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Old 05-23-2010, 04:27 PM
Nefarious Chipmunk Nefarious Chipmunk is offline
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Why are vision and dental insurance separate from medical insurance?

If I have a problem with my ears, I don't need to worry about having "hearing insurance". My medical insurance covers the problem. Why do the eyes and teeth have separate insurance. I would think that the health of my teeth and eyes would effect my general health. So why do I have different insurance for those two body parts/functions and not any others?

There are certainly other kinds of specialist that would be covered under my health insurance. I would use the same insurance for a podiatrist that I would use for an ENT. Why are dentists and optometrists different?
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  #2  
Old 05-23-2010, 05:42 PM
robert_columbia robert_columbia is offline
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Perhaps it's because, at least in the US, optometrists and dentists are not normally board-certified Medical Doctors with the MD degree, but have separate degrees/qualifications and licensures? When you get measured for glasses, you normally see a DO, not an MD, and dental work is done by a DDS (though I do believe that an MD Opthamologist can give you a glasses prescription).

This might not be the full story, as wouldn't health insurance normally cover a visit to a MA or PhD Psychologist?

Last edited by robert_columbia; 05-23-2010 at 05:44 PM..
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Old 05-23-2010, 05:43 PM
Shagnasty Shagnasty is offline
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The basic answer is that they are two distinct health professions that aren't all that closely aligned and they operate under separate systems from both a health and economical model. In others words, it is that way because it has been that way for a long time.

It is a good question though. Dentists used to have a reputation for being the ones that couldn't hack medical school so they became dentists instead. That isn't true anymore for the ones that I see. My dentist's office is right across the hall from my primary care doctor's office and she is a cutting edge medical professional who runs a tight ship. There isn't any difference in the way the two offices run except that my main doctor takes care of 95% of my body and I get sent across the hall to a whole different system if the problem involves the mouth. The insurance is vastly different however even when she does surgery which doesn't make a lot of sense as you say.

There are ENT's and oral surgeons that work in the mouth area that are doctors just like there are opthamologists that will do some of the same things that an optometrist can but the insurance plans are different. The medical professions aren't always laid out in clean-cut divisions between roles and the insurance schemes add more complication to that. It doesn't make much sense. I can see an acupuncturist or a chiropractor under my medical insurance but they won't pay if I see dentist for anything even if the problem could result in general infection, jaw damage or heart problems later.

We have threads on the reasoning (or non-reasoning) of this before. I will see if I can find one.

Last edited by Shagnasty; 05-23-2010 at 05:46 PM..
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Old 05-23-2010, 05:53 PM
Shagnasty Shagnasty is offline
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Here is a related thread with some insight although the pure logic isn't sound if you had to rebuild the system from the ground up IMHO:

http://boards.straightdope.com/sdmb/...d.php?t=551769
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  #5  
Old 05-23-2010, 06:34 PM
Markxxx Markxxx is offline
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The real reason is it costs too much.

In the 80s and even as late as 1994, my MEDICAL insurance would pay for a root canal. Now I don't know of any medical insurance that will do that.

Now explain that. You can't. Did a root canal suddenly cease to be a medical procedure and become a dental problem. No it didn't. It got too expensive and insurers dropped it.

Medical insurance pays for cheap things. This is why they often cover things like Christian Scientist Practitioners. Because it's a lot cheaper to pay for them, then an actual medical treatment.

You can go into justifications and rationalizations on why teeth are different, but there is no REAL reason for it, other than costs. You can bet if a root canal was $100 that medical insurance would cover it.

And of course people will argue the point, but it really comes down to this, "it's like that 'cause they can get away with it."

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Old 05-23-2010, 07:13 PM
cromulent cromulent is offline
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I should point out that the existence of different doctoral practitioners argument doesn't really hold water at the present time, as both optometrists and ophthalmologists can accept vision *and* medical insurance depending on what is wrong with your eyes. A diagnosis of nearsightedness is charged to the vision plan and a diagnosis of cataracts is charged to the medical plan.

