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PDA urges lawmakers to require general anesthesia coverage

Ian Kreher

Today, the Pennsylvania Dental Association held a press conference at the Capitol, calling on legislators to pass a bill that would require insurance companies to cover general anesthesia for kids and special needs patients for their dental visits.

Below is the press release for the event.


HARRISBURG – The Pennsylvania Dental Association (PDA) today urged the General Assembly to pass House Bill 532 that would require insurers to provide general anesthesia coverage for young children and patients with special needs who need the procedure to receive quality oral health care.

“Young children with severe anxiety often need general anesthesia so dentists can provide care. The same holds true for individuals with special needs,” said Dr. Dennis Charlton, PDA president.

Charlton made his remarks at a news conference in the Capitol Rotunda attended by dentists, dental students and advocates for patients with special needs. In addition to Charlton, speakers included the bill’s sponsor, Rep. Stan Saylor (R-York); Rep. Babette Josephs (D-Philadelphia); Nancy Murray, president, the Arc of Greater Pittsburgh, and Dr. Brian Martin of Children’s Hospital of Pittsburgh.

Saylor said, “Cavities and tooth decay remain one of the most prevalent diseases among children, despite strides in dental care and education. When insurers do not cover general anesthesia for children and patients with special needs, they are effectively denying them adequate dental care.”

Saylor’s legislation would require insurance coverage for children seven years or younger and patients with special needs who require general anesthesia to allow dentists to examine and treat them. Thirty-one other states have enacted similar general anesthesia coverage legislation. The Pennsylvania bill is modeled after a Maryland law passed in 1998.

Many of the dentists at the media conference noted that oral health is an integral part of a person’s overall health. Untreated dental-related diseases can severely impact patients, because they are unable to properly eat and maintain proper nutrition. The potential consequences of neglecting oral health problems include infections, facial swelling, lack of sleep due to pain and low-grade fevers.

Some young children and patients with special needs are unable to understand their oral health issues or clearly communicate their needs to caregivers. Murray noted that both her adult children have disabilities. She said her son, Mickey, needs general anesthesia for any dental procedure except a regular cleaning.

“Mickey’s communication skills are quite limited and he would be very fearful of the dental instruments and equipment. Most likely, he would try to push the dental professionals away as a means to protect himself,” Murray said. “Attempting to treat my son without general anesthesia would not be successful and it would border on cruelty.”

 In some cases, families have difficulty affording the cost of general anesthesia, which can vary from $500 in a private facility to as much as $3,000 in a hospital. If they cannot afford the anesthesia, some caregivers may be faced with delaying oral health care for small children or patients with special needs.

Charlton estimated that the number of patients requiring general anesthesia would be relatively small, because most of Pennsylvania’s at-risk patients are covered under Medical Assistance or CHIP. However, he said some patients fall through the cracks and do not receive the care they need.

Martin, a dentist and the Program Director of the Pediatric Dentistry Residency Program at Children’s Hospital of Pittsburgh, said: “Support of HB 532 will enable Pennsylvania dentists to provide needed care for infants, children and individuals with special health care needs.”

Charlton noted that, under the legislation, coverage for general anesthesia would apply to medical insurance policies and not dental insurance policies for several reasons. He said the administration of general anesthesia is a medical procedure and more people have medical insurance than dental insurance. The cost of anesthesia would likely exhaust the benefits in a dental plan while medical plans provide more benefits. Also, he noted that many patients would be able to afford to pay for routine dental procedures without dental coverage but not general anesthesia.

Charlton and supporters urged state lawmakers to follow the lead of 31 other states and require insurers to cover general anesthesia for young children and patients with special needs who need the procedure to receive quality oral health care.