Oral hygiene

I went to the dentist yesterday, to get a couple of fillings replaced. The office staff told me that my dental insurance covers 85% of the cost, with a $25 deductible for the year. (The previous appointment, for the six-monthly checkup and cleaning was completely covered.) Since I also need a couple of crowns replaced, we’re waiting to see what the insurance will cover before proceeding. (The dentist is concerned that I’m not currently working and wants to find the most cost-effective way to get things done.)

Now, here’s the thing: this insurance is part of my former employer’s overall health coverage. The medical part of this has to be the best in the country: 100% of allowed services paid by the insurance, no deductible and no co-pays; and 100% of prescriptions paid, no deductible and no co-pay. And, back in the day when I was working there, 100% of premiums were paid by my employer.

In the US, it really don’t get any better than that.

And yet my dental coverage is only 85%, and crowns are probably around 50%.

So my question is—why is dental coverage so much worse than medical? Do insurers think we go to the dentist for fun? Can they possibly imagine that we make that bi-annual trip for any reason other than that it’s absolutely necessary for basic oral health?

What’s up with this discrepancy?

A few months ago I heard an NPR report on how cuts to Medi-Cal (the state of California’s Medicaid program) dental coverage were affecting recipients. They found far fewer dental care providers than even before and were thus developing more major problems that might have been obviated by preventive care.

And one of the interviewees said something that absolutely left me gobsmacked: insurance companies stint on dental coverage because “they don’t view the mouth as an organ”.

Blow me—is it possible that any of these actuaries or plan adminsitrators don’t see the connection between oral hygiene and healthy operation of other organic systems? Really?

I mean, that theory totally explains how insurance plans cover dental care at such a crappy rate. But—what freaking world are they living in?

My first response: the ADA doesn’t have nearly the clout that the AMA has.