What is Covered by OHIP?

Oral & Maxillofacial Surgeons of Ontario will sometimes admit patients to hospital where services are covered by OHIP. Which services are they?

The Ministry of Health & Long Term Care of Ontario publishes a list of services that are covered under OHIP approximately every 10 years.  In general, where an illness or disorder is being surgically corrected, and it would not normally be provided in an out-patient facility, and it would require an overnight stay in hospital then it is covered by OHIP.  For instance, large tumors of the face, facial reconstruction, and infections that require hospitalizations.

OHIP does not provide coverage if a procedure is completed in an out-patient facility such as dental implants or wisdom tooth removal which are normally completed in a private Oral & Maxillofacial Surgery office.

There are certain hybrid situations, where a person would normally have a procedure completed in an out-patient facility but their health situation demands that it be completed in hospital.  For instance, someone in long-term care with fragile health may need to be hospitalized for removal of multiple teeth.  In this case, OHIP will cover the cost of hospitalization and anaesthesia but not necessarily the teeth*.

Wisdom teeth are not a scheduled benefit from OHIP.   Where a patient’s health is too fragile to have the procedure in an out-patient facility, OHIP will cover the cost of hospitalization (‘OR time’ and any overnight stay), but not the cost of the professional services from the surgeon or the anaesthetist.

Some procedure are covered by OHIP but the ancillary services required to complete the surgery are not.  Orthognathic surgery (surgical orthodontics) for instance, is covered under OHIP but the service to prepare the surgery, creation of the surgical stents, and special x-rays are not covered.

If you have questions about whether or not your surgery is OHIP eligible speak with your Oral & Maxillofacial Surgeon.

*In some cases a person's health is fragile enough that removal of the teeth is medically necessary OHIP will provide special written approval.  These circumstances are strictly regulated by the Ministry of Health, and require written prior approval from them to cover the cost of the dental professional services.