Many people in the US are learning the hard way that dental insurance is not really insurance at all, wrote David Tuller in Kaiser Health News. He says during his period of intense dental care, he hated wearing temporaries and often braved the public with missing front teeth. Tuller, 61, an academic at the University of California-Berkeley and a San Francisco homeowner, said he relied on handouts from his mother for the $50,000 in restorative dental work he has received. This is the “Great Divide” between medicine and dentistry, particularly in how treatment is paid for, or mostly not paid for, by insurers, he said. Dental cover works pretty well for millions of Americans but others learn that it does not provide significant protection against unexpected or unaffordable costs. His own insurance is about $1,500 a year but dental policies are more like prepayment plans for basic levels of care, generally offering full coverage for routine preventive services and a small co-payment for fillings. Such coverage is reduced as more major treatment is required, with crowns often offered at only 50 percent and implants generally not covered at all. This means prices for major procedures after often beyond the reach even for many middle-class patients, with some resorting to dental tourism in countries such as Mexico. Underlying this system is a premise that dental treatment is optional, even a luxury, said Tuller. In his case, his problems were due to an advanced case of periodontitis, a chronic inflammatory condition which can destroy gum and bone tissue and is said to affect nearly half of Americans over 30. His diagnosis came after two lower front teeth collapsed and treatment since has included extractions, crowns, titanium implants and a series of gum surgeries. Tuller has at least received treatment but the situation is far worse for those on low incomes and without family support. Medicaid covers children’s dental services but it is up to individual states to choose whether they offer benefits to adults, and many dentists do not accept Medicaid patients due to low reimbursement rates. Medicaid typically pays half of what private coverage pays. Many older adults also lose employer-based cover when they retire due to increasing dental problems, despite some 70 percent of those over 65 suffering some form of periodontal disease, according to the Centers for Disease and Prevention. But basic Medicare packages do not include dental care, although there are options to buy it. The bold line between what is covered by medical or dental insurance is what often strikes patients as nonsensical. Tuller ends his piece citing the example of Lewis Nightingale, 68, who required surgery for a benign tumor in bone near his upper right teeth. A few years of the most likely to be able to have been treated tooth decay The oral surgeon was classified a dental specialist, leaving Nightingale stuck with a $3,000 bill as the treatment was not covered by his medical insurance.
Many people in the US are learning the hard way that dental insurance is not really insurance at all, wrote David Tuller in Kaiser Health News. Tuller, 61, an academic at the University of California-Berkeley and a San Francisco homeowner, said he relied on handouts from his mother for the $50,000 in restorative dental work he has received. This is the “Great Divide” between medicine and dentistry, particularly in how treatment is paid for, or mostly not paid for, by insurers, he said. Dental cover works pretty well for millions of Americans but others learn that it does not provide significant protection against unexpected or unaffordable costs. His own insurance is about $1,500 a year but dental policies are more like prepayment plans for basic levels of care, generally offering full coverage for routine preventive services and a small co-payment for fillings. Such coverage is reduced as more major treatment is required, with crowns often offered at only 50 percent and implants generally not covered at all. This means prices for major procedures after often beyond the reach even for many middle-class patients, with some resorting to dental tourism in countries such as Mexico. Underlying this system is a premise that dental treatment is optional, even a luxury, said Tuller. In his case, his problems were due to an advanced case of periodontitis, a chronic inflammatory condition which can destroy gum and bone tissue and is said to affect nearly half of Americans over 30. His diagnosis came after two lower front teeth collapsed and treatment since has included extractions, crowns, titanium implants and a series of gum surgeries. Tuller has at least received treatment but the situation is far worse for those on low incomes and without family support. Medicaid covers children’s dental services but it is up to individual states to choose whether they offer benefits to adults, and many dentists do not accept Medicaid patients due to low reimbursement rates. Medicaid typically pays half of what private coverage pays. Many older adults also lose employer-based cover when they retire due to increasing dental problems, despite some 70 percent of those over 65 suffering some form of periodontal disease, according to the Centers for Disease and Prevention. But basic Medicare packages do not include dental care, although there are options to buy it. The bold line between what is covered by medical or dental insurance is what often strikes patients as nonsensical. Tuller ends his piece citing the example of Lewis Nightingale, 68, who required surgery for a benign tumor in bone near his upper right teeth. A few years of the most likely to be able to have been treated tooth decay The oral surgeon was classified a dental specialist, leaving Nightingale stuck with a $3,000 bill as the treatment was not covered by his medical insurance.