I would be retired today if I had a dollar for every time a patient asked me if their insurance was going to cover something. If it is not covered, I don’t want it. Whatever it was that I was recommending.
Why does my medical insurance not cover it if I need it? This is a great question. After all, the mouth is part of the body! Yet even with insurance, it is treated separately. Why?
What is the role of the mouth?
Our mouths and teeth let us make different facial expressions, form words, eat, drink, and begin the process of digestion. The mouth is essential for our survival. With the lips and tongue, teeth help form words by controlling airflow out of our nose and mouth.
The mouth and teeth are an organ that is vital to the well-being of the individual. Digestion. In a healthy mouth, tissues are moist, pink, firm, and pain-free.
Your mouth is part of your digestive and immune systems. This oval-shaped opening in your skull starts at your lips and ends at your throat. Your mouth allows air and nutrients to enter your body, and it also helps you eat, drink, speak, breathe and sleep.
Saliva is produced in the mouth aids in digestion and contains the antibody IgA that lines your oral cavity and helps kill bacteria. This helps prevent cavities and bacteria from being ingested and passing into the rest of the body through the digestive tract.
Throughout history, there has been a disconnect between the mouth and the body. “When was the last time a physician asked you about your mouth?
Doctors should be asking about oral health because more and more research has emerged in the last few decades showing the health of the mouth has a direct impact on the health of the body.
Somehow the insurance companies seem to dictate the treatment options in Dentistry. Why? Because we let it! Which I cannot wrap my mind around.
Insurance does not cover prevention much in the way of prevention. If it did, they would cover sealants for both molars and premolars until the teeth erupt in the mouth and fluoride for adults if they believed it was so beneficial. The best time to apply fluoride for high-risk patients is right after they have a cleaning because that is when your teeth are the cleanest. I have seen hundreds of children who do not get the second molars until 14-16 their insurance only covers sealants up to the age of 13. So that benefit is lost to the patients whose development does not match the insurance criteria.
Dental insurance covers treating disease and usually at only 50% with a yearly maximum of $1000-2000 a year. Which is fine if you have a healthy mouth. Sixty-four million Americans do not have a healthy mouth.
For the millions of Americans who are walking around with an infection in their mouth, their dental benefits are only going to cover half of the expense. Since most people are living paycheck to paycheck, guess what is last on the list of things to do? By the time you pay your bills and the insurance premiums these days there is not much left for extras.
When you have an infection in your mouth, you generally do not feel pain until the disease has progressed.
Dental disease is a silent disease most people do not even know they have it.
If you were to compare dental disease to cancer by the time you feel the symptoms, you would be in stage four.
If you went to your Dr. and he told you you had cancer and recommended a course of treatment……
Would you research alternative treatment options? Would you just go with the recommended treatment? Would you do whatever you can to fight cancer?
Would you say I need to know what my insurance will cover first? Let me think about it. Trust is a major issue when it comes to treatment these days.
Studies show that gum disease is linked to several chronic diseases, including the leading cause of death in the US, cardiovascular disease, stroke, diabetes, and pregnancy complications. The disease starts with how you breathe and what you put in your mouth.
This is because your mouth is full of bacteria – both good and bad. Without proper oral hygiene, bad bacteria can lead to an oral infection. Since the mouth is the gateway to the body, the infection can get into your bloodstream and travel to other parts of your body.
it is all connected, a very synchronized ecosystem. When are we going to start paying attention to our greatest asset and making choices to prevent disease or catch it early so we can change our habits rather than treat the symptoms once they manifest?
Your mouth is a window into the body, and some diseases have warning signs that start in the mouth. When it comes to health, the mouth is usually the last place we look. Your dentist is a great source of preventative care
According to the CDC, only half of Americans between the ages of 18 and 64 with private health insurance have dental coverage. The important thing to remember is you don’t need dental insurance to visit a dentist.
Some dentists recommend you visit them every six months for a cleaning. Your dentist can advise you best on how often you should schedule a visit. The dentist will screen you for oral cancer and check the health of your mouth so you can prevent future health problems and treat any issues before they get worse. Prevention is the keyword. It will save you both time and money in the long run.
Dental insurance generally covers two cleanings per year. Without insurance, the cost of cleaning can range between $100 and $500 with an exam and X-rays.
