How Dental Insurance is Improving Subscribers' Health

Today, everyone is more aware of the close relationship between dental health and medical health. It is common for physicians to refer their patients to a dentist before a major procedure to ensure that dental health is optimal. Poor dental health may affect the heart. Uncontrolled gum disease may make it difficult for diabetics to control their blood sugar level. It has even been suggested that there is a link between gum disease and low birth weight. Dental insurance companies recognize this relationship and are working to improve their clients' overall health while supporting improving dental health.

A year ago, Dental Blue of Blue Cross Blue Shield of Massachusetts rolled out Enhanced Dental Benefits. Dr. Robert Lewando, Associate Medical Director of Dental Blue, describes the Enhanced Dental Benefit this way:

The Enhanced Dental Benefit Program is designed to help keep the amount of infection or inflammation in the member's mouth to a minimum. With this program, one would receive coverage for an additional two cleanings (or periodontal maintenance visits if their dental plan offers group 2 benefits) every twelve months at 100% coverage with no co-pay. Additionally, periodontal scaling and root planning would be covered at 100% with no co-pay once every 24 months. These Enhanced Benefits will not be subject to a member's deductible or calendar year maximum so that your coverage for other services will not be reduced.

To qualify for the Enhanced Dental Benefit Program, you currently must have a diagnosis of Diabetes or Coronary Artery Disease (CAD) or are pregnant.

How is it that increasing the frequency of dental prophylaxis will benefit those patients with diabetes and heart disease? Is there published research that supports this?

There is an association between oral health and the control of diabetes, the progression of coronary artery disease, and the risk of having a pre-term or low-birth weight baby. Although oral infection does not cause these conditions, it is considered a risk factor that can make control of theses conditions more difficult if left untreated. Whether the treatment needed is scaling and root planning or simply more frequent cleanings, all of these treatments are geared to decreasing the amount of inflammation in the mouth and its potential systemic effect.

Studies have shown that the control of diabetes may be more difficult when oral inflammation is present. Oral inflammation may be a risk factor in the worsening of coronary artery disease, and oral inflammation may make the likelihood of having a pre-term low birth weight baby greater.

This benefit is available to all Dental Blue members. When their medical coverage is through Blue Cross Blue Shield, enrollment in the program is automatic. Without BCBS medical coverage, enrollment requires that the member's physician fill out a short, one page form indicating that the member has heart disease, diabetes or is pregnant.

Blue Cross Blue Shield will begin researching the utilization and effectiveness of this program later this year.

Dr. Doyle Williams, Chief Dental Officer of Delta Dental of Massachusetts, reports that his company has a similar benefit available to their members. When describing Delta's benefit plan Dr. Williams begins by pointing out that that only about one half of diabetics carry a diagnosis. Many people who have heart disease do not know it. Therefore, Delta Dental believes that it is important to treat anyone who has gingivitis or periodontitis (gum disease) aggressively.

Delta's plan includes the provision for deep cleaning, also known as scaling and root planing, every 2 years, and 100% coverage for periodontal follow up and cleaning every three months. That way, if someone develops or has a sub clinical (not so noticeable) case of heart disease or diabetes, or if a woman becomes pregnant, gum disease does not become a factor.

Other insurance companies such as Cigna and Aetna have their own way of using dental coverage to improve physical health. Since there are so many insurance companies with so many different plans, it is very difficult for dentists and dental staff members to become expert on each plan. Dental patients should study the benefits manual for their own plan. Bring the manual to your dental office. Discuss your coverage with your dentist and the person who prepares the insurance claims.