Not at all sure about dental, but as far as vision insurance goes, the yearly vision-insurance eye exam is almost like a "checkup" for your eyes. Once you have a non-refractive problem (that is, something not hyperopia, myopia, or presbyopia) it is charged under ones medical insurance, not vision.
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Old 05-23-2010, 07:25 PM
Cunctator Cunctator is offline
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Health insurance here comes with the option of buying "extras" cover, that includes dental and optical expenses.
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  #8  
Old 05-23-2010, 07:51 PM
Nefarious Chipmunk Nefarious Chipmunk is offline
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Quote:
Originally Posted by robert_andrews View Post
Perhaps it's because, at least in the US, optometrists and dentists are not normally board-certified Medical Doctors with the MD degree, but have separate degrees/qualifications and licensures?
When I go to the doctor's office, I often see a Nurse Practitioner and not an MD. The insurance still covers it.

Quote:
Originally Posted by Markxxx View Post
The real reason is it costs too much.

In the 80s and even as late as 1994, my MEDICAL insurance would pay for a root canal. Now I don't know of any medical insurance that will do that.
I don't understand this. I am sure that I have cost insurance companies significantly more money medically than dentally. I have had a lot of dental work in my life, but I know that three trips to the ER blow all that out of the water.

I also wear glasses and have since I was eight. They are not that expensive, as health related things go, so why wouldn't health insurance cover it? In fact, it seems that when things start the get expensive, that is when the health insurance takes over.

Furthermore, my dental insurance has a yearly maximum that isn't that high. I assume that this is because a lot of individual treatments wouldn't reach that maximum.

Am I being short-sighted in my understanding of health insurance costs? I suppose "because that's how it has always been done" is about what I expected, but you say that your health insurance used to cover the cost of a dental procedure and now does not. I didn't realize they could do this (although I am not terribly surprised).


Quote:
Originally Posted by cromulent View Post
I should point out that the existence of different doctoral practitioners argument doesn't really hold water at the present time, as both optometrists and ophthalmologists can accept vision *and* medical insurance depending on what is wrong with your eyes. A diagnosis of nearsightedness is charged to the vision plan and a diagnosis of cataracts is charged to the medical plan.
This just confuses me even more.

Quote:
Originally Posted by Shagnasty View Post
The basic answer is that they are two distinct health professions that aren't all that closely aligned and they operate under separate systems from both a health and economical model. In others words, it is that way because it has been that way for a long time.
I guess I just don't see a huge difference between an optometrist check-up and a medical one. Mental health treatments are often covered by health insurance. This is true, even for non-prescription mental health treatment. A stay at a rehabilitation facility, for example, is often covered. That seems like a hugely different professional model which is covered.


I really appreciate everyone's responses. "That's just the way it is" seems to be what I am gathering here.
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  #9  
Old 05-23-2010, 11:37 PM
AboutAsWeirdAsYouCanGet AboutAsWeirdAsYouCanGet is offline
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If I have a problem with my ears, I don't need to worry about having "hearing insurance". My medical insurance covers the problem
What state on you in? It's quite rare to have health insurance that covers hearng aids and audilogical exams. Most insurances only cover coachlear implants or Bone Anchored Hearing Aids.
I think in the cases where expensive technology is covered it's b/c only a small percentage of people will opt for it. So the insurance companies don't go broke.
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Old 05-23-2010, 11:45 PM
Nefarious Chipmunk Nefarious Chipmunk is offline
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I live in California. Whenever I have had an audiological exam, it has been covered by my insurance. I have never needed a hearing aid, so I don't know about that.
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  #11  
Old 05-24-2010, 12:03 AM
TriPolar TriPolar is online now
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there is also the reason that not everybody perceives the need for eye and dental insurance. some people have great teeth and vision and wouldn't see a positive benefit from the added cost of insurance coverage for either. damage to teeth and vision caused by accidents are somethimes covered by general health insurance (although this might be much rarer in the current environment). for a similar case, single men may pay less for insurance because they don't need maternity related benefits. i'm not advocating for this system, but along with the other reasons mentioned in this thread, it seems reasonable that this is how our traditional private insurance system would work.
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  #12  
Old 05-24-2010, 12:41 AM
Nefarious Chipmunk Nefarious Chipmunk is offline
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Quote:
Originally Posted by ed malin View Post
there is also the reason that not everybody perceives the need for eye and dental insurance. some people have great teeth and vision and wouldn't see a positive benefit from the added cost of insurance coverage for either. damage to teeth and vision caused by accidents are somethimes covered by general health insurance (although this might be much rarer in the current environment). for a similar case, single men may pay less for insurance because they don't need maternity related benefits. i'm not advocating for this system, but along with the other reasons mentioned in this thread, it seems reasonable that this is how our traditional private insurance system would work.
I have good skin and would like to not have to pay for dermatologist coverage, but I don't get that option. It is included in my health insurance. How is that different? (I am not trying to be argumentative, I am just trying to more clearly understand your point.)
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Old 05-24-2010, 01:13 AM
thelurkinghorror thelurkinghorror is online now
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Originally Posted by robert_andrews View Post
Perhaps it's because, at least in the US, optometrists and dentists are not normally board-certified Medical Doctors with the MD degree, but have separate degrees/qualifications and licensures? When you get measured for glasses, you normally see a DO, not an MD, and dental work is done by a DDS (though I do believe that an MD Opthamologist can give you a glasses prescription).

