14:13 PM

Is Anyone Listening?

Sometimes, at the end of the day, I wish I believed that there was a single politician in Washington who wanted to understand dental insurance.

I am a dentist. And, for the past 20 years, I have been chief dental officer, first for a medical insurance carrier and now, for a dental insurance carrier. One of the reasons I was attracted to my current position is the singular mission of this organization to improve the oral health of the residents in the regions we serve through dental benefits, through research into better ways to deliver care, and through philanthropy that extends oral health services to underserved groups. When your one and only focus is dental benefits, you want your offering to be the best – in prevention services and in reimbursement for dental work when it is needed.

With half of all dental payments being made by insurance companies, many of the improvements in the care you receive at your dentist are made possible thanks to forward thinking dental carriers. Do you have children? Dental carriers led the way with coverage for sealants and fluoride treatments because they help prevent cavities. Have gum disease? Dental carriers paved the way for multiple cleanings and screenings each year. Other innovations? How about coverage for brush biopsies, localized antimicrobials that halt gingivitis in adults, risk-based care and benefits, disease management programs, oral health report cards, and prevention-focused care.

For medical carriers, dental is a plan enhancement, an add-on commodity that can be downsized, restructured, or even eliminated when the carrier needs to meet bottom line demands. Medical plans don’t innovate in the area of dental services, and only sometimes do they watch dental carriers closely and copy new benefits that are popular and financially advantageous. Medical carriers often use the same customer service staff to respond to medical and dental calls, which may leave the caller wondering if the customer service representative understood their questions about tooth decay and gum disease.

So I am concerned that one of the current health reform bills under consideration advocates bundling essential dental services for children into medical plans offered under the Exchanges. And I am concerned that none of the bills include dental benefits for adults. It’s a bad idea to separate children’s coverage from their parents. If parents don’t see a dentist because they don’t have dental insurance, then chances of their children seeing a dentist drop significantly. Keeping standalone dental carriers among the options on the Exchanges makes sure cost effective and prevention-focused innovations in dental benefits will continue. That is the kind of innovation that makes care more efficient and keeps health care costs under control. Without proper support for oral health, current health reform proposals may actually undermine the progress we are making as a nation toward improved oral health and add new barriers to care for the individuals and families that this reform legislation is intended to help. Good oral health is critical for the entire family—parents and children alike.