An estimated $108 billion was spent in the U.S. on dental services in 2010, according to the Centers for Disease Control and Prevention. Because of the high cost of dental care, more employers are scaling back or eliminating dental coverage as a benefit. Encouraging employees to make cost conscious decisions might be a better way to curtail the growth in dental costs borne by employers and employees, according to Change Healthcare, a provider of medical claims pricing data.
Change Healthcare's third-quarter 2011 Healthcare Transparency Index report reveals considerable price disparities and local savings potential for the most common dental services. That's significant because dental plan designs typically have higher out-of-pocket costs for patients than do medical plans, making the market for dental services much more consumer-driven—and providing an incentive for employees to comparison shop, once they understand that doing so can save them a considerable amount of money.
The index, which analyzed more than 30,000 in-network claims nationwide over a 12-month period, found that the billed amounts for dental services could vary by more than 400 percent in the same area for the same service.
Billed amounts varied by more than 400%
in the same area for the same service.
“Unfortunately, dental services are one of the first benefits to be cut when the budget gets tight, creating risk related to a lack of compliance with recommended dental care, including checks for secondary conditions such as mouth cancer,” commented Howard McLure, Change Healthcare’s chairman and CEO. The index data, he added, “demonstrates that patients do have significant cost saving options for common dental services, especially important as the employee’s share of these expenses increases.” Below are highlights from the index report.
Preventive Dental Exams
Routine dental exams are the primary way to prevent tooth decay and gum disease. An estimated 75 percent of U.S. adults suffer from gum disease, and while tooth decay is the most common and preventable disease in children, a U.S. Department of Health and Human Services study found that only 48 percent of children entering kindergarten had seen a dentist in the previous year. With cost a significant barrier to proper care, the index found that the same preventive exam for adults could cost as much as $240 and as low as $55 in the same area, while pediatric exams ranged from $180 to just $35.
Cavity Fill and Repair
One of the most common dental corrective procedures, cavity repair offers major savings potential. The index revealed that patients could be paying up to three times as much per cavity, with cavity repair at the high end costing as much as $360—making these services unattainable for many and leading to more expensive long-term health issues.
Having braces is a fact of life for millions of American children and adults. However, insurance carriers often offer a fixed amount or maximum benefit allowance for braces, and in many cases individuals might need braces twice in their lifetime. The index reported a high cost for orthodontic services (including a pre-visit, braces application and follow-up visit) of $6,960 vs. a low cost of $2,400 in the same area.
Wisdom Teeth Removal
Recommended by most dentists as a way to maintain oral health and appearance, removal of wisdom teeth is a generally painful procedure, physically and economically. The index showed that a patient could save more than $2,000 by changing providers. Many medical plans cover wisdom teeth removal, and as more employers and consumers switch to consumer-driven health plans, cost transparency offers significant savings opportunities.
The index uncovered other trends regarding dental services, including the following:
• Seasonality. The claims data indicated a steady decline in dental visits in each quarter, with 38 percent of all services occurring in the first quarter of the year and trailing to only 16 percent in the fourth quarter. This is in stark contrast to the medical industry, where claims typically increase toward year-end, according to the index report.
• Mars and Venus. Women were more likely to receive dental care, averaging 1.31 visits per year vs. 1.11 for men.
• Young and old. Seniors aged 60 and above were the most likely age demographic to receive dental care, while young adults aged 21 to 30 were the least likely—although good dental health when young can prevent serious problems later in life.
Stephen Miller, CEBS, is an online editor/manager for SHRM.
Health Care Consumerism Needs Transparent Cost, Quality Data, SHRM Online Benefits Discipline, April 2011
Tips for Evaluating Dental Provider Networks, SHRM Online Benefits Discipline, March 2011
Dental Benefits Undervalued Without Effective Communication, SHRM Online Benefits Discipline, August 2009
SHRM Online Benefits DisciplineSHRM Online Health Care Reform Resource Page