The Broken State of Dental Insurance

by Cathy Miller on March 6, 2012

in Dental

If you’ve ever had a tooth abscess, you understand pain. 

But is that the kind of pain that sends you to a hospital’s emergency room (ER)?

ER visits for dental-related conditions is a trend on the rise.

  • In 2009 – 830,590 Americans visited the ER for preventable dental conditions – a 16 percent increase from 2006
  • In Florida alone – dental-related ER visits cost an estimated $88 million

The Pew Center for States website shares details of their recent study, A Costly Dental Destination.

The director of the Pew Children’s Dental Campaign, Shelly Gehshan, was quoted as saying –

“The fact that so many Americans go to hospitals for dental care shows the delivery system is failing,”

With a focus on the high cost of medical insurance, dental insurance is often overlooked. Is it time to take a second look?  

Dental is Different

In a former life, I was a dental hygienist. I left that life to work in employee benefits with insurance companies, brokerage and consulting firms.

You could say I’ve seen dental insurance on both sides of the chair.

  • Dental insurance is a bit of a misnomer
  • It doesn’t protect you from catastrophic losses
  • It was never meant to

A Brief History

Fifty years ago, about the only coverage you found for dental procedures was on some major medical plans. And that was very limited – e.g., impacted wisdom teeth or the surgical removal of a tooth’s root tip (known as an apicoectomy).

In the 1960s and 1970s, dental insurance plans cropped up. They looked very similar to many of the plans in existence today.

  • The intent was to provide limited financial assistance for dental procedures
  • Plans divided procedures into Preventive, Basic and Major Services
  • Plans typically covered preventive procedures at 100 percent
    • Basic at a lower percentage (e.g., 80 percent)
    • Major services at the lowest percentage (e.g., 50 percent)
  • Basic and major services usually had deductibles
  • There were numerous benefit limitations and exclusions
  • There were annual maximums for the dollars paid by the plan (e.g., $1,000)

 Sound familiar?

Dental Benefits Today

While scores of plans have evolved with networks of participating dentists, few plans provide comprehensive dental coverage.

A recent report from the National Association of Dental Plans (NADP) and Delta Dental Plans Association (DDPA) offered the following snapshot of the dental benefits industry today.

  • Only 1 percent of dental policies are purchased by individuals
  • 81 percent have dental benefits through group policies (e.g.,employer coverage)
  • Nearly 2 percent have dental benefits integrated with medical coverage
  • 15 percent have dental benefits through public policies (e.g., Medicaid)

Dental Insurance’s Future

Despite evidence of links between dental disease and certain medical conditions, there remains barriers to accessing dental care.

  • Many state Medicaid plans cover a limited amount of dental treatment (e.g., emergency dental care)
  • Health Reform’s Affordable Care Act did not ignore dental, although much of it focused on children (“Pediatric Oral Services”)
  • Most dental policies purchased by individuals have a minimum of a 12-month waiting period before major services, such as crowns, bridgework or dentures, are covered under the policy
  • Generally, annual maximums on group policies offer little or no coverage of major services, such as crowns

Let’s face it, most people hate to go to the dentist. Then add in the sad state of the economy and the large out-of-pocket expenses from having inadequate or no dental coverage.

It could explain why the ER has become the dental office of the future.

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Notice of Disclaimer –Cathy Miller is not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal or health care advice as to your specific circumstances. We recommend you review legislation with legal counsel and visit your physician or dentist for health care issues.

 

 

 

 

{ 14 comments… read them below or add one }

Paula H March 6, 2012 at 9:49 am

Very interesting, Cathy.

Being self-employed, I’ve often looked into buying dental coverage but discovered very few individual health plans cover dental. One broker told me it’s nearly impossible to find individual dental plans anymore, either. I used to love going to the dentist – nothing like how great your teeth feel after a good cleaning – but now I dread the idea of going and learning I have a cavity or something else that needs costly dental work. (At least my health insurance has deals for discounts at certain dental offices!)

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Cathy March 6, 2012 at 9:57 am

As a fellow self-employed person, I feel your pain. Here in this region (and I would think most), Blue Cross offers a dental plan, but it’s not worth it for me. Like I mentioned in the post, major services aren’t covered for the first year and there’s too much out-of-pocket.

It seems like the only alternative are discount plans, but I’m not thrilled with those either. Dentists can get around the discounts by billing for non-covered services.

For example, most discounted plans do not include the lab bill in the cost of a crown so SOME dentists might jack up the cost of the lab work to much higher than it really is and charge that to the patient. So now in addition to the whole amount of the discounted fee, patients are responsible for a lab fee.

There are a lot of discount plans out there, but like anything, you need to read ALL of the fine print.

Thanks for sharing your view, Paula.

