting a molar.
Recently, Guardian backtracked on this conservative position. To quote one of their assistant vice presidents: “Soon after that change was implemented, the feedback we received from our customers and professional community was that the new medical necessity review process did not align with customer expectations.”
It’s good to see an insurance company responding to customer and dentist complaints! If you use Guardian dental insurance and have held back on wisdom teeth extraction because you thought your sedation might not be paid for, please contact the Sacramento Dentistry Group to schedule your treatment immediately. Based on our diagnosis, we can once again speak with confidence regarding the ability of your insurance to pay for the procedure.