Over the past couple of years, I’ve been relentlessly pestered by my dentist’s office. I’ve lost track of the frequency of texts, emails and phone calls. When the overt neediness increased even more at the end of last year, I realized it had barely been six months since our last date.

Is it just me or are dentists really stepping up the pressure lately?

I finally responded to the regular missives and saw my dentist in mid-January. As usual, it was an uneventful checkup and cleaning, followed by the increasingly common suggestion, as I headed out the door, that we see each other more often. If it’s necessary, I have no problem seeing my dentist twice a year, but the reason for more frequent visits isn’t related to my dental hygiene or general health — I’m told I should come in regularly because it’s covered by my insurance.

Read: Understanding the costs of dental benefits

Due to the nature of my job, I’m very familiar with how my benefits plan works. For dental benefits, I have a co-pay and a set maximum annual spend. But just because I have a set amount to cover the dentist, it doesn’t mean I have to reach that maximum every year. This type of blatant, unnecessary overuse begins to verge on benefits abuse.

In this month’s Benefits Update, Green Shield Canada’s Ned Pojskic says emerging evidence is suggesting that, for healthy adults, regular dental cleanings may not actually be necessary. That really surprised me. As far back as I can remember, I was told to diligently visit the dentist every six months — no questions asked. If it turns out a biannual visit isn’t necessary, then I’m not about to keep it up just to make use of my benefits plan.

In breaking down the $26.9 billion in extended health-care costs covered by insurers in 2018, $8.5 billion went to dental coverage, according to the Canadian Life and Health Insurance Association’s annual fact book. That amount has been on a gradual upswing, rising from $7.9 billion in 2016 and $8.1 billion in 2017.

As the Benefits Update notes, the industry has been focused on the rising costs of drug and paramedical benefits, while dental benefits fly under the radar. But we need to start paying attention. While I hate to point a finger at my dentist, focusing on how much my benefits plan covers rather than whether I actually need my teeth checked leads to over-billing. I imagine many people — especially those who aren’t in the industry — just do what they’re told by a health professional, rather than considering the impact on their employer and their insurance company.

Read: What dental benefits topics should plan sponsor be considering?

Fortunately, the industry is starting to recognize this trend. The Canadian Life and Health Insurance Association is concerned about over-billing, but it doesn’t yet have its own research on the issue and so relies on resources from dental colleges instead. There are levers to help insurers assess whether a claim is appropriate, as you can read in the Benefits Update, but how often are these actually being used?

As employers face challenges from all sides, I urge everyone to consider whether the coverage they’re claiming on their benefits plan is actually necessary — and sustainable. We all have a part to play in ensuring private health benefits continue to address our needs, whether you’re the patient, the employer or the insurance company. It’s a fine balance and it’s so important that we get it right.

Jennifer Paterson is editor of Benefits Canada.

Copyright © 2020 Transcontinental Media G.P. This article first appeared in Benefits Canada.

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jennifer paterson:

Dental costs are indeed back on the radar! Check out dentist per capita, no price competition, the growth of corporate dental, succession planning of old time dentists, growth of dental business consultants, etc. Interesting that years ago a dentist was unable to advertise outside of a listing in the Yellow Pages.

Re: 6 vs 9 month recalls. It could be urban myth, but I’ve been led to understand the root of this was a business deal between a toothpaste ad campaign and a dental association. Years ago, the ODA had commentary on 6 vs 9 months posted to their website — that posting is long gone.

The golden goose (benefits plans) laying the dentist’s golden eggs is tired.

Friday, March 20 at 10:31 am | Reply

Dave Patriarche:

RIGHT ON !

We are seeing more and more dentists using software that collect and track your plan design in order to maximize utilization. This is a big driver of costs. Don’t even get me started on the co-pay dental fraud.

Tuesday, March 24 at 8:34 am | Reply

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