Oral Health Group
Feature

Insurance for Implants? It’s Still Merely a Dream!

August 1, 2004
by Blake Nicolucci, BSc., DDS


In the spring of 1984, I was actively negotiating with insurance companies to have dental implants considered a covered treatment under their plans, and to this day it is still not a reality for the general population. This is not an acceptable situation.

Initially, the major excuse used by the insurance companies (to counter the request) was that the governing bodies for dentistry didn’t recognize implants as an approved modality of treatment. Thus, the insurance companies had no obligation to even consider implant therapy as a covered benefit, since it wasn’t even considered a legitimate prosthetic option. This was reinforced by the fact that there were no implant codes in the fee guide, and at that time–in Canada–there were no plans to even consider implants being placed in the guide. Implants were being approved in the United States, but had only recently been approved in Canada. Branemark implants began sales to the public in 1983 (Branemark was the first–their clinical studies began in 1977). This approval has to be endorsed by Health Canada (the Canadian equivalent of the FDA).

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It wasn’t very long after that implants became accepted as a viable alternative to fixed and removable prosthetics. This eliminated ‘one excuse’ being used by the insurance companies for not having dental implants as covered benefit. The other side of the coin being that if implants were to be considered as an option for treatment, then someone was going to have to foot the ‘very hefty bill’ that was going to be accompanying this treatment. The responsibility for having implants as a covered benefit then shifted from the insurance companies to the actual employers.

Well, it doesn’t take a brain surgeon to figure out that since regular dental insurance was considered a ‘loss leader’ by most insurance companies when implants weren’t available as an option, there would be a large premium increase to offset the ‘implant rider’ offered by any of the insurance companies that did consider the implant option. Under normal circumstances, the insurance companies were willing to lose a little on the dental side of things for the opportunity of acquiring all of the other insurances for the company (including life, disability, etc.). And you guessed it–nearly all employers rejected the implant rider because of the cost. When you compare the costs involved in the different prosthetic options available when implants are used, you can see how the insurance companies want this benefit to remain on the back burner for at least the immediate foreseeable future.

The option of implants should be made available to the general population, even if it was on a progressive coverage type of insurance. Perhaps the amount allowed for traditional treatment by the insurance company could be applied to the cost of implant treatment. For example, if the fee for a removable partial denture was $1,200.00, then perhaps this amount could be applied to ‘offset the costs’ of the more desirable implant therapy for our patients. This could be construed as compromise, but at least the patient would have a choice. I cannot think of any good reason to deny this approach to our patients. Perhaps insurance companies are concerned about how many individuals who are not candidates for fixed prosthetics would now become candidates. They would be able to discard their dentures, and enjoy the benefits of fixed and stable prosthetics once again.

Here we are after 20 years of at least a moderate amount of effort, still wondering when implants will become a benefit. ‘Patience is a virtue’ and we will just have to remain good salesmen (and women) and continue to explain the virtues of implant therapy over the alternatives. And when they ask if implants are ‘guaranteed’, remember that the only things that are guaranteed in life are DEATH, and TAXES!


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