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DENTAL INSURANCE:  IT’S A MISNOMER

There has always been a long and deep divide between dental care and the practice of medicine. The field of modern medicine has established its domain of the human body with one remarkable and notable exception: the mouth, and in particular, teeth. This often leads to painful consequences, and a substantial body of current scientific research has declared that oral health is the gateway to general wellness.

So just how did this split between oral and medical care come about to begin with?

The Historic Rebuff: 19th Century Drama

In 1837, Chapin Harris, a practicing physician who performed dental surgery and Horace Hayden, a dental surgeon, requested the University of Baltimore Medical School to establish a dental department with a full course of training dentists, with the belief that dentistry should be part of a formal systematic medical education. Their petition to recognize dentistry as a medical specialty was denied and this has gone down in the annals of dental history in the United States as The Historic Rebuff. In response, Drs. Harris and Hayden, now known as the Fathers of Dental Education, co-founded an independent dental school, The Baltimore College of Dental Surgery in 1840.

The rest, as they say, is history.

Early Dental Benefits

The positioning of dentistry as a separate niche of healthcare was further reinforced by the development of medical insurance in the U.S. In 1932, the Federal Committee on the Cost of Medical Care overseen by Secretary of the Interior Ray Lyman Turban advocated for public funding of comprehensive health services including dentistry.  Stiff opposition from organized medicine, however, led to the creation of modern medical insurance as a private, mostly employer-sponsored system, and it excluded dental care.

Source: New York Times, 2017

The concept of insurance for dental expenses emerged decades later. In 1954, longshoremen at the docks in California, Oregon, and Washington sought to add dental coverage as a benefit, and the first prepaid dental plans emerged from those efforts. These prepaid plans grew in popularity in the 60s and 70s, usually with a maximum benefit of $1000, and for many, those limits still exist today despite the rates of inflation over the years. Preferred Provider Organization (PPOs) were introduced in the late 80s and dominate the industry today.

Little has changed with the dental insurance industry over the decades, in spite of technological advancements and the rising costs of oral care delivery.

Why We Purchase Insurance

The purpose of insurance is to protect people from steep financial expenses if they face unexpected crises. If your home is destroyed in a storm, insurance will allow you to rebuild. Medical insurance will pay for an emergency heart surgery or appendectomy. When we purchase health, home, or auto insurance, we are insuring ourselves for catastrophic events. Yet, unlike health, home, and auto insurance, dental insurance does not cover the unexpected cost of a critical and necessary procedure today.

Dental insurance can be severely limiting, and many discover that a serious procedure can leave them with a hefty bill they will need to cover out of pocket.

Getting dental insurance is not the ideal solution for receiving good oral care either. The annual maximum is not very high and there is usually some type of deductible. Dental insurance often covers some preventative aspects of dental care, and is simply not designed to cover major and necessary dental procedures.

Dental insurance can also drive up the cost of care given the addition of administrative staff to work with insurance providers and navigate the processes that entails. Yet we contract with a traditional dental insurance company and pay hefty insurance premiums. All of this to discover that we need to pay out of pocket, even for a majority of simple services such as mouth guards to prevent TMJ.

So How Is Dental Insurance Really Insurance?

While protection from catastrophic medical expenses is perceived as a necessity, the coverage of dental services, since its inception, has been conceived as a benefit. 

So let’s tell it like it is. Dental insurance is not insurance in the traditional sense of the word. It’s good to have some benefit, but that doesn’t make it insurance.

Dental insurance is, quite simply, a prepaid specific group benefit.

A benefit that is enveloped in processes and procedures: the procedure of locating a dentist within a network, the procedure of procuring pre-approval, the procedure of filing claims, and the procedure of billing.

Why Preventive Care And Early Detection Are Important

When dental care is not included in basic health insurance packages, and must be covered out-of-pocket or as an add-on insurance cost, individuals often choose not to purchase dental coverage and only visit their dentist for emergencies.

For others, the intersection of sizable insurance premiums, confusing benefits, and a low cap on what is covered keeps many Americans from visiting a dentist’s office and enjoying regular preventative oral care.