This might not be the full story, as wouldn't health insurance normally cover a visit to a MA or PhD Psychologist?
A DO is a Doctor of Osteopathic Medicine. An eye doctor is an OD, Doctor of Optometry.
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Old 05-24-2010, 07:13 AM
kayaker kayaker is offline
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Quote:
Originally Posted by heraldgwena View Post
If I have a problem with my ears, I don't need to worry about having "hearing insurance".
Not so quick. When I finally broke down and had my hearing checked, my insurance paid for the exam. However, the $3,000 hearing aid that was absolutely necessary? Insurance covered exactly $0.
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Old 05-24-2010, 08:44 AM
TriPolar TriPolar is online now
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Originally Posted by heraldgwena View Post
I have good skin and would like to not have to pay for dermatologist coverage, but I don't get that option. It is included in my health insurance. How is that different? (I am not trying to be argumentative, I am just trying to more clearly understand your point.)
actually, a lot of dermatology services are not covered by general insurance and considered cosmetic (as are many dental services), but most necessary care performed by dermatologists, such as excising a pre-cancerous mole could be done by any licensed physician or surgeon. the services provided by dentists, and optical practitioners are much more specialized. also, the term 'good skin' doesn't really address your overall health needs, it sounds generally cosmetic.
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  #16  
Old 05-24-2010, 10:08 AM
Nefarious Chipmunk Nefarious Chipmunk is offline
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Quote:
Originally Posted by ed malin View Post
actually, a lot of dermatology services are not covered by general insurance and considered cosmetic (as are many dental services), but most necessary care performed by dermatologists, such as excising a pre-cancerous mole could be done by any licensed physician or surgeon. the services provided by dentists, and optical practitioners are much more specialized. also, the term 'good skin' doesn't really address your overall health needs, it sounds generally cosmetic.
I would say that anything covered by most dental insurance is not cosmetic. Any dental insurance I have had won't cover cosmetic procedures. On the flip side, my sister has had insurance cover acne treatments. I would say a root canal is less cosmetic then that. The visit to the dermatologist was completely covered with a co-pay on the medication.

I guess hearing aids aren't covered by some insurance, but you still can't buy separate hearing insurance that would cover it (unless you count a more inclusive plan).
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Old 05-24-2010, 10:23 AM
TriPolar TriPolar is online now
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Originally Posted by heraldgwena View Post
I would say that anything covered by most dental insurance is not cosmetic. Any dental insurance I have had won't cover cosmetic procedures. On the flip side, my sister has had insurance cover acne treatments. I would say a root canal is less cosmetic then that. The visit to the dermatologist was completely covered with a co-pay on the medication.

I guess hearing aids aren't covered by some insurance, but you still can't buy separate hearing insurance that would cover it (unless you count a more inclusive plan).
ok, i didn't clearly make my point initially. traditionally, dental and vision care were not seen as core medical issues relating to overall health, and that contributed to the structure in question as a marketing consideration. that was my only point.
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  #18  
Old 05-24-2010, 10:48 AM
Omar Little Omar Little is offline
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Markxxx hit it the closest...it costs to much. Not necessarily on an individual basis, because a heart transplant on an individual will certainly costs more than eyeglasses or a tooth filling. But in the group of insureds as a whole, including coverage for normal dental procedures with your medical procedures would be one of the most costly items covered...because normal dental work is a routine service that almost everyone needs regularly throughout their life. Open heart surgery...much more rare.

