According to the 2014 National Health Interview Survey and the American Dental Association’s Oral Health and Well-Being Survey, the cost of dental care is the biggest barrier preventing adults from having necessary dental care. Unlike medical care in the U.S., both public and private dental insurance have limitations on benefits from annual dollar limits ranging from $500 to $2,500 a year, plus procedure restrictions. Dental insurance reimbursement has not kept pace with inflation, and therefore is paying less in real dollars today than in the past.
As a practicing dentist, I can tell you that dealing with dental insurance companies is frustrating and time-consuming. After a dental visit, our office sends in an electronic request to the insurance company for reimbursement. Often, this request is lost in its system, delaying payment and requiring our staff to redo the paperwork. I hear this same complaint from other dentists. The delay of payment and redo of work all increases the cost of the dental service to the patient.
According to the above surveys, private dental insurance plans also have many provisions that limit consumers’ financial protection. Co-insurance rates as high as 50 percent and high premiums together were found to exceed the value of the dental procedure. That’s not insurance; that’s not even a good savings account. This causes many beneficiaries to question the value of dental insurance from a financial perspective.
The design of public and private dental insurance needs to be changed. Dental benefits should pay to provide a person’s oral health and well-being instead of listing tooth by tooth restrictions and arbitrary dollar limits. A person with dental problems following an insurance reimbursement schedule often needs to spread the dental care over many years, which is often impossible without incurring additional pain and suffering. Postponing dental care because of cost also adversely affects health beyond the mouth, increasing health care costs of people with chronic conditions such as diabetes and heart disease.
It’s time we pressure our employers and legislators to redesign dental insurance plans to provide the care necessary for oral health.