Katie Bradford, a 31-year-old Baltimore woman, brought her daughter into the city clinic Thursday for a regular checkup — exactly the kind of preventive effort Bell-McDuffie and other dentists say staves off the potential for bigger, more expensive problems down the line.

Bradