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Can Your Company Dental Plan Reduce Your Medical Claims Cost?

By James Edholm

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Published: 11Dec2010
Word count: 630
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New research is showing that your company health plan costs may be affected by your company dental plan.

It makes sense when you think about it. Your mouth contains about six billion bacteria of up to 400 species at any given time. And how many hundreds of times per day do you swallow?

Add to that research studies that show that chronic inflammation such as that involved with periodontal (gum) disease can lead to heart disease, particularly if diabetes is also present. Moreover, in one study pregnant women with periodontal disease were almost twice as likely to have an early delivery as women without periodontal disease or those who were properly treated. And a premature baby can cost $100,000.

What's missing in the discussion is the proven cause/effect relationship. There is a definite association between heart disease and periodontitis and between periodontitis and premature delivery, but that's different than actual cause and effect.

As Dr. Miles Hall, chief clinical director for Cigna, a leading health and dental insurer, puts it, "I'll be very frank: The studies that are out there show a strong association. At this point, they do not necessarily show a causal relationship."

Part of the reason for the lack of causal relationship is the lack of random studies. All they've looked at is the number of people with diabetes who have periodontal disease and develop heart disease. But some people with diabetes may go to the dentist regularly and get their gums cleaned appropriately. Those same people may also be more rigorous about measuring and controlling their blood sugar and may thus contribute to understating the health risks from poor dental practices.

What Carriers Are Doing About It

Two major insurance carriers, Cigna and Aetna, (both of whom write both medical and dental plans) are identifying the insureds who are at risk for heart disease:

those already identified,
those with diabetes and
those who are pregnant.

They are then incenting them to get their dental health evaluated. In addition to contacting them by mail and email, if they haven't seen the dentist within a prescribed time period, the carrier then calls them.

Is it worth it? Well, look at these facts:

* Stroke victims who got periodontal treatment prior to their stroke spent $10,000 per year less than those who only got the treatment after their stroke.
* Diabetes patients who got appropriate care for periodontal disease saved the carrier $1,418 annually in medical costs.
* Avoiding a premature birth can save as much as $100,000.

What Employers Can Do About It

The challenge is that your dental and health carriers are probably two different insurers. It's much harder to coordinate between two carriers than it is when there's only one.

But it's not impossible. With the appropriate use of a Health Reimbursement Arrangement and a properly communicated wellness program, you could institute your own claims reduction plan.

For example, here are some provisions to consider:

o Anyone with diabetes who is also diagnosed with periodontitis will be eligible for a one time root scaling and planning. The employer will reimburse any deductible or coinsurance incurred in the process.
o Furthermore, ongoing cleanings can be covered in full up to four times yearly (some dental carriers are already doing this for insureds with gum disease.)
o Likewise, employees diagnosed at risk for heart disease and pregnant women with periodontitis will also be eligible for no-cost periodontal treatment.

In structuring such a program it's crucial to coordinate via an outside administrator so as to avoid running afoul of HIPAA restrictions. It's a long-term payoff, but it could well be worth your company's effort.

Jim Edholm is an independent benefits consultant and broker. He founded BBI Benefits, in Andover, MA, in 1982, providing benefits design for companies in MA, NH and ME. To get his report on new dental trends for small - midsized companies, "Is Your Dental Plan Stuck in 1985" click here and enter the words "Dental 1985" in the question area of the form.

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