A family relative recently sent me an email about her dental plan and its failure to keep up with the times. Read below:
I have recently submitted a Dental claim, but the portion relating to a topical treatment, Prevora, was rejected, “as the claimant is not covered for this service.” Why not? I object to this exclusion -Prevora is a preventative treatment and is important for my general health. I have high blood pressure and a family history of heart disease – oral bacteria have been clearly linked to heart disease, and the reason I wanted this treatment very badly was to protect my heart health. Similarly, my husband’s claim should also be honoured, as he has a family history of dementia, and oral bacteria are also implicated in that disease. I feel strongly that my claim should be covered.
This problem is rooted in the old days of “the mouth is not part of the body.” This approach was taken by Canadian dental plan administrators in the 70s and 80s. This approach involves “chasing disease” as it primarily pays for fixing teeth after the bacteria in the dental plaque had done their damage. It is archaic and divorced from emerging science and preventive routines.
So why not get up to speed with the new reality that what happens in the mouth is closely interrelated with what happens in the body?
Inertia and self-interest it seems. The fact of the matter is that this “insurer”, like many others, makes its money from processing dental claims rather than getting its claimants healthy. A dentally sick individual makes more dental claims and generates more commission for the “insurer” than someone who is dentally fit.
Disappointing for all of us who simply don’t want an implant, or a crown or to have inflamed gums. My family relative will likely have no joy in dealing with her dental benefit plan and she seems upset.
My relative will pay for Prevora out of pocket for reasons cited in her email. She’s more up with the times than her insurance company. Go figure.