Policy on Third-Party Reimbursement of Medical Fees Related to Sedation/General Anesthesia for Delivery of Oral Health Care Services

Policy statement

The AAPD encourages all policy makers and third-party payors to consult the AAPD in the development of benefit plans that best serve the oral health interests of infants, children, adolescents, and individuals with special health care needs.

The AAPD strongly believes that the treating dentist determines the medical necessity for sedation/general anesthesia³ consistent with accepted guidelines on sedation and general anesthesia⁹ . The AAPD strongly encourages third-party payors to:

1. recognize that sedation or general anesthesia is necessary to deliver compassionate, quality oral health care to some infants, children, adolescents, and persons with special health care needs.
2. include sedation, general anesthesia, and related facility services as benefits of health insurance without discrimination between the medical or dental nature of the procedure.
3. end denial of reimbursement for sedation, general anesthesia, and facility costs related to the delivery of oral health care.
4. regularly consult the AAPD and the ADA with respect to the development of benefit plans that best serve the oral health interests of infants, children, adolescents, and patients with special care needs.³⁸

The AAPD encourages all states to enact legislation that requires third-party payors to reimburse for facility and sedation/ general anesthesia costs associated with providing oral health care for children.