I am not a medical provider, I am a new student taking a dental billing code class. My background was billing for a family physician. The reimbursement for dentist in contrast to a physician is wide. Physicians bill on 15-minute increments. A doctor could exam the patient, leave the room and a assistant could handle some of the patient tests and see another patient in between. A patient can be in the office for an hour and maybe the actual time with the patient would be fifteen minutes. In contrast, a dentist care requires physical time seeing the patient . An hour is usually scheduled for the patient.
Unless the physicians/dentist specialize, they work twice as long to try to keep up with the financial needs of running the office. Dentist retention is difficult due to low reimbursement and difficulty finding time to document. Dentist often do not like to deal with the insurance, so they tell the patient they will accept direct patient payment and the patient can bill their insurance directly. I initially thought if dentist could bill more under medical insurance it would be more equitable. I'm not sure this is the right direction. Any thoughts ?
I'll make sure to let my dentist know about this so thanks for the heads up!
The $1000 or $1500 cap hasn’t changed since the 1970s.
3
It' s always worth a try. It' s time we recognize dental health as part of overall health. Having worked in the dental field, the medical field as well as for a major insurance company I know how difficult/ impossible it is to get dental/oral procedures covered under dental plans. I also have first hand experience with dentist scammers. My husband went to Costa Rica for root canals, extractions, implants, crowns and bridgework. He is happy as a clam. Major savings.
3
How much time did your husband spend in Costa Rica to have the various work done and how many times did he have to go there? Thanks,any further info would be appreciated.
What a joke. Most people with health insurance have large deductibles and copays these days. So even if health insurance pays for some of this dental work the patient ends up having it going towards his or her deductible and they end up paying the bill anyway.
3
Dentist may have as many conferences as they want. It’s just a show. I pay $ $900 per year, dental insurance which has $50 deductible and is capped at $1500 per year. So I am paying $950 a year for a max benefit of $1500. Problem is if I don’t take the insurance the dentist charges are way above the insurance approved charges. I asked my dentist why don’t you charge me the same as you would charge the insurance company. The answer ‘ can’t do that. So if I am in insurance my dental cost could be say $2000 a year but if I am not the same could be as high as $3500. So my choice? buy $1500 max insurance and pay out of pocket $500 plus 950 in insurance premium.
If I am not in insurance I would pay $3500.
Can’t win
13
Good, but these are but baby steps.
It's outrageous that the mouth area (teeth and gums included) are excluded by medical insurance. For overall health there are countless articles how a healthy mouth prevents many illnesses.
Americans should care about this, but most don't even care about eating poorly, exercising, or excess fat.
We are as dumb as rocks.
10
Most healthcare plans today cover x rays and a cleaning, not cavities. In other words, without buying a separate costly dental plan, dental work is not covered. So if you have a tooth infection and need a root canal, you have to pay for it yourself. If you want to save the tooth and have it capped, double the price.
Meanwhile, it should be covered because without treatment it could kill you. I have watched insurance coverage that was great in the 80s get worse and worse. What we have today is no coverage for dental in these plans. A root canal with a cap cost a $15 copayment in 1985 in NYC and our employers paid the premium in full for our insurance. Today that cost is $950 and you pay over $200 month towards the monthly insurance premium on top of that. Premiums have skyrocketed even though services covered have gone down. Feel like you're getting ripped off? You are.
11
@kay
"Most healthcare plans today cover x rays and a cleaning, "
Nonsense.
8
We have been using a dental savings plan for years now rather than dental insurance. There is no waiting period and no annual cap. We pay half of what we were paying before. Our plan even includes extra like free telemedicine and even mental health. Check our dentalplans.com or just google dental savings plan. Your existing dentist is probably already in network with one of the companies.
2
Dentists have been gaming the system for years. If you haven't been down that road yourself, ask a friend or family member how much they were charged for a root canal or similarly common procedure. Usually paid out of pocket, so there's no oversight from an insurance company middleman.
Forget the fact that our insurance companies have by and large utterly failed in their roles as responsible gatekeepers fighting to keep costs down. In both directions- they deny needed procedures and tests while overpaying for those they approve. Also notwithstanding the fact that teeth (and eyes) were part of the human body last time I glanced in the mirror or at my anatomy books.
16
@drdeanster I share your suspicion that dentists wrangling to bill medical insurance for services is unlikely to reduce dental care costs!
3
Yes, indeed, for sure, definitely, "health insurance should cover costs that are “medically necessary”" but do they? So often, too often, no. However, the teeth are fundamental to health. Period. Stop. Bad teeth lead to other "conventionally medical" problems like infections and, in some cases - which has been documented in this very news outlet - death. That we do not treat the ENTIRE system as one and cover it all in these days, knowing what we know, is just wrong.
24
Based upon ads, dentists first and foremost fix smiles. For your convenience the dental assistant tells you how bad your teeth are before the dentist comes in to have a look. Dental issues or money issues at work?
6
The article might have mentioned why Medicare does not include dental coverage -
https://www.theatlantic.com/health/archive/2017/03/why-dentistry-is-sepa...
12
@Steve ~
Thanks for the link. Good article! But, I wish it had revealed why dental work is not covered by Medicare.
11
What about those who need coverage the most....seniors on Medicare????
29
@Carol
My Medicare plan from Blue Cross Blue Shield of North Carolina is going to cover some dental work starting next year. I don't know the extent of the coverage yet but any help is good.
