By My Eyes and Teeth: The Vision and Dental Coverage Gap

Earlier this year, I started having trouble seeing street signs again. It’s a thing that happens when your eyes get worse over time, which tends to be par for the course for many of us who work with computers all day — even when I’m diligent about eye exercises, getting up now and then to reduce eye strain, and remembering to periodically switch focus so my eyes aren’t constantly doing close work, my eyes still can’t keep pace with my hectic lifestyle. I try to get an eye exam every two years, or earlier if there’s a problem, and it had been about that, so I made an appointment to get them looked at, but then, as always, I was reminded of my frustration with a major component of health insurance in the US: dental and vision coverage typically isn’t covered, or costs extra.

Back when I didn’t have health insurance, this wasn’t such a big deal, because I paid for everything out of pocket, and while it annoyed me, it was a fact of life. Now that I do, and now that I pay rather a lot for it, I resent that my eyes and teeth are’t considered part of my body. Instead, they’re not covered at all, and I have to pay cash for every component of the process from an optometry consult to buying glasses, from a quick dental inspection and cleaning to a more serious dental procedure.

Eyes, and vision, are important, though. Vision problems can be a warning that something else is going wrong; high blood pressure, for example, or diabetes. Even if you don’t care whether the people on your insurance plan can see, you should at least consider their eyes as a great first line of defense for warning you about more complex health problems that need to be addressed. The same holds truth for teeth — that lingering jaw pain my father experienced in the 18 months leading up to his heart attack, for example, was angina, which could have been caught by a more attentive dentist.

These are not disconnected parts of your body, and I don’t know when or why the insurance industry made them so with this strange insistence on covering them separately, if at all. Actually, I do — because vision and dental issues are common, and insurers can make a lot of money by excluding them from coverage. The problem is, though, that when people are forced to pay out of pocket for expensive things, they tend not to get them done in a timely fashion, or to wait until the issue is excruciating and unavoidable, and at that point, they may have incurred serious medical damage, including damage that the insurer will have to cover.

How much do insurers really save by not covering dental and vision needs? Clearly, someone somewhere has done the math on this and come out in support of not offering coverage, because insurers are very canny, and they’ve spent a long time with a lot of very smart mathematicians to determine how to offer the minimum amount of coverage possible for the most profit. If they thought it was more expensive to deny dental than to offer it, for example, they’d have reluctantly folded at least some dental care into their plans.

But it does disturb me because it falls into the larger trend of refusing to consider preventative medicine to be the priority, and because it chops the body up as though it can be broken into different parts that don’t function as important components within the larger whole. Not being able to see, or experiencing eye problems of other forms, is a huge problem that affects your whole body. Dental and jaw pain, likewise, is a significant health issue that impairs your quality of life and can be an indicator of a major issue like an infection that may spread to other areas of the body.

These are issues that people should feel comfortable going in to the doctor’s to resolve ASAP, with the help of the insurance plans that are supposed to help them with the expenses associated with medical care. When patients are forced to pay cash, they hesitate, wonder if the problem is ‘really that bad,’ wait, and don’t act until it’s unavoidable. At that point, the damage may have already been done. The patient with pain and discomfort in her eye discovers that she’s experienced irreversible vision loss that she’s going to live with for life. The patient who was struggling with jaw pain so severe that it kept him up at night now has a weakened heart because the lurking infection in his jaw spread and caused endocarditis, leading to life-long health complications.

People keep telling me that health insurance reform magically bought health for this country, and that people would live better and be healthier as a result. Maybe that’s true, for some, but I look around at the huge flaws and gaps in coverage, and I have to wonder. What about the people who can’t afford to pay out of pocket for these medical needs? Hm? What happens then? Should we just leave them to endure agony and frustration, along with future health problems, because insurers are too stubborn and cheap to do the right thing by their customers? Is this really what we’re calling health reform in the United States, a country where you can die of a dental infection even when you have ‘excellent’ insurance?

Image: The eyes have it, Allan Foster, Flicker.