Why is dental always considered separately from health care?

[nereo]

Serious question here - why do we treat teeth* differently from the rest of the body when we talk about health insurance?  Seems to me that oral health is as important to quality of life as many other sub-specialties that are covered under normal/basic insurance, and mouth problems (e.g. Tooth infections) can cascade into serious health situations.

Dentists are even segregated with their own schools, industry standards and accrediting proceedures.

What gives?? During the formation of Obamacare (and now with Trumpcare) did anyone ever suggest we ought to provide dental coverage too?
*the same question could be asked about vision. 

[ketchup]

I've researched the topic extensively and the best answer I can find is "because fuck you."

It's quite arbitrary.

I suppose dentists and optometrists are specialists that "everyone" "should" see on a schedule, so maybe that's why they're split off?

I know that from what I can tell dental and vision (especially vision, which tends to just include an exam and maybe a discount on glasses) insurance is almost always a bad deal if you're paying for it (and not a work benefit).  Also, both are not nearly as smoke-and-mirrors about billing.

[mskyle]

Dental and vision insurance are tricky, price-wise, because the costs are usually either low OR predictable and delayable. Regular dental and vision exams are cheap. Glasses are very predictable and can be cheap or expensive. Stuff like fillings and root canals is also very cheap compared to, say, knee surgery.

But then there are properly expensive dental things like implants and dentures, and generally someone knows ahead of time that they're going to need dentures or implants, so the sensible thing to do, as a consumer, is to *not* have dental insurance until you need something major. This is a bad deal for the insurance companies, which is why individual dental plans are a bad deal for consumers.

Only people who wear glasses are ever going to pay for vision insurance. So everyone is just sharing the cost of each others' exams. Which all cost about the same anyway. So why have insurance?

FWIW my health plan (through my employer) does include vision and pediatric dental care as part of the main plan (we have a separate dental plan for adults). The pediatric dental part is mandated at the state level (by the Commonwealth of Massachusetts); I'm not sure if the vision part is too.

[nereo]

I suppose dentists and optometrists are specialists that "everyone" "should" see on a schedule, so maybe that's why they're split off?

... that's another thing I don't understand (oh, the list is long...)
As another poster brought up one of the ACA threads, there's no good medical reason for many healthy adults to see the doctor every single year, as it doesn't measurably improve health or outcomes.
BUT, seeing a dentist once a year for an exam and cleaning is something that virtually EVERYONE should do, and it absolutely does improve outcomes.
Yet few plans health plans cover it (except as an expensive 'add-on'). I'd imagine requiring annual dental checkups would eliminate a lot of expenses (root canals, gum disease, infections).

[seattlecyclone]

For one thing, dentistry and optical services almost never are expensive enough that someone with savings should need to insure against them. Get some cavities and spend a few hundred bucks on fillings, or use an insurance company as a middleman to inflate the costs some more. The upper bound on dental costs is nowhere near the same as for health issues.

I know the vision plan provided by my work specifically excludes any type of actual medical treatment. This is handled by health insurance, and the vision plan just gives a discount on an eye exam and glasses. It's a nice enough corporate perk I guess, but such a plan is not really cost-effective for an individual to purchase.

[wonkette]

I went to school with someone who made this very question her dissertation, which is now a book. One big reason is that dentists make the most money from thing that are not medically necessary so they do not want to be lumped in with doctors and subject to that standard. The standard for "healthy" teeth in the US isn't if the teeth are rotting out of your mouth or not, it is if your teeth are white and straight. The history of convincing middle class America that their kids need braces is fascinating.

Here's the book, it is a pretty quick read. It is printed by a university press so kind of expensive, but the library may be able to inter-library loan for it. https://www.amazon.com/Making-American-Mouth-Dentists-Twentieth/dp/0813545358

[nereo]

Awesome wonkette!  I'm putting in an ILL today for that! (Yes, I actually am that dorky).

I suppose including dentistry with medical insurance would require a lot of sorting about what was 'cosmetic' vs what was necessary/preventative.
I stand by my belief that every medical insurance plan (Regardless of how its administered) ought to include one dentist cleaning & checkup per year.

[Helvegen]

Interesting.

I will note that in Germany anyway, dental is covered by your regular health insurance. Thank all the gods, because I used it to have my impacted and diseased wisdom teeth pulled and caught up with several years of neglected dental maintenance for nothing because of it at one of the best, if not the best, dental schools in the country. Dumb luck would have it I happened to live in the same city as it.  I gather that Germany is real odd duck in that regard though.

[MoonLiteNite]

I am actually confused on how dental insurance can even make it as a business.
Basically your monthly fees add up to be the cost of 2 normal cleanings a year. Sooo if you use that, then the ins is breaking even. If you do have a problem and the ins pays for it, you come out ahead and they are wayyyyyy behind.

Unless 95% of people don't get their free cleanings, i am really confused on how they are still in business.

[fatcow240]

I am actually confused on how dental insurance can even make it as a business.
Basically your monthly fees add up to be the cost of 2 normal cleanings a year. Sooo if you use that, then the ins is breaking even. If you do have a problem and the ins pays for it, you come out ahead and they are wayyyyyy behind.

Unless 95% of people don't get their free cleanings, i am really confused on how they are still in business.

For me, my work dental plan is so cheap for the family that I tend to break even.  I am then motivated to go to my twice a year cleanings.  I opt-in and out of this depending on the year. ($624/year)

[nereo]

I am actually confused on how dental insurance can even make it as a business.
Basically your monthly fees add up to be the cost of 2 normal cleanings a year. Sooo if you use that, then the ins is breaking even. If you do have a problem and the ins pays for it, you come out ahead and they are wayyyyyy behind.

