The Reason Your Dental Work Isn&x27t Covered by Medical Insurance
I recently went to the dentist for a toothache. took some x-rays, took a quick look at my mouth, said it looked like my tooth was chipped (probably from my severe tmj) and would need a root canal. he sent me to an endodontist. the endodontist discovered that he had a strange mass in his jaw that seemed unrelated to the broken tooth. he prescribed antibiotics to prevent infection and referred me to an oral surgeon, who confirmed the mass was harmless. now I go back to the endodontist for the root canal and then to the dentist for the crown. I have spent over $500 and about eight hours in dental chairs to get this far. it will be thousands of dollars more and dozens more hours before I solve this problem. none of that is covered by health insurance.
I should have gotten dental insurance, right? That’s what I kept telling myself, until I actually researched the dental plans I qualify for (more on that in a bit). but the real question here: why doesn’t health insurance cover dental care? The same can be asked of your eyesight, but at least there if you have a serious eye problem (such as glaucoma or cataracts) you go to the ophthalmologist, who is covered by a doctor. that’s not the case with dental.
Reading: Why isn’t dental part of health insurance
The division between dental and medical makes little sense since “oral health is directly related to general health,” says dr. Gary Glassman, an endodontist based in Toronto, Canada, who also practices in the United States. “The oral cavity is a gateway to your body. many things in the mouth can indicate kidney disease, heart disease, diabetes, hpv, cancer, etc. your dentist can be your first line of defense.”
the barbaric history of dentistry
Despite being a clearly medical problem, oral health has always been an outlier. Until the 1800s, dentistry was the domain of barbershops, practiced in the same chair, and usually by the same guy who shaved your beard.
“How would you feel if you went to your hairdresser and had a tooth pulled or an abscess pierced?” asks dr. glazier.
It’s such a strange and frightening image that it’s almost comical, but the story of our teeth and jaws being treated as incidental as our hair and nails still haunts us.
“Dentistry has always had a disconnect with medicine,” says dr. michael tischler, specialist in reconstructive dentistry and editor of implants for dentistry today. “In 1840 dentistry was proposed as a medical specialty to the University of Maryland at Baltimore and was rejected.”
It is possible that since then we have evolved a lot in the way we consider and understand dentistry, but we have not adopted it as a primarily medical problem; if we did, it would be covered by health insurance, or at least things like a root canal would be, because if you need a root canal and you don’t get it, you could end up with all kinds of lethal problems that lead to hospitalization. Queen Elizabeth is rumored to have died of blood poisoning as a result of an untreated dental infection. that was a long time ago, but hey, it happens.
why is a health problem not so serious that it can be fatal and not considered medical? To some extent, it’s because it’s not that common to end up in the hospital as a result of a dental or gum problem, not if you keep up with preventive dental care.
the insurance risk game
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“the reason dental is separate from medical is that the nature of the risk is fundamentally different, as is the deferral of care,” says dr. adam c. Powell, president of Payer+Provider Syndicate, a management advisory and operational consulting firm focused on the managed care and health care industries. “If you’re having a heart attack, you’ll go to the emergency room right away. dental problems can often wait and sadly they often do. the problem can get worse, but it is often not necessarily life-threatening.”
Yes, dental problems usually wait. mine is waiting until my next paycheck (or three). But the argument that dental problems are less serious than “medical” ones doesn’t quite hold water, not when you look at the number of ER visits that tooth-related problems represent.
“More than 800,000 annual emergency room visits stem from preventable dental problems,” says Dr. Allena Willis Kennerly, Orthodontist. dr Glassman adds that this year alone, 50,000 people will be diagnosed with oral cancer, adding that “probably 10,000 of those people will die, but these are things that, if caught very early, can be better treated, before they spread.” and metastasize.”
dental insurance is like ‘triple a for your mouth’
Now, let’s say you have dental insurance. that is certainly more favorable than the alternative, but it is not ideal. if you have a serious procedure, you will likely still have a hefty bill.
“dental insurance, unlike medical, is unregulated and tends to be very limited,” says powell. “The annual maximum benefit isn’t that high, and there’s usually some sort of deductible.”
and it’s a relatively new type of insurance, with dr. bobbi stanley, dentist, noting that it was first introduced about 60 years ago. “dental work was a fee-for-service arrangement until the mid-1950s when dental insurance was introduced in california,” says dr. stanley “[the plans] grew in popularity throughout the 1960s and had a rebate of about $1,000.”
Inflation may have catapulted the value of the dollar for decades, but the dental insurance reimbursement rate hasn’t budged much. “Most dental insurance companies have a [annual] maximum of $1,500.00,” says dr. anil dwivedi, general dentist specializing in anesthesiology.
Clearly, the purpose of dental insurance is not to cover serious problems, but to prevent them by encouraging regular maintenance. dr Powell likens dental plans to “triple the benefits for your mouth,” noting that “it’s not like [catastrophe] car insurance, but it does include some free oil changes.”
A few oil changes can go a long way (to stick to Powell’s disturbingly accurate analogy), and preventative care has a terrifyingly positive impact on oral health. but it does not avoid all problems. take me for example. I need a root canal because I broke a tooth from clenching and grinding, even though I wear a $600 bite guard at night (made for me by a dentist when I had dental insurance and was not covered by my dental insurance). Problems like mine are obviously not that rare.
“Unfortunately, we see extreme situations like this all the time,” says Dr. tischler “so even though i preach prevention, prevention, prevention, it will not save you from serious dental emergencies. And that’s compounded by the fact that while dental insurance will cover preventive aspects of dental care, it doesn’t always cover major dental procedures for adults. this is something that people should take into account from a financial planning point of view.”
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dr. powell says one of the main reasons dental plans tend to be so minimal in what they cover is because people don’t want to pay higher premiums.
“If [dental plans] were more inclusive, that could be a problem because the premiums would be higher, and if the premiums were higher, the plans would be less attractive to people,” Powell says. “I buy the dental plan because it has a good rate and is cheaper than paying out of pocket. if it started covering these high claims, it wouldn’t be a $400 a year dental plan, it would be a $700 a year plan, and then I wouldn’t buy it.”
the case for merging medical and dental services
Many people still don’t buy dental insurance, even though many plans cost less than a Netflix subscription. no judgement, folks, i’m in the same camp.
“about 74 million Americans did not have dental coverage in 2016,” says dr. tischler “the dental uninsured rate has increased about four times the rate of uninsured people, even with dental coverage expansions. In part, this is due to the lack of dental coverage in traditional Medicare. Those 65 and older can still have coverage through an employer, can purchase individual dental coverage, or get dental coverage as a supplemental benefit through a Medicare Advantage plan; however, only 52.9% reported having dental coverage in the 2016 nadp consumer survey, while nearly 100% of seniors have medical coverage with medicare.”
Interest in dental insurance doesn’t look like it will pick up in 2017, but one day we may not have to worry about it. there is a glimmer of hope that dental services will eventually be covered by medical services in the future.
“It’s widely accepted that dental and medical services are separate, but the gap is closing as we go,” says glassman. “Dentists are trying to bridge the gap between dentistry and medicine because we are doctors of oral medicine.”
There is also mounting evidence that the health industry could benefit from covering dentistry as part of health care. consider those 800,000 emergency room visits per year for dental problems. Wouldn’t more people get preventive dental care if it was covered by their health insurance? Couldn’t health insurance companies ultimately save lots of money on emergency care if the problem were nipped in the bud for free?
dr. glassman certainly thinks so.
“It would be cheaper if health insurance included basic dentistry,” says dr. glazier “would not only save many lives, it would also save a lot of money.”
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