The financing model is complicated and there is no easy solution, said Jeffrey Johnston, chief science officer for Michigan dental insurer Delta Dental.
The legislative charter that allowed Delta Dental to be established in 1957 only allows Delta Dental to reimburse certified dentists, so hospitals and anesthesiologists cannot reimburse it.
“Even if they were reimbursed for services at a competitive rate, dentists just don’t bill as much as a cardiologist would say for an angioplasty,” Johnston said. “Your typical dental procedure in the operating room will probably run out to less than $7,000, which is next to nothing compared to a knee replacement or bypass.”
And dental plans have maximum payouts, making coverage cheap enough for customers. Delta Dental’s maximum payout is $2,000 per year for the most expensive plan, meaning an expensive operating room procedure would have to be paid for out of pocket by the pediatric patient’s parents if it exceeds $2,000. That’s way too rich for the patients who often need these procedures.
“If you look at the population, the greatest need for this care is in the Medicaid population,” Johnston said. “But they also have the lowest amount to pay out of pocket.”
Delta Dental is promoting two solutions to the problem: bringing pediatric anesthesiologists to the dental office and providing comprehensive benefits to low-income dental patients to prevent 4-year-olds from needing 12 crowns in the first place.
Currently, pediatric anesthesiologists are certified by the Michigan Board of Medicine and not by the Board of Dentistry, which prevents them from performing anesthesiology outside of medical settings such as a hospital or outpatient surgery center.
But Governor Gretchen Whitmer, May signed a package of bills that covered wider use of anesthesiology services across the state. Under House Bill 4067, which does not take effect until September 1, 2022, the Dentistry Board can certify specialties such as oral radiology, oral health, and dental anesthesiologists.
Vazquez said it is a win for pediatric patients and dentists.
“It’s very important that we use an anesthesiologist here, in this environment where we feel comfortable and the kids feel more comfortable,” said Vazquez, taking a break from his young patient’s drilling and screaming. . “She won’t remember this. The drugs cause temporary memory loss. But she’s scared. She wouldn’t be under the right anesthetic.”
But there are only a limited number of pediatric anesthesiologists in the country who can act in the dental space, Johnston said. Prevention therefore remains the biggest step in combating the problem.
In the fall, Delta Dental plans to increase funding for low-income patients. This allows for more dental cleaning visits and other preventive care. The insurance company also pays for dentists to take online courses from the University of Pennsylvania that specialize in patients with special needs.
“We need to encourage dentists to see more patients with special needs,” Johnston said. “If we can increase (dental) use in children, we can prevent all of these problems and prevent these children from even needing an operating room.”