Several companies, Cigna for example, have policies that are progressive.  A progressive maximum policy is one that stipulates if a patient receives care within a given year, they are entitled to a larger benefit for the following year.  Another insurance company may offer a regressive plan, which is just the opposite of the progressive plan.  If the patient doesn't present for treatment within a year they loose benefits the following year. We need to be able to offer our patients the best options for their benefit package while continuing to offer a complete diagnosis and treatment plan based on their dental needs.
 
Insurance companies are very intelligent.  They are aware of the latest dental research and they are all about saving money.  The carriers are well-versed on the research into the oral-systemic connection.  Some have even invested in their own research.  For example, Aetna performed a research study of over 145,000 people with both medical and dental insurance and found that without a doubt, when people maintained regular dental care, there were lower costs in managing diabetes, heart disease, pregnancy complications and other health issues.  As a result of this research Aetna changed what they cover for dental care for some procedures.  With appropriate documentation benefits for more frequent prophylaxis may be available for some patients.  Delta, Cigna and several other major insurance carriers have since done the same.
 
The case of the 12 year old Illinois patient, Deamonte Driver, a boy who died after the bacteria from an abscessed tooth spread to his brain, has added more fuel to the systemic connection.  In this case, an $80 extraction would have saved the boy, along with $250,000 in medical costs.

 

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