Oral Health Integration Programs
The connection between oral and overall health is well documented and widely accepted in both medical and dental industries. Thankfully, insurers are starting to acknowledge the relationship too, designing benefit plans that reflect that. A recent news article from the American Dental Association (ADA) took a look at some of these currently available plans.
Cigna, an American worldwide health services organization, offers their Oral Health Integration Program, providing certain patients 100% reimbursement for copays or coinsurance for some dental procedures. Patients who are pregnant, or who are living with certain conditions, like diabetes, chronic kidney disease, side effects from head and neck cancer radiation, among others, can receive this benefit for periodontal treatment or cavity protection at no additional charge. Dental providers can find out if their patients qualify for the additional coverage when they call the insurer to verify benefits.
“We’re starting to see this more and more as insurance companies begin to realize how closely oral health is connected to a patient’s overall health,” said Dr. Ronald Riggins, chair of the ADA Council on Dental Benefit Programs. “We want dentists to be aware of these benefits so they can alert their patients, who may not be aware these are available to them.”
In 2007, insurer Aetna began its Dental Medical Integration program after they were involved in a study that found that people with diabetes, coronary artery disease and cardiovascular disease had significantly improved risk scores when also receiving dental care. The same study also found that medical costs for patients with those conditions who had been treated for periodontal disease were approximately 12% lower. This program offers extra benefits, like additional cleanings and periodontal services, covered at 100% for plan members that qualify. Since its inception, more than 1.5 million members have received over $30 million in benefits.
Northeast Delta Dental has focused on the concept that benefits are most effective when personalized, with their “health through oral wellness,” or HOW, program. In order to qualify, patients must submit a risk assessment, completed by their dentist, that indicates their risk of developing periodontal disease or dental caries as moderate to very high. Eligible patients are then awarded four prophy or periodontal maintenance visits annually, up to four fluoride varnish treatments annually, sealants for adult and deciduous molars, oral hygiene instruction, nutritional counseling or tobacco cessation, and caries susceptibility testing.
To find out if your dental coverage offers extended benefits, call your carrier or speak to your dental professional team.