Dental Frequency (Benefit Tips ® - © 2014)
Employees can get their teeth cleaned every 3 months even when their dental coverage limits recall dental visits to every 6, 9 or 12 months. It’s been going on for years and insurance companies have not been able to stop it.
Most dental insurance plans were designed decades ago when dentists performed all the services. Limits were placed on how frequently you could see the dentist for a routine checkup. In the early 1990s the 6-month limit was replaced with 9-months or even 12-months for adults.
At the turn of the century, dentists hired hygienists and encouraged patients to come in for a cleaning between dental visits and charged the insurance company for periodontal scaling. Dental claims increased quickly, driving benefits costs up dramatically.
Some insurers caught on pretty quick and required periodontal scaling in excess of an hour (four 15-minute units) to be performed by a periodontist (dental specialist) rather than the general practitioner (GP). This approached minimized the excessive scaling claims from GP, and encouraged serious cases to be referred to a specialist.
Another approach was to cover the recall exam which includes one 15-minute unit of scaling at 100% and have the employee pay a percentage (i.e. 25%) for extra scaling. This approach identifies what is considered additional cleaning and shares the financial responsibility.