Definition of Sound Natural Teeth and Gums
Posted 07/27/11

Effective October 1, 2011, HealthChoice and DOC are adopting the following definition of “sound natural teeth and gums” when the phrase is used in the context of a dental accident:

1. Teeth and gums were in “sound” condition prior to the accident and;
2. Medically necessary treatment is a direct result of the accident itself; in other words, had an accident not occurred, treatment would not be indicated.

The definition does not necessarily mean the teeth and gums were free of caries, inflammation, etc., prior to an accident, only that the specific nature of the post-accident treatment is a direct, primary result of the accident.

Questions should be directed to Provider Relations at 1-405-717-8790 or toll-free 1-800-543-6044. Send email inquiries to oseegibproviderrelations@sib.ok.gov.

DOC Network Providers should direct questions to DOC Provider Relations at 1-405-717-8750, toll-free 1-866-573-8462, or email DOCProviderRelations@sib.ok.gov.