Dental Coverage for Children Not Covering Costs – Story

A few weeks ago my daughter’s dentist told us the enivitable had come about. Rachel’s wisdom teeth were erupting and beginning to crowd her teeth. They had to come out. They gave us a referral to an oral surgeon and told us to do it sooner than later.

I knew the procedure is not cheap, but I also knew that under the ACA, dental is covered for children. I checked our regular dental coverage and noted that we only get cleanings covered, so I checked my daughter’s healthcare to see what was covered for dental. Carefirst’s website showed that oral surgery is covered under her Healthy Blue plan.

I called to check on the exact coverage. The first guy didn’t know what he was talking about and said there was no dental. I knew that was not true. I called again a few days later and was told exactly what I thought, Rachel would be covered! The plan paid 80% after a $25 deductible. Meanwhile, however, the oral surgeon called and was told no coverage. We were told we would have to pay 2800 out of pocket.

I knew this was not accurate and called carefirst a third time. They had not checked the box for coverage. I guess they forgot the law. Rachel has dental coverage on her healthcare plan until the end of the year when she turns 19. We will NOT be paying 2800 for her wisdom teeth.

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I just came back the Ortho surgeon and they say I am responsible for the wisdom teeth removal on my 16 year old and the dental that is covered does not apply to wisdom teeth removal. I am going to check into it further, thanks to your story.


Dental doesn’t work the same way medical does, even child dental. Your plan covers it’s share of costs up to a maximum amount and then you pay the rest. If the insurance isn’t paying anything at all this is something that should be appealed and fought. Don’t give up until you understand what is going on and your plan has lived up to what it has promised.

If it is paying, but you are noticing the amounts are underwhelming then you have experienced what many others have… dental insurance cost sharing really can be underwhelming when it comes to oral surgery.

It would be really cool if we could treat dental and vision like medical insurance and part of overall health.


Actually, dental is covered under ACA for children until they are 19. That is why we won’t have $2800 for our daughter’s oral surgery.

Cleanings, and preventative are free, filings and other procedures will cost, probably 80/20 which is pretty standard for most dental plans. This is all under your healthcare.

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