Another thread in this forum makes me wonder (again) why there is a separate insurance stream for problems that occur inside your mouth. I presume there is some historical or technical reason for this, as opposed to a physiological reason. That is, why does that one part of the body require a separate type of insurance? We don’t have nasal insurance, or rectal insurance. It’s a totally different type of coverage, and never, in my case, anyway, pays the entire amount. Why do we have medical insurance AND dental insurance? Is it “simply” a matter of the different type of degree the practitioners hold? And is there any movement to consolidate them?
But the mouth is covered by medical insurace. When a spot appeared on my tongue my dentist sent me to an oral surgeon. Thank god it wasn’t cancer. It’s basically the teeth and gums that are separated from medical insurance. Mostly I assume because of thier unique nature in the body, it’s the only area where bone breaks thru the skin. That interface has unique enough problems to warrent it’s own special care and most of those problems are preventable with proper hygene.
So are boils on your butt if you don’t bathe. I doubt that’s the reason. I think there must be some other historical factor.
When I had my wisdom teeth out they used my dental and medical insurance to cover it. So, the mouth is covered by medical insurance.
Ok - maybe I need to be more specific. Dental insurance - whatever it covers - is separate from medical coverage. Both deal with problems of the human body, whatever the cause. It seems somewhat peculiar that there is a separate insurance system for TEETH, alone. If you go to a dentist, you’ll have to avail yourself of dental insurance. If you go to a medical doctor, it’s different. I’m wondering why the insurance should be separated. If I’m correct, one can use medical insurance to help pay for a visit to an acupuncturist or even a chiropractor. What’s the reason for the distinction with dentists?
Vision care may be separate also, if you have it. It’s a separate insurance stream that pays for eye exams, etc.
What gets really hairy is the jaw, and any problems with it. Most dental insurance rejects TMJ coverage, saying it’s a medical issue, and medical insurance excludes it out as a dental issue.
OTOH, if my jaw got broken somehow, it would be treated under my medical insurance, and if any teeth got broken, they’d be treated by my dental coverage, once the jaw was healed.
Basically, the reason is isolation of risk, and premium management.
Most people will require some level of dentistry during their lifetime, and factoring the risks and costs would load the premiums if cover was for medical and dental. The products are separated so that people can make their own choices about premiums and cover plans for medical and dental insurance.
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The REAL reason is dental as well as vision, is too costly to cover. So they develop a seperate insurance for it.
Up until 1989 my medical insurance through Blue Cross of Illinois COVERED my dental and vision. So it wasn’t always seperate. I got a root canal, fillings, eye exams, and drugs (both generic and brand name - you chose) and it was covered as the old fashioned $100/10%/Free. (You pay the first $100, then pay 10% of the cost up to $10,000 then everything else is free.
Then HMOs became popular and dental was sepearted, then vision, the drugs. Now my last job I had sepearte insuarance for Medical, Dental, Vision, Prescription, and Long Term Acute Care. My job wouldn’t even cover name brand IF there was a generic equivilent. Even if you’re doctor ordered it. I recall helping one person with her claim and her doctor insisted she use a newer antibiotic and the insurance absolutely refused to pay it. Unicare said “Our doctors don’t feel you’re doctor is correct. She’ll have to find another doctor who will prescribe her the correct medicine.” (In other words the generic)
All were different and carried an additional charge as part of my paycheck.
The insuarnce industry will give you a lot of garbage, but the actual bottom line is dental and vision were too expensive, especially once people stopped getting dentures and they started fixing teeth. Do you know how HARD it is to get a tooth pulled if it doesn’t have to be. I saw three dentist who refused to pull my last molor, even though it hurt and was broken, because they said it could be fixed. ( I went to Cook County Hospital and got it pulled).
The insurance industry won’t admit it, but it’s purely money. They found a way to seperate the insuarnce and they won’t turn back.
Just as a guess, I’d say the thing about dental and vision is that virtually everybody will need both if they live long enough. And the thing about insurance is that they are like a form of legalized gambling: you periodically pay a small amount in hopes that you will win (i.e., receive the benefits of) a big amount later. If everybody is virtually guaranteed to need glasses and dentures as they get into their 50s, 60s and 70s, there’s not much of an angle for insurance companies to profit on.
Ah, yes, this is the historical and economic perspectives I was looking for. Such the great resource, the SDMB!