Unless 95% of people don't get their free cleanings, i am really confused on how they are still in business.

At least for the coverages we've been offered, insurance covered the cleanings but only a portion of fillings and an even smaller portion of more advanced things (like root canals, which I think was 20%).

My guess is that
1) a large group of people simply skip their annual cleaning (my dentist quasi-confirmed this)
2) the 'sticker cost' of cleanings is higher than either the actual cost or the reimbursement cost from insurance
3) most of the money being made is through fillings (only partially covered under our insurance) and cosmetic things like teeth-brightening and straightening.

I had to read the fine print to discover that a fluoride treatment was covered under my insurance, but my dentist never offered it to me.  I asked him if he would recommend it and he said "yes, absolutely" but then said "very few people ever ask for it, so it's not part of our normal cleaning."

[fatcow240]

3) most of the money being made is through fillings (only partially covered under our insurance) and cosmetic things like teeth-brightening and straightening.

It took me a while to find a dentist that didn't always ask to do multiple fillings, braces, and other cosmetic things each visit.  They have even gotten a new tool for finding smaller cavities so they can fill them.

[Proud Foot]

I have never purchased actual dental insurance.  I only had dental insurance at my last job where it was paid for by my employer.  Even then it wasn't really that great.  It was mainly a discount plan that covered cleanings and then had three different coverage tiers.  Most of which would not be too expensive.  And it did not cover any orthodontics such as braces. The monthly premiums on the plan were about half of what a cleaning would cost out of pocket.

[Helvegen]

I am actually confused on how dental insurance can even make it as a business.
Basically your monthly fees add up to be the cost of 2 normal cleanings a year. Sooo if you use that, then the ins is breaking even. If you do have a problem and the ins pays for it, you come out ahead and they are wayyyyyy behind.

Unless 95% of people don't get their free cleanings, i am really confused on how they are still in business.

For me, my work dental plan is so cheap for the family that I tend to break even.  I am then motivated to go to my twice a year cleanings.  I opt-in and out of this depending on the year. ($624/year)

I'm motivated to get mine because my employer gives me $50 HSA bucks a six month cleaning and extends that to my spouse. Used to get that for the kid too, but then the rules changed this year.

I have what would be considered great dental insurance, which is still pretty poor in the grander scheme of things. I think the value in it is more in the negotiated rates than anything else. I think if it wasn't employer provided, I wouldn't really bother and just pay out of pocket or use the HSA.

[NeonPegasus]

For one thing, dentistry and optical services almost never are expensive enough that someone with savings should need to insure against them. Get some cavities and spend a few hundred bucks on fillings, or use an insurance company as a middleman to inflate the costs some more. The upper bound on dental costs is nowhere near the same as for health issues.

+1

ITA. My new dentist found that one of the roots in one of my molars was dead and I had infection setting up above it. I got a consult ($75) with an endodontist to see if it could be saved with a root canal. No dice. I went to another dentist to get it pulled (first dentist didn't do extractions anymore and wanted me to see an oral surgeon). That cost $298 and included novocaine but nothing else. I had the option of getting a bone graft and an implant but the endodontist assured me it was unnecessary and 75% of the people who get this back molar extracted never replace it. So all together, this cost $373. That's not even as much as a dental policy would have cost. it's not like getting in a car accident and running into costs of $20k+, KWIM?

[mm1970]

I am actually confused on how dental insurance can even make it as a business.
Basically your monthly fees add up to be the cost of 2 normal cleanings a year. Sooo if you use that, then the ins is breaking even. If you do have a problem and the ins pays for it, you come out ahead and they are wayyyyyy behind.

Unless 95% of people don't get their free cleanings, i am really confused on how they are still in business.

Easy!  Annual cap on benefits for my dental insurance is $1500 a year, for the family.

My premiums are $1000 a year for my family.

[nvmama]

I am actually confused on how dental insurance can even make it as a business.
Basically your monthly fees add up to be the cost of 2 normal cleanings a year. Sooo if you use that, then the ins is breaking even. If you do have a problem and the ins pays for it, you come out ahead and they are wayyyyyy behind.

Unless 95% of people don't get their free cleanings, i am really confused on how they are still in business.

Easy!  Annual cap on benefits for my dental insurance is $1500 a year, for the family.

My premiums are $1000 a year for my family.

I don't get our dental that's offered.  For a family its $60 a pay check.  I'm paid every other week.  It's cheaper for my husband and I to pay out pocket.  The kids are covered for preventive dental in our medical.  Maybe once the kids are older it may be worth it, but not yet.

[chasesfish]

I am actually confused on how dental insurance can even make it as a business.
Basically your monthly fees add up to be the cost of 2 normal cleanings a year. Sooo if you use that, then the ins is breaking even. If you do have a problem and the ins pays for it, you come out ahead and they are wayyyyyy behind.

Unless 95% of people don't get their free cleanings, i am really confused on how they are still in business.

Dental insurance is only a business because of its tax treatment (ability to purchase with before-tax dollars) and low HSA limits.   I buy dental insurance through work and over the years its equaled out to about what I would have spent otherwise (we go 2x/year and had an average amount on cavities).  I could pay for it out of the HSA, but I'm limited to under $7,000/person and spend some on medical care.

If they increased the HSA limits and/or removed the pre-tax treatment of dental insurance, the industry would die.  Its statistically just a tax-advantaged payment plan