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Ann March 6, 2012 at 11:45 am

Cathy, here’s how bad things are. I had to have a back molar pulled. It was supposedly broken and abscessed. The bill was over $750. I either had to pay the whole thing out of pocket or take out a credit card loan that paid the whole thing. I have a year to pay off the loan with no interest, but there are credit card fees that weren’t discussed in big enough print to be seen. This is highway robbery and as a self-employed person, I can barely pay for the high risk health insurance I have. And I was so messed up, I didn’t even get the corpse.
Ann´s last blog post ..Caregiver Confessions: When You Don’t See Friends Much Any MoreMy Profile

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Cathy March 6, 2012 at 11:53 am

Unfortunately, Ann, that’s all too familiar a story. I imagine the credit card is one of those for health care services. More than one person has missed the descriptions of all the fees.

I hope things work out for you. Thanks for sharing your story.

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Christi Johnson March 6, 2012 at 12:54 pm

My sister is a dentist practicing in Carrollton, Texas (Sales Family Dentistry), so I know all too well the woes of the Dental practitioner. There is not enough insurance coverage offered to patients who do have insurance, and therefore, Dentists not only have to work overly hard to collect full payment for their services, but patients often have to come out of pocket. I wish there was a solution. Dental care is massively important and not everyone can afford to pay for care in cash. We are blessed, but I wish that everyone had better access. Great article. I am going to share this with my sister!
Christi Johnson´s last blog post ..Simple Ways To Make Money – 3 Realistic Options For Those Who Want To Work From HomeMy Profile

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Cathy March 6, 2012 at 1:21 pm

Thanks, Christi. That’s what makes it frustrating all the way around. It is not a win-win for anyone. Thanks for sharing your view.

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Suerae Stein March 6, 2012 at 3:10 pm

A well stated article Cathy. It is a sad state of affairs. My husband and I are self employed and do not have dental insurance. I recently had fillings replaced, which landed me in the emergency room because of panic I suffered as a result of nerve damage due to the dental injection. After several doctor and dentist visits, I finally received help from a neurologist. This has been a costly venture in both money, time, and emotional health. I didn’t realize this was such a common problem everywhere. It’s a shame, really.
Thank you! ~ Suerae
Suerae Stein´s last blog post ..Guns in the NeighborhoodMy Profile

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Cathy March 6, 2012 at 3:31 pm

Suerae – I am so sorry for your pain. Talk about stepping on your last nerve. :-) I hope you are over your problems. Thanks for sharing your very real experience.

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Paula H March 6, 2012 at 3:35 pm

One thing I forgot to add, if you have a Heathcare Savings Account (to go along with the sky-high deductible health insurance plan like I have), you might be able to HSA funds for dental or vision (yet another touchy issue – as evidenced by my constant squinting).

The only problem? Using HSA funds for vision or dental bills might leave you short when you need those funds to cover medical costs. I won’t even get started at how much of my HSA contributions go straight to the bank for their monthly “fees” for allowing me to put money in my account.
Paula H´s last blog post ..Crochet AwayMy Profile

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Cathy March 6, 2012 at 3:39 pm

Thanks for sharing that, Paula. I have an HSA, too, and you are right, you can use those funds for dental services, but the truth is, I’m at the age where other health issues take precedent – like vision. As a writer, that’s a biggie.

I am also religious about my annual physical, mammogram, and such.

Thanks again for sharing that information.

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Kristen March 6, 2012 at 8:29 pm

What a timely post. I am going to the dentist tomorrow. Lack of dental care is a major public health problem. My dental insurance costs nearly as much as my health insurance, but I went with one with a higher premium because I was able to choose the dentists for my family and the dentists that I found are great. The other plans are dental HMOS and the HMOs in my area only provide care at a limited number of underpaid dental corporations who, in my experience are not that great. Because they get paid so little, they often recommend costly and possibly unnecessary services or charge you for things like cleaning the tools they use. I am so grateful that I have access and the ability to get the dental care that we need.
Kristen´s last blog post ..The Stress of Owning a HomeMy Profile

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Roy A. Ackerman, PhD, EA March 6, 2012 at 9:18 pm

I admit that I have not looked into dental insurance for almost a decade. But, I do recall that the offerings were not worth the paper upon which they came delivered. High prices, lots of loopholes, selected practitioners… and then we see many practitioners are taking early retirement.

This portion of the health care system is one that is most ripe for changes..
Roy A. Ackerman, PhD, EA´s last blog post ..Leadership <> ManagementMy Profile

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Cathy March 7, 2012 at 6:45 am

Hi Kristen: Wishing you good health for your appointment. :-) Like any business or health care provider, there are good ones and not so good ones. I am glad you found someone you are happy with.

Thanks for sharing your story, Kristen.

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Cathy March 7, 2012 at 6:48 am

Hi Roy: Sorry, I had to drag you out of the spam folder again – must be because you’re so controversial. :-)

You are so right in your assessment, and sadly, it has not changed in that decade. Thanks for sharing your thoughts, Roy.

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