The real pisser about this is that dental always has extremely low caps on coverage amounts, so anything but the most routine dental problems cost you out of pocket. I’ve worked at two major software companies that were regarded as having some really fantastic health coverage, and both had $1500 maximum payout caps on dental. $1500 doesn’t even begin to make a dent in the type of dental expenses I have. I actually got an estimate from a single dentist once to fix my problems for $90k. There was a thread here a while back where a poster mentioned his troubles with dental implants that have easily gone into 6 figures. So in my experience, dental coverage is almost worthless.
Most people are going to have two dental cleanings a year. For a family of 4, that’s 8 cleaning a year. This isn’t really preventive medicine although I’m sure you could argue that it is but you don’t HAVE to go. Your teeth won’t fall out any time soon. But, for most people, they WILL go twice during the year. My dentist bills me $75 for each cleaning so that’s $600 of charges that the insurance company would have to shell out.
If one only had to go to the dentist for a filling or extraction, dental would be more likely to be included in the average medical insurance coverage.
Yeah, BTDT :mad: A few years ago I was caught in that jam, after my medical insurance carrier originally said my TMJ appliance was covered. I was out $1500.
The thing that really pissed me off was when a number of years ago, I was diagnosed with an irregular heartbeat (mitral valve prolapse). It meant that I had to take a megadose of prophylactic antibiotics before dental appointments, to prevent possible heart infections.
Normally, prescriptions for this purpose are written by a dentist, just as a matter of convenience. My HMO refused to cover the freaking $8 prescription for generic antibiotics, even though they were for a medical issue, not a dental issue, because the prescription was written by my dentist instead of my internist. So they would rather I scheduled a totally unnecessary appointment to have the same prescription written by an M.D.
I’m hoping that as further relationships between dental issues and medical issues are discovered (like the one between gum disease and heart disease), insurance companies will see fit to be less of a PITA about these things.
We ran into this a few months ago–my husband has a degenerative bone disease, and so gets terrible, terrible tooth abcesses. He had one flair up very quickly one weekend and by Sunday morning needed antibiotics at once. The urgent care place made us pay out of pocket because it was a dental issue, even though all a dentist would have done was written a prescription for antibiotics, exactly the same as the doctor did.
“They” and “insurance companies” covers a lot of ground. Usually nameless entities that provide fodder for the notion that corporations have some sort of conspiracy to Rob the Public.
Many of these answers might be satisfying, but the ones implying the cause is any sort of corporate conspiracy are BS, basically.
It’s not expense. Medical expenses can pretty much outdo your average dental expense. It’s not robber corporations. In our crazy US healthcare systems there is no question that assorted irregularities, downright inequities and a fair amount of sleaze all go on, but that’s not a reason dental insurance is separate coverage from vison and dental.
There is one main historic reason: Whose specialty domain are we covering?
Dentists do dental work.
Physicians (in the US, mostly MDs and DOs and assorted other providers working in the same general field) do medical work.
Optometrists do eye refraction analysis and correction.
Of course, it was never quite that simple, and it’s much more complicated today, with a lot more overlap. But as a rule of thumb, those specialties have distinct pathways for the folks who are degreed and licensed in them, and the various procedures those specialties do fall under larger umbrellas that are generally maintained and governed and regulated under those umbrellas.
In order to stay in business, an insurance company has to be able to assign an overall risk. One practical way to do that is to figure out the scope of what you are covering. To do that, your actuary must have some sort of definition to work with–for example “What physicians control” or “What dentists control.”
There isn’t any a priori reason a particular company couldn’t bundle all three, and of course in recent years there’s pressure to bundle a lot more: “What massage therapists do” and “What acupuncturists do” and “What homeopaths do” and on and on.
Where overlap occurs in what the core professions do, things get sticky and ridiculous fast, I agree; see Eva Luna’s post for an example.
You gave you own answer. Two different systems. Normally you do not go to a MD for your teeth, and if you have a major problem and need a MD for teeth work that work should be covered by your medical plan.
Dental plans can be complex on what they do and what the do not coverand what the limits are. Medical plans are also complex. If the plans were combined into one plan the administration of the plan would be hard and it would be imposable for the member to keep track of it all.
But what if you do not know the cause of something? I had a swelling on one side of my mouth. I didn’t know whether it might be an abscess or something else. I guessed to go to my dentist. Bad choice - it was a partially blocked parotid gland. While the dentist knew enough to diagnose it, this was a medical problem so neither my dental insurance nor medical insurance would pay. Welcome to the US medical insurance system - if you cannot diagnose yourself accurately, you pay for it.
Also, aren’t there non-eye diseases that can be caught early on with regular eye exams?