By Marianela Toledo | Florida Watchdog
MIAMI — Receive a crown at the dentist and pay in cash.
That’s what Elena Lopez did at a recent appointment with her dentist in Coral Gables.
Though she has dental insurance, it isn’t nearly enough to cover the basic expenses in just one visit.
“Cheap always ends up being expensive,” she told Florida Watchdog. Her dentist recommended paying nearly $1,400 out-of-pocket for the new crown, forgoing the options available with her dental coverage.
“I work for you, the patient,” Lopez’s dentist told her. “But it’s better to not have the dental insurance.”
Lopez has paid $32.72 each of the past 10 months for the insurance, but in the middle of the treatment she learned it would cover just 10 percent of the total cost.
“You need to find out exactly what is covered by your dental insurance,” explained Denise, a customer service representative on the hotline provided by the Florida Office of Financial Services, the state’s insurance watchdog. “If your monthly payment is low, your coverage will be low as well. But it’s true that doctors and dentists can agree on direct costs with the patients.”
“That’s not illegal,” she added, admitting that many Florida residents have resorted to paying health-care professionals in cash, despite their insurance plans.
“The way our system is structured in this country is making the health insurance companies a very profitable business,” said Scott Tomar, professor at University of Florida’s College of Dentistry. “Whether or not it’s a good thing, it’s the reality.
“The unfortunate part of the way dental care is covered in this country is that those who have insurance still pay out-of-pocket for deductibles and co-pays.”
In 2006, Americans spent about $91.5 billion for dental treatment, $40.6 billion of which was paid out-of-pocket by patients, and $45.3 billion by private insurance. About $5.5 million was paid through public health programs.
“I have been a long-term proponent of universal access to at least some basic level of dental services,” said Tomar. “The unfortunate reality is that many policymakers view dental care as discretionary or optional, but the mouth is an integral part of the body.”
Under the framework of the new Affordable Care Act, insurance companies are barred from denying health coverage to patients with pre-existing conditions and requires everyone to obtain health insurance or face a penalty.
But the new measures do not affect dental insurance.
“Obamacare will not provide so much care for the adults,” Tomar said.
A 2010 investigation by the Florida Oral Health Coalition reveals that more than 115,000 people ended up in emergency room because of a dental problems that could have been avoided.
This represents an increase of 9 percent compared to 2009, which cost the state about $88 million, half of which was covered by the Medicaid program.
According to the Florida Department of Health, 5 percent of adults received dental care through a subsidized program or from volunteers.
Contact Marianela Toledo at [email protected].