A disease when I was 16 cost me all my upper teeth and most of the bottom ones. I've worn dentures for over 50 years. The bone forming the upper and lower mouth is almost nonexistent due to recession. I can no longer feel comfortable with dentures. They won't stay in even with denture pastes. I have constant pain from pressure just eating since they move. I have to cut my food into tiny pieces so I can chew it. I have no bite. the poor fit caused one of the little flaps that connected my upper lip to my gums got so irritated that it swelled up and I couldn't wear my upper plate. The oral surgeon who removed it charged $3500 which I had to pay because my medical insurance said it was a dental procedure. It seems that anything done in the mouth is dental to the health insurance folks.
I've been told by three dentists that implants would improve my complaints but the prices would require I take out a loan on my home. One quote was almost $50K. The lack of bone is the problem. Dental insurance would go a long way in helping me.
19
@Carol
The North Dakota state dental association offers a one time free fix-up for low income seniors. I hadn't applied yet because taking out my remaining teeth and getting dentures would be the quickest cheapest fix since I take a couple of meds that really dry out my mouth.
When my dentist at the time had a custom bottom mouth guard to prevent grinding it provoked a serious gag reflex. My dentist couldn't reduce that by thinning and reshaping, and I never could 'get used to it' and the dentist and I finally abandoned it.
I wouldn't want implants, just removing the remaining roots and attached partial teeth, and maybe a bridge for the very left front tooth that's been out of line since some of permanent front teeth came in double. Removing the 'extras' was all my mother would/could pay for.
1
I really can't understand why dental care is not included under health plans with all other medical care. Last time I checked, my teeth and gums were part of my body...
45
Eight years ago I was diagnosed with head and neck cancer. We had $2000 of dental insurance, some of which went to make tooth trays for fluoride treatment. Unfortunately my dentist did not realize the damage radiation does to teeth, and that it's especially bad for people like me who have bone loss due to gum disease.
So I had all my teeth pulled before treatment--and got a bill for over $6000, with only about $1500 left in my dental insurance pot. I argued with my health insurance that it was medically necessary, but no dice. So I had all of my doctors--the ENT/surgeon, the radiation oncologist, and two dental surgeons, write to the board that makes exceptions. Each of them felt it would be better done by one of the others, but I persisted.
The board at the insurance company wanted me to wait until after treatment (maybe I'd forget?), but I explained that I was about to become very, very sick and needed to do this while I was still well.
Well, the medical insurance paid the entire amount, and I was able to apply the remaining dental insurance to my new dentures. It took awhile, but it was worth it.
All this is to say that it's worthwhile to fight for what you think is right. There are ways to get what you need that go beyond the regular channels, and exceptions can be made. Thank goodness!
49
The separation between teeth and gums and the rest of the body is absurd. There is a well known connection between periodontal disease and heart disease, for example. Failure to treat periodontal disease, which is extremely expensive and not covered by health insurance, surely leads to increased costs down the road for people who develop heart disease. I remember reading at some point that some people are refused heart surgery if they have untreated gum disease because the outcome is likely to be bad. How does any of this make any sense, even from an economic point of view?
59
@rockstarkate Numerous anthropological studies have shown that early humans and our hominid forebears had tooth and gum disease, broken and missing teeth at time of death, which frequently occurred under the age of 35. Possibly only correlative and not causative but definitely food for thought.
My spouse needs to have periodontal surgery, so this headline caught my eye. I subsequently looked up what our medical insurance policy says on the subject: "No benefits are provided for services that Blue Cross Blue Shield determines to be for dental care (including orthodontic services), even when the dental condition is related to or caused by a medical condition or medical treatment, except for those services that are described as a covered service" (the latter I suppose including things like CT scans that are mentioned in the article). So, no dice. Fortunately we have dental insurance, although of course it will not cover the full cost.
16
i switched almost by accident from united healthcare aarp to just plain united healthcare [at a monthly plan savings of well over 200$]. the plain united has dental, a first. it reimbursed very well for my dentist's xrays/cleaning/exam visit, wherein was found a cavity.
i subsequently had the cavity filled. plain united rejected it - while you say in this article it's covered. what's the deal?
7
Yes, with the more obvious 'medical' overlap certainly there can be some insurance coverage. But of course the elephant in the room is that dental is medical and should be covered. If dental standard care which is very expensive is not done it sure turns into the obvious medical arena. 'Dental Insurance' is such a joke the words are a misnomer. I don't like the entire insurance system but whatever we have so that at least in theory most people can get care, it definitely should included dentally oriented 'medical' care. Everyone now talks about how their 15 years of medical care including surgeries haven't added up to cost of the dentist. Absurd and the mouth is important...
15
I remember when Medicare was first instituted and when HOMO started. Both time insisted that wanted nothing todo with third party payors. They knew very well the downsides of negotiating and having their lives controlled by insurance companies. They were able to get way with it because the relative costs of dental vs medical hospitalizations is and was so low. However now with implants a pediatric orthodonture, they are getting close to parity with hospital; surgery. Unfortunately many people have to do without dental; care in the current system. Until we get thousands of immigrant dentists (Like the thousands of immigrant doctors) The dentists will control the marketplace and little can be done.
5
@Matthew Carr
Dental insurance companies should be ashamed of themselves. With the rising cost of dental care, you'd be lucky to have a dental crown covered. Add an implant and the cost becomes prohibitive.
Three years ago, I had to have an implant and three crowns which totaled 10,000! The insurance company basically ignored the requested treatment. Hello Costa Rica!