Dental insurance is intended to cover healthy mouths. You get a max of $1000-2000 per year if you are lucky to cover dental expenses with a lot of restrictions. You are allowed two cleaning a year, but that is for a healthy mouth. Pink gums, no bleeding, no bone loss, gum measurements within 1-3 mm.
85% of our population has some form of gum disease, and dental insurance does not even have a code to cover those cleanings. 4-6 mm probing depth with no bone loss. They have a periodontal maintenance code that may cover 4 per year every three months, which is recommended to disrupt the bacteria before it can cause damage to the bone, but it is only covered if you have had a deep cleaning and a deep cleaning is only covered if you have radiographic bone loss, which is subjective to the human eye or AI.
It becomes a question of even though you have insurance, why won’t cover what you need, or do you max out your yearly benefit? If you have waited until there is pain, dental disease is expensive to fix, and you will have to pay out of pocket to get back to a healthy baseline. Cavities, bleeding gums, and pain are all signs that something in the body is out of balance.
Despite the connection between oral and overall health, doctors and dentists have separated the two. We believe it’s time doctors and dentists work together to improve patients’ overall health care. We encourage you to listen to your body and share information about the health of your mouth with your doctor.
Print this helpful guide with the five questions we recommend you ask your dentist. We’ve included a checklist you can take with you to your next dental appointment. Share the information you learn from your dentist with your doctor. You might identify health issues that started in your mouth so your doctor can better treat them.
Today’s increasing everyday costs mean many Americans are looking for ways to save money. One simple way to save yourself time and money is on your at-home dental hygiene routine. Look at how you are breathing. What are you eating?
Doctors will not make you healthy. Drugs will not fix the root cause; they may mask the pain or manage the symptoms. The choices you make will determine your fate, good or bad.
You always get to make the decision. No decision is a decision. If you have insurance, use it when you are paying for it anyway. You can choose to go with the recommendation or not. At least know the health of your body.
There are blood tests, urine tests, and hair analyses to let you know what is in balance and not in your body. I wish I had known about these before I had cancer.
Your insurance may or may not cover them. When I was diagnosed with cancer, they did not look at the rest of my body; they only treated the breast.
They did not scan my whole body? The standard blood work did not check for heavy metals or what was out of balance in my body.
I researched what I could do and found there is much more we can do to find out where we are now and take action to get our bodies back in balance before we get a wake-up call, as I did. I have a friend Melissa Dealy who has a podcast called don’t wait for the wake-up call. She is a slayer of toxins. In next week’s podcast episode, she will be sharing things you can do to get ahead of disease or bring your body back into balance and take action before you spend your savings on costly treatments to cut out. Burn out or poison your body to treat the symptoms, not the cause.
My insurance was billed over $150,000.00 for my cancer, and it drained my health saving account to pay my deductible and out-of-pocket expenses to treat my cancer.
I had to fight my insurance company and the hospital for my treatment to run a test that was in my best interest to see if my cancer would respond to chemotherapy. They did not run it automatically because the insurance did not cover it. I had to ask, are you treating my insurance company or me?
I got the test done, and I did not need chemotherapy or radiation, but I would have had it done if I had followed the protocols. Not everyone fits into the protocols. You need to be your one advocate and listen to your gut.
I have found alternatives to the standard of care. I want more. I am demanding more. There are tests that are not invasive and can give you answers if you ask the right questions to the right people.
I had a thermogram done. It was $475 dollars for my whole body, and it showed I had a tooth that was a problem and that the cancer was just in my breast before the biopsy. There are tests you can do that will cost a lot less than waiting until you have symptoms to find out if you are healthy.
You get to choose your path. Your thoughts are what keep you where you are. If you want better, you need to make a change in your thoughts, your habits, and who you surround yourself with.
Insurance is a gamble on how much we pay into what gets paid out. You may need it, or you may not. For most Americans, taxes and insurance are their biggest expense. They work to pay for both. Yet feel they cannot afford to use the insurance because of the deductible and out-of-pocket expenses. We have a broken system and it is so sad to watch so many people struggle just to be healthy.
Why not start with where you are now and what you can do today?
When you focus on problems, you have more problems. You get to decide what your habits will be, and your habits will determine your future. I am not sure who said this, but for me, it is true.
If you are depressed, you are living in the past, and if you have anxiety, you are living in the future. If you are at peace, you are living in the present.
No matter what the situation, never let your emotion overpower your intelligence.
In the end, you have to take responsibility to save yourself. No one else will.
A healthy mouth is a healthy body and a happy, healthy life.
