Common use of Anesthesia for Dental Services Clause in Contracts

Anesthesia for Dental Services. We cover general anesthesia and associated hospital or ambulatory surgical center Services for dental care provided to Members: • Who are 7 years of age or younger or are developmentally disabled; • For whom a successful result cannot be expected from dental care provided under local anesthesia because of a physical, intellectual, or other medically compromising condition; and • For whom a superior result can be expected from dental care provided under general anesthesia; or • Who are 17 years of age or younger who is extremely uncooperative, fearful, or uncommunicative with dental needs of such magnitude that treatment should not be delayed or deferred; and • Whom a lack of treatment can be expected to result in oral pain, infection, loss of teeth, or other increased oral or dental morbidity; or • For adults age 17 and older when the Member’s medical condition requires that dental service be performed in a hospital or ambulatory surgical center for the safety of the Member (e.g., heart disease and hemophilia). General anesthesia and associated hospital and ambulatory surgical center charges will be covered only for dental care that is provided by: • A fully accredited specialist in pediatric dentistry; or • A fully accredited specialist in oral and maxillofacial surgery; and • For whom hospital privileges has been granted. Anesthesia for Dental Services Exclusions: • The dentist’s or specialist’s professional Services. • Anesthesia and related facility charges for dental care for temporomandibular joint (TMJ) disorders.

Anesthesia for Dental Services. We cover general anesthesia and associated hospital or ambulatory surgical center Services for dental care provided to Members: •  Who are 7 years of age or younger or are developmentally disabled; •  For whom a successful result cannot be expected from dental care provided under local anesthesia because of a physical, intellectual, or other medically compromising condition; and •  For whom a superior result can be expected from dental care provided under general anesthesia; or •  Who are 17 years of age or younger who is extremely uncooperative, fearful, or uncommunicative with dental needs of such magnitude that treatment should not be delayed or deferred; and •  Whom a lack of treatment can be expected to result in oral pain, infection, loss of teeth, or other increased oral or dental morbidity; or •  For adults age 17 and older when the Member’s medical condition requires that dental service be performed in a hospital or ambulatory surgical center for the safety of the Member (e.g., heart disease and hemophilia). General anesthesia and associated hospital and ambulatory surgical center charges will be covered only for dental care that is provided by: •  A fully accredited specialist in pediatric dentistry; or •  A fully accredited specialist in oral and maxillofacial surgery; and •  For whom hospital privileges has been granted. Anesthesia for Dental Services Exclusions: •  The dentist’s or specialist’s professional Services. •  Anesthesia and related facility charges for dental care for temporomandibular joint (TMJ) disorders.