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Dental Insurance Leaves Consumers With A Financial Cavity

Wednesday, September 29, 2010 at 5:01 AM

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For those in need of any major dental work, there's often a pain that lingers long after the Novocain wears off - the cost. All too often, the most severe pinch one feels after a visit to the dentist is financial rather than physical. In this installment of our special series…Watch Your Mouth, ideastream® health reporter Gretchen Cuda, peers into her past to explain the mysteries of dental insurance.

I’ll never forget my first foray into dental debt.  After a routine cleaning, my dentist suggested replacing four silver fillings in my molars that I had had since childhood.  I wasn’t in any pain, but since I was already in my late twenties, I figured …it was probably a good idea, and after --all I had insurance

Three root canals, and three crowns later, I had a bill that usurped the better part of my generous credit card limit.  And that was after my dental insurance paid its portion - a measly $1500.  I’m not alone in experiencing dental insurance shock.  I have dozens of friends that have found themselves in similar situations and the internet is littered with similar anecdotes.  Nabil Bissada , who heads up the periodontics department at Case Western Reserve School of Dental Medicine says the maximum limit was $1000 in the late 1960’s when dental insurance was first introduced - virtually the same as it is today.  By today’s standards, the term “insurance” is not entirely apt when it comes to dentistry.

BISSADA: It’s really dental assistance rather than dental insurance

Insurers don’t disagree.  Here’s the way Jeff Album puts it; he’s a representative of Delta Dental, a non-profit dental insurance company that operates in several states, including Ohio. 

ALBUM: Dental benefits, both historically and currently have always been a cost sharing kind of benefit, in which people are incented to participate in the cost of the care.

Album says that unlike medical insurance, dental insurance is designed to be primarily a preventative benefit - and that the basic care of many comes at significant cost to a select few.

ALBUM: With an annual maximum- generally in the range of 15 hundred to 2 thousand dollars a year --- all but 6-7 percent of people insured through a group employer program will have all their needs met…

That was true in my case…Since that root canal extravaganza a few years ago, I haven’t had a dental bill anything like that one.  - but even once or twice in a lifetime, it really stinks to find yourself one of the unlucky 6 percent.  Dental insurers also defend covering little of the cost of major restorative dentistry because…as Album points out….few people go bankrupt from their dental bills.

LEW: We’re talking in the 100’s and thousands of dollars rather than the tens, and hundreds of thousands and even millions of dollars in terms of the type of care that’s to be covered.

But even a few thousand dollars can take a long time and a lot of interest to pay off when the patient has to resort to a credit card. And that’s if they even haven insurance. 

According to a 2010 survey by the Delloitte Center for Health Solutions, a third of baby boomers and two thirds of seniors are without any dental insurance at all - either because they can’t afford it, or they don’t think it’s worth the money. 

Despite mounting evidence that poor oral health is linked to a number of chronic diseases, certain cancers, and low-birth-weight babies, it would appear that the mouth is still seen as secondary to the body.  There’s a sign though that the tide may be changing.  Medicaid, the government insurance for the very poor, now provides dental coverage up to age 21, and thanks to the health care reform bill all private plans must also include dental insurance for children.

As for those who have dental insurance, but are unhappy with the coverage they get - Album of Delta Dental insurance says don’t blame the insurance companies- blame the employers.

ALBUM: The standard dental benefit program continues to be dictated by the employer community. The people who are paying for their dental plans really tell us how they would like the benefits structured.  If the employer asks we can provide it.

…but such plans would cost employers…and employees a heck of a lot more in monthly premiums than they now pay. 

Album says some employers are sold on the idea that better dental health lowers overall medical costs in the long run - but in this economy of employers simply aren’t looking to expand their dental benefit plans.  So for big dental problems, most of us can continue to expect the dentist to drill a hole in our wallets as well as our teeth .

Gretchen Cuda, 90.3

Additional Information

An earlier version of this story mistakenly identified the representative of Delta Dental as Adrienne Lew. The story has been corrected with proper attribution to Jeff Album. We sincerely regret the error.

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Health, Watch Your Mouth!

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