Claiming for wisdom teeth removal
Has your healthcare provider recommended that your wisdom teeth need to be removed? Whether your teeth are removed at the dentist or in hospital, together with your level of cover, will determine what you can claim with your health insurance and any possible out-of-pocket costs you may have.
We’ve put together an easy-to-follow guide and some frequently asked questions to explain how wisdom teeth removal is claimed with private health insurance.
How does wisdom teeth removal differ to other in hospital (inpatient) procedures?
The difference between wisdom teeth removal and other inpatient procedures is that the costs charged by your surgeon are claimed under your extras cover, even though the services are performed in a hospital.
Extras cover, also known ancillary cover, covers healthcare services that are provided outside of hospital, which Medicare doesn’t usually cover. These include items such as dental, optical and physio.
On our Total Extras and Essential Extras policies, a fixed benefit is paid per tooth removed, up to your general dental annual limit.
This means if you only have hospital cover, you can claim for hospital services including accommodation, theatre fees and anaesthetist fees, but you are unable to claim for your surgeon’s costs.
How much should I expect to pay and how much will I get back?
Whether your wisdom teeth are removed at the dentist (outpatient) or in hospital (inpatient), the way the procedure is billed will determine your benefits and any out-of-pocket costs.
Preventing unexpected costs
Members may be surprised by out-of-pocket costs if fees charged by their surgeon or dentist are billed under Medicare Benefits Schedule (MBS) item numbers instead of Australian Schedule of Dental Services and Glossary (ADA) item numbers.
To avoid unexpected costs, it’s important to call us before your procedure. By providing us with the item numbers from your dentist or surgeon, we can confirm:
• the out-of-pocket costs you may need to pay,
• the benefit you can expect to get back from Doctors’ Health Fund, and
• whether waiting periods apply.
If you choose to have your procedure in hospital (inpatient), we recommend checking if Doctors’ Health Fund has an agreement with your preferred hospital, which you can do online here, or during your phone call with us. If we don’t have an agreement, you are more likely to incur out-of-pocket costs.
Do waiting periods for wisdom teeth removal apply?
If you’re new to health insurance, or didn’t have prior cover for wisdom teeth removal, a two-month waiting period for teeth extraction, and a two-month waiting period for any inpatient hospital services (i.e. accommodation, theatre fees and anaesthetist) applies. However, if the condition is classed as pre-existing, a 12-month waiting period will apply.
You only need to wait two months for the extraction because it is a general dental service covered by extras cover. This is regardless of whether your teeth are removed in hospital by a surgeon, or at the dentist.
If your teeth are removed in a dental surgery, additional services such as the administration of anaesthesia or sedation can receive a fixed benefit under extras cover. These services therefore have a two-month waiting period.
Why aren’t services provided by oral or maxillofacial surgeons covered by my hospital policy?
This is because the MBS doesn’t pay benefits towards the extraction of teeth in hospital. To allow for patients to claim something back with extras cover, oral and maxillofacial surgeons bill their services according to the ADA instead of the MBS. Common item numbers for wisdom teeth removal under the ADA schedule include 322 and 324 (‘Surgical Extractions’).
If you have your wisdom teeth removed by your dentist, we recommend you ask if your dentist can bill their services under ADA item numbers instead of MBS item numbers, so you can claim the benefit under your extras cover.
Can I choose whether to get my teeth removed in hospital (inpatient) or in a dental clinic (outpatient)?
Yes, however this is a decision that needs to be made in consultation with your healthcare providers. It is often determined by the complexity of your treatment and whether the removal can be performed by a dentist or surgeon.
How do I make a claim?
To claim extras benefits (your surgeon’s or dentist’s invoice), please submit a photo of your invoice through our Doctors’ Health Fund app, via Online Member Services or email us, and we’ll get your benefits processed and paid to you in the business days that follow.
In most cases, we will receive the invoices for your hospital stay directly from the hospital and anaesthetist. If applicable, you will pay any out-of-pocket costs to these providers separately.
Note: This article is correct and up to date as at 5 May 2026.
Private health insurance products are issued by The Doctors’ Health Fund Pty Limited, (ACN 001 417 527). Cover is subject to the terms and conditions (including waiting periods, limitations and exclusions) of the individual policy, available at www.doctorshealthfund.com.au/our-cover.
