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The Ontario Health Insurance Plan (OHIP) does not cover dental services performed in a dental office. Therefore, any procedure (even oral surgery) completed by your dentist will not be covered by OHIP.
OHIP doesn’t provide coverage for oral surgeries performed in any out-patient facilities. Although oral surgeons’ offices have areas resembling hospital operating rooms, the facilities of oral and maxillofacial surgeons are considered private offices.
However, some dental or oral surgeries must be performed in a hospital. For example, the surgery may be complicated by the patient’s health needs, or the patient’s health condition requires additional monitoring. When oral surgery is completed in the hospital, OHIP does cover the cost of the surgical procedure, but not the cost of any initial assessment or consultation.
Patients must attain prior approval for the oral surgery or services to be considered medically necessary, a process which can take some time. OHIP generally covers in-hospital dental surgeries such as:
• Fracture repair
• Tumour removal
• Reconstructive surgeries
• Medically necessary tooth removal
It can be challenging for patients to navigate some of the fine print, as sometimes only select portions of the procedure are covered. For example, orthognathic surgery (orthodontic surgery) is covered by OHIP, but some preliminary services may not be. Patients that have questions about whether their surgery is OHIP eligible should talk to their oral surgeon.
