http://www.npr.org/templates/story/story.php?storyId=147544667
I had no idea people go to ER for dental problems…
How can we fix this and what is it like in other countries?
To start, there is no logical reason that dental insurance isn’t part of medical. If medical will cover a broken bone it should really cover a broken tooth.
What is the basis for not including dental as a part of medical insurance coverage? Is it because dental care is considered cosmetic and/or luxury?
What if you cannot afford to get dental treatment and you have abscessed tooth or gum infection?
Honestly, I have no clue about the rationale. Makes no sense. Most dentists will try to work out a payment plan, or there are clinics and dental schools. But many, many people just suffer. 
There was a case several years ago (sorry, I don’t have a cite) about an 8- or 9-year-old boy in Washington D.C. (?) whose mother could not afford a needed tooth extraction for him. By the time the infection became severe enough for him to be taken to the ER, he was in dire condition. As I recall, approximately $250,000 was spent in an effort to save his life – which they didn’t. Kid’s dead, a quarter of a million dollars of taxpayer/premium-payer money gone, and a grieving mother. For want of a $90 tooth extraction.
Or less for the check up and filling that would have prevented the abscess in the first place. What a terrible story.
Here in Brazil we have universal healtcare, but dental care is not a part of it. I really don’t know why.
I believe that if you have a serious problem they will treat you, but i really don’t know how that works.
Found the article. Apparently he was called Deamonte and he was 12. My parents went to Washington D.C. in the 90s to visit the legal offices of the lawyers investigating accusations of CIA cocaine shipments (I think they were pro bono)… apparently a mile in any direction of Capitol Hill and there’s immense poverty, not sure if it’s changed since.
In the UK, Thatcher partially dismantled the UHC nature of dentistry. Now, most dentists are private; however in most locales there are one or two “NHS dentists” which provide dental care that is subsidised by the state. They get paid a standard amount by the NHS per procedure.
There is usually a huge waiting list for them, and IME the level of service is not as good because they are oversubscribed - though the level of care is. There are rumours of them performing unnecessary fillings etc. to get more money out of the NHS (highest payment for the least work), but I can see there would be a similar issue with private dentists too.
ETA: never heard of people in the UK going to the ER for treatment though.
Because dental repair is something almost everybody needs, so it is difficult to spread the cost over a group. Dental insurance rarely saves you much money after paying the premiums.
You suffer until you’re sick enough to go to the ER.
Cost and difficulties obtaining treatment are good places to start, along with the real fear and unpleasantness of the experience.
Going to the dentist blows. For those of us that don’t live in large cities, there ay not be a lot of choices in providers, so they usually have a good wait for new patients. Usually they are rather expensive and not covered by insurance. (you need a separate policy) Payment plans seem out of reach or ridiculous for a lot of people, as do the costs of maintaining a separate dental policy. Assuming those are not issues, there are often problems with the dentists actually accepting the insurance you DO have…etc etc… All for a procedure which is never pleasant, always painful, and for many filled with shaming lectures. So people just don’t go.
A good start would be insurance reform here. Mandate that basic dental services, such as extractions, fillings, and cleanings are included in all medical policies; and at no cost for cleanings, and an extremely low co-pay >20$ for other basic services.
Assure that providers must accept all insurances legal in the state. We should have been doing this years ago anyway. This should be tied to their license to practice.
I’m a government employee, and they don’t offer us dental insurance. A year ago, I went to a local dentist for some tooth pain. I had to pay 100 bucks up front, and the dentist examined for less than a minute and told me I would need a root canal and crown. Like $1500 in repair work.
I asked about doing a payment plan, and the best they can offer is a loan service if you get credit approved. Otherwise, $1500 up front. It’s definitely a money making racket. 100 bucks of my hard earned money for just one minute of service. No other business rapes customers like that.
