270960 Insurers' willingness to reimburse oral HIV rapid testing in the dental setting

Tuesday, October 30, 2012 : 4:30 PM - 4:45 PM

Rebecca Winitzer, MS, MSW , School of Social Service Administration, University of Chicago, Chicago, IL
Harold A. Pollack, PhD , School of Social Service Administration, University of Chicago, Chicago, IL
Lisa Metsch, PhD , Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL
Margaret R. Pereyra, DrPH , Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL
Stephen Abel, DDS, MSD , Office of Extramural and Public Health Programs, Nova Southeastern University College of Dental Medicine, Ft. Lauderdale, FL
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.

Learning Areas:
Administration, management, leadership
Planning of health education strategies, interventions, and programs
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Discuss insurance policy on covering HIV screening in the dental setting. Identify multiple barriers preventing dental providers from offering HIV screening in the dental setting. Suggest approaches to promote insurance coverage of HIV testing in the dental setting.

Keywords: HIV/AIDS, Health Insurance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a doctoral candidate at the University of Chicago's School of Social Service Administration. I have many interests in the area of health care service research, including exploring alternative pathways to offer HIV testing and services to individuals at risk.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4403.0: HIV/AIDS Policy