If a small cavity is detected during a routine exam, the cost of fixing it is marginal, costing perhaps a couple hundred dollars. If that cavity is not detected early on, it will grow larger, causing pain and swelling. At this juncture however, it may require a root canal and crown, or even worse, an extraction and implant. The delay in diagnosis and treatment can quickly go from a few hundred to several thousand dollars in cost.

Preventive care in the form of regular cleanings and checkups reduces the need for serious and expensive procedures. Addressing preventable problems early on can avert bigger problems down the road; an untreated abscess can cause profound medical complications. Given oral issues are also inextricably linked to medical issues, this connection cannot be ignored.

The Costs Of Delayed Care

Dental disease such as tooth decay and gum disease, if left untreated, do not just disappear. The condition worsens over time, resulting in infection and pain, and many times it escalates outside business hours, necessitating an emergency department visit.

According to the Carequest Institute, more than 76.5 Million Americans do not have access to dental coverage. There is an unexpected medical cost to this lack of coverage. Researchers at the Texas A & M University School of Public Health found that the number of emergency room visits that arose from  preventable dental problems  cost taxpayers, hospitals, and the government about $2 billion each year.

The solution is obvious and simple: treat the mouth as a gateway to overall health and wellness. Preventive dental health care should be a part of comprehensive medical care, and regular visits with a dentist should be as important as annual physicals. 

Why Transparent Pricing Is Important

In the absence of insurance coverage for a procedure, a visit to the dentist can be costly. Patients should have the right to understand costs before they agree to a procedure. Many patients often sit down for a routine cleaning and checkup, only to find they have a problem. The dentist offers to take care of the situation right away, and the patient agrees but is hit with a shocking bill at the end of the visit. Americans today lack visibility into out of pocket costs related to their care.

Price transparency in oral care should be about making patients feel informed and empowered to make the right choices. A user-friendly tool such as an app on digital devices can play a pivotal role in delivering this information. Thoughtful technological innovation that balances high-tech and high-touch can play a crucial role in secure bidirectional flow of information between patient and provider. When the patient explores and chooses options for service and the provider selected has real time access to all information and records necessary, the results can be a wonderful thing: swift, precise and personalized care. 

All Americans deserve the right to timely, accurate and trusted information about the cost of care so they feel prepared and confident they are making the right decisions for their general health. Oral care providers should be sensitive to how patients respond to transparent pricing, negotiated rates, and potential cost savings on charges, and recognize that it is an integral part of the patient experience.

Transparency around cost and quality is critical to establishing a trusted partnership between a patient and dentist.

Given the value of a healthy smile for one’s physical, emotional, and psychological well being, all Americans deserve access to both preventive and critical oral care– one that is seamless and transparent, with easy access to quality care and which places everyone on a path to better oral health and general wellness.

Modernizing Oral Benefits

The current dental benefit landscape is outdated, mired in opaque processes and does not recognize the critical importance of oral health to general health and well being.

In the absence of significant and sweeping health reform to reunite healthcare and dentistry, employers, patients, and dentists need to converge on a common platform of stakeholders, which can only happen through technological innovation. Transforming the way oral care is rendered requires collaboration between stakeholders who have existed in historical silos, who each own small pieces of the solution. Enveloping this process with innovative technology can deliver a valuable oral care benefit that sheds cost and needless processes.

The time is ripe for change and innovation. Let’s shatter barriers to care and create a modern oral health benefit system that is infinitely more transparent, efficient, and valuable for general wellness.

SOURCES

  • https://journalofethics.ama-assn.org/article/overcoming-historical-separation-between-oral-and-general-health-care-interprofessional/2016-09
  • https://journalofethics.ama-assn.org/article/education-solutions-medical-dental-divide/2022-01
  • https://www.dentistrytoday.com/emergency-room-visits-for-dental-problems-cost-2-billion-a-year/
  • https://www.carequest.org/resource-library/snapshot-765-million-americans-without-dental-insurance
  • https://jada.ada.org/article/S0002-8177(14)60010-6/fulltext