The best way to handle it is to separate it and insure it stand-alone.
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Old 05-24-2010, 11:15 AM
TriPolar TriPolar is online now
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Originally Posted by Wilbo523 View Post
Markxxx hit it the closest...it costs to much. Not necessarily on an individual basis, because a heart transplant on an individual will certainly costs more than eyeglasses or a tooth filling. But in the group of insureds as a whole, including coverage for normal dental procedures with your medical procedures would be one of the most costly items covered...because normal dental work is a routine service that almost everyone needs regularly throughout their life. Open heart surgery...much more rare.

The best way to handle it is to separate it and insure it stand-alone.
if you look at the cost of necessary dental care, cleaning, filling cavity, and the occasional extraction, insurance may cost more than those procedures. i don't have the statistics, but most dental insurance seems to cover more non-essentials than most general health insurance. you usually don't need root canals, an extraction will do. for most of your teeth, the extraction will cost less than the root canal.

as far as optical care, most of that cost goes to corrective lenses, which i consider a major rip-off. i see that most corrective lenses, spectacles and contacts, inflate the cost of the raw materials about 10000%. these are almost all made by pretty simple machines now, and i can't find a justification for this, unless you count outrageous profit taking only possible due to corrupt legislation a justification. now that i'm almost 100 years old, i use reading glasses occasionally. i can buy a pair of those for under $5. why should standard prescription eyeglasses cost hundreds of dollars? (yes this is off topic, but i said it anyway)
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Old 05-24-2010, 01:31 PM
thelurkinghorror thelurkinghorror is online now
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They shouldn't. Zennioptical and others put out cheap eyeglasses. Last time I bought from Walmart they were expensive. I haven't been paying attention too much, but it seems brick and mortar stores are getting cheaper, perhaps because of online competition.

Not everyone needs vision also, which might make it more "optional."
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Old 05-25-2010, 12:06 AM
AboutAsWeirdAsYouCanGet AboutAsWeirdAsYouCanGet is offline
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guess hearing aids aren't covered by some insurance, but you still can't buy separate hearing insurance that would cover it (unless you count a more inclusive plan).
actually it's MOST insurances that don't cover hearing aids. It's usually only the cadillaic plans that cover hearing aids
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Old 05-25-2010, 12:25 AM
Derleth Derleth is offline
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How close to the teeth before you have to switch insurances?

For example, I imagine throat cancer would be under medical insurance, correct? What about oral cancer sited exclusively on the tongue? Oral cancer on the gums but not directly threatening a tooth? A similar cancer, but this time one or more teeth will need to be pulled? Oral cancer on the gums that has invaded the pulp of one or more teeth?

I suppose you could do similar feats of insurance gymnastics with guys who get into fistfights and have injuries that involve the teeth, skull, and a lot of soft tissue at the same time. What about cases like those?
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Old 05-25-2010, 12:38 AM
Erdosain Erdosain is offline
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Originally Posted by Derleth View Post
How close to the teeth before you have to switch insurances?

For example, I imagine throat cancer would be under medical insurance, correct? What about oral cancer sited exclusively on the tongue? Oral cancer on the gums but not directly threatening a tooth? A similar cancer, but this time one or more teeth will need to be pulled? Oral cancer on the gums that has invaded the pulp of one or more teeth?

I suppose you could do similar feats of insurance gymnastics with guys who get into fistfights and have injuries that involve the teeth, skull, and a lot of soft tissue at the same time. What about cases like those?
I'm not aware of any dentists that treat cancer. If you have cancer, you go to a doctor, end of story.
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Old 05-25-2010, 02:42 AM
Derleth Derleth is offline
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I'm not aware of any dentists that treat cancer. If you have cancer, you go to a doctor, end of story.
OK, how about the street fighters? How much of a lacerated and fractured face is dental insurance and how much is medical?
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Old 05-25-2010, 02:07 PM
Cliffy Cliffy is offline
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Originally Posted by Derleth View Post
How close to the teeth before you have to switch insurances?

