Insurers' willingness to reimburse oral HIV rapid testing in the dental setting

Background: 2006 CDC guidelines recommend widespread HIV screening in a variety of health care settings. Prior research highlights the potential of the dental care setting as a promising venue for the screening of otherwise untested individuals at risk for HIV infection. Insurers' current and future reimbursement policies have been identified as one important set of factors in implementing HIV screening in dental care.

Methods: To examine insurers' perspectives, semi-structured interviews were conducted with fourteen managers and business executives at leading dental insurance plans. The firms employing these individuals accounted for a 54 percent cumulative market share of the U.S. group dental insurance market.

Results: Although six insurers believed that screening would provide public health benefit, no firms currently reimburse HIV screening nor considered HIV screening to be a reimbursable service within the relatively confined scope of dental coverage. Insurers identified several factors inhibiting coverage: HIV stigma undermining patient acceptance of the service, dentists' reluctance to provide screening and accompanying lack of training in informing patients of a reactive result, and the lack of employer/customer interest in coverage for such services. Insurers also cited the lack of rigorous clinical trial data and advocacy within the dental profession for the provision of HIV screening services.

Conclusions: Dissemination of rigorous clinical data and additional research on financial returns could help to promote uptake of coverage by insurers. Wider issues of integration between dental and medical care payment systems must be addressed to expand opportunities for preventive services in dental care settings.