The funding model is complicated and no easy fix is evident, said Jeffrey Johnston, chief science officer for dental insurer Delta Dental of Michigan.
The legislative charter that allowed Delta Dental to form in 1957 only allows Delta Dental to reimburse board certified dentists, so it can’t reimburse hospitals and anesthesiologists.
“Even if they were reimbursed at a competitive rate for services, dentists simply don’t bill out as much as say a cardiologist does for an angioplasty,” said Johnston. “Your typical operating room dental procedure probably tops out at less than $7,000, which is almost nothing compared to a knee replacement or bypass.”
And dental plans have maximum payouts, which allows the coverage to be cheap enough for customers. Delta Dental’s maximum payout is $2,000 annually for its most expensive plan, meaning an expensive operating room procedure would have to be covered out of pocket by the pediatric patient’s parents when it exceeds $2,000. Which is far too rich for the patients often requiring these procedures.
“When 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 of funds to pay out of pocket.”
Delta Dental is promoting two solutions to the problem: bringing pediatric anesthesiologists to the dentist office and to offer extended 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 not the Board of Dentistry, therefore not allowing them to perform anesthesiology outside of medical establishments like a hospital or outpatient surgery center.
But Gov. Gretchen Whitmer signed a package of bills May that covered a wider use of anesthesiology services across the state. Under House Bill 4067, which doesn’t go into effect until Sept. 1, 2022, the Dentistry Board can certify specialty fields such as oral radiology, oral public health and dental anesthesiologists.
Vazquez said it’s a win for pediatric patients and dentists.
“For us to use an anesthesiologist here, in this setting where we’re comfortable and the kids are more comfortable is a big deal,” Vazquez said, taking a break from the drilling and screams of his young patient. “She won’t remember this. The drugs give a temporary amnesia. But she’s scared. She wouldn’t be under the right anesthesia.”
But there are only a limited number of pediatric anesthesiologists in the country capable of performing in the dental space, Johnston said. So prevention remains the biggest step to combating the issue.
In the fall, Delta Dental is planning to increase its funding for low-income patients. This is allow for more teeth cleaning visits and other preventive care. The insurance provider will also pay for dentists to take online courses from the University of Pennsylvania specializing in special needs patients.
“We need to encourage dentists to see more special needs patients,” Johnston said. “If we can increase (dentistry) utilization in children, we can prevent all these problems and prevent these children from even needing and operating room.”