I’m going to stick up for my poor, unloved dentist friends here. Keep in mind if your tooth hurts like hell, just pulling it out and performing a root canal/crown will both address the problem, but the latter can cost 50 times more than the other, depending on the tooth. Does everyone get the root canal? What you are describing isn’t really insurance, it’s just subsidized dental care. Nothing wrong with that, of course. But if everyone gets good dental care, it’s going to be expensive, and those least able to pay for will be the ones who need it the most
Great! I’m going to start a plan that pays providers 10 dollars for a filling, 50 dollars for a root canal, has a 5 dollar copay and a 10 dollar a monthly premium. Cleanings are free. I’m guessing it will be very popular with consumers, less so with actual dentists. I’d be willing to bet quite a lot of money that there are still people who don’t bother to sign up for it though.
Will my plan be legal? Because if so, sounds like easy money.
If a dentist has a busy schedule full of paying patients, does he have to cancel some of them to make room for my discount insurance patients? Can he limit the number of discount patients he sees in a month, like many Medicare and Medicaid providers do?
How many dental plans do you think are typically available in a given state? (It’s more than you probably think) How much time do you think it takes to sign up for each one including paperwork, paper and electronic claims registration etc? Dealing with a few companies for the majority of your claims makes things much easier for your business office. Will providers be compensated for the hassle of dealing with dozens of different insurance companies? If an insurance company is late with reimbursements checks, routinely loses claims or otherwise provides poor customer service, does a dentist still have to deal with them?
By the way, if you want all medical insurances to cover dental, and all dentists have to accept all insurances, they will be signing up with literally 500+ insurance plans.
I’m all for heavily subsidized dental care for kids, though I realize that’s going to be a significant expense. We should probably get them medical coverage first, though. For adults? That’s a harder sell for me.
Timely thread for me here. I’m just today taking my last penicillin vk after a trip to the ER ten days ago for an abscessed tooth. In my case I thought it was the most horrendous ear infection the world, but still, I did go to the ER for dental reasons. I would have gone even if I knew it was dental because I have no other option, like most poor adults in the United States. When we have no option but to wait until we have an abscess and then JUST treat the abscess, the cost is much greater for everyone. I don’t know where “most dentists” do payment plans but I haven’t found one yet who will take on a new patient with any payment plan and the oft-given advice to find a dental college is useless as well. Yes there is a dental college but it’s still going to cost over 100 dollars upfront.
When I asked the SDMB once why dental isn’t part of medical insurance, I got this excellent answer from RealityChuck:
I am a dentist and let me add my two cents worth. Usually going to the ER for dental problems is a waste of time about the only thing they will do is give you pain meds and or antibiotics. They seldom take care of the source of the problem. As to why dentists want money up front, we can’t take our work back if you don’t pay and at least in my state, you cannot refuse to treat a patient of record just because they owe you money. If someone comes in with a broken front tooth and I put a crown on it and they don’t pay, I’m out about two hours of overhead and $100 of lab bills. If they show up a month later with an emercency I am required to treat them. I Can’t say "I’ll treat you when you take care of your bounced check. Try buying groceries at a store using a check where your last one bounced. Or asking to take the food home with a promise to pay next month.
One other thing, about 40% of my practice is Medicad, that is free dental care for minors. Many of them will have decay diagnosed at a cleaning appoint and yet wil not get it fixed even though it is free to them. They may come in every six months for a couple of years and never get the cavity fixed, then one weekend it swells up and the go to the ER. After spending several hundred tax dollars in the ER they finaly get the tooth fixed, but now it is $1800 for a root canal, build up and crown on wht two years before would have been a $100 filling. Are all Medicad patients this way? Of course not and I truely enjoy helping those that are responsible, but dental care(insurance) and by extension medical care should not be free. People need to be responsible for themselves. Help is one thing free is something completely different.
The problem is that you have to go to the dentist for a cleaning, with the corresponding price that implies. Dental hygienists have argued that this is a problem.
http://www.adha.org/profissues/preceptorship/paper.htm
More access to better preventative care cheaper. IMO.
It isn’t. There’s probably another thread as to whether it’s better to have society, individuals or insurance pay for medical care though.