For example, I imagine throat cancer would be under medical insurance, correct? What about oral cancer sited exclusively on the tongue?...
My grandfather's dentist discovered a lesion on the roof of his mouth and referred him to an oncologist.

As for the OP, the short answer is that dental and optometry insurance isn't really insurance. Medical insurance is hired by people who might never get sick but don't want to be caught flatfooted if they do. Vision "insurance" is purchased by people who know they need glasses -- other people just don't go to the eye doctor. Occasionally people will have eye problems that require expensive treatment, but it's awfully rare. Dental insurance is similar, although not as dramatically differen than medical.

--Cliffy
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Old 05-25-2010, 03:00 PM
suranyi suranyi is offline
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Originally Posted by Wilbo523 View Post
Markxxx hit it the closest...it costs to much. Not necessarily on an individual basis, because a heart transplant on an individual will certainly costs more than eyeglasses or a tooth filling. But in the group of insureds as a whole, including coverage for normal dental procedures with your medical procedures would be one of the most costly items covered...because normal dental work is a routine service that almost everyone needs regularly throughout their life. Open heart surgery...much more rare.

The best way to handle it is to separate it and insure it stand-alone.
That's correct, and the same is true of vision insurance.

Remember, insurance companies work based on the average expenses of large numbers of people. The average person has very low medical expenses until quite late in life, but substantial dental expenses from childhood on. Also, many people need glasses starting at an early age, so once again many people have subtstantial vision care expenses starting quite early. Since the patterns of expenses are so different than for regular medical expenses, insurance is separate.

ETA: On Previewing, Cliffy also gave a very good answer.

Last edited by suranyi; 05-25-2010 at 03:02 PM..
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  #27  
Old 05-25-2010, 03:01 PM
md2000 md2000 is offline
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Medical insurance cover doctors etc.
Dental insurance covers what dentists do.
Eye care insurance covers new glasses.

In fact, my benefit is specifically called "vision benefit" and only covers glasses. Even with Canadian health care, I have to personally pay the $60 or whatever it was last time for the checkup to verify my prescription. Blue Cross only covers the specific purchase of glasses, every to years two a max of $250 or if the prescription changed appreciably before then.

Dentists, IIRC, only touch soft tissue in as far as it matters to tooth health (I.e. sew up after an extraction, kill the nerve tissue in a root canal.

In Canada, supplemental health care (minimal) pays for things Medicare does not cover, like private room if necessary, ambulance cost, TV rental in room, some prosthetics.

So real simple. Different professions, different benefits plans.

Dentists have fancy, state of the art offices because all that equipment is fronted to them by supply companies. You and I (or our employers on our behalf) pay for it. I recall a few dental students the year they were graduating and the huge amount of company propaganda they received and loan offers and term payments should they want to set up their own office.

Doctors, OTOH, don't usually need much big shiny equipment; anything too advanced you are referred to a specialist who does have (or has a hospital access for) the big toys. The examination tables don't wear out and nobody offers them new ones with built-in TV every 5 years... So a doctor usually just has those faded charts from drug companies on the wall; basically, all they do 90% of the time for their freebies is prescribe expensive drugs.

Last edited by md2000; 05-25-2010 at 03:02 PM..
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Old 08-28-2011, 12:10 PM
Snnipe 70E Snnipe 70E is offline
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Quote:
Originally Posted by Nefarious Chipmunk View Post
If I have a problem with my ears, I don't need to worry about having "hearing insurance". My medical insurance covers the problem. Why do the eyes and teeth have separate insurance. I would think that the health of my teeth and eyes would effect my general health. So why do I have different insurance for those two body parts/functions and not any others?

There are certainly other kinds of specialist that would be covered under my health insurance. I would use the same insurance for a podiatrist that I would use for an ENT. Why are dentists and optometrists different?
I have a problem with my ears. And I just found out this year that my medical insurance will not pay for hearing aids. Very few do. It cost me about $3000 all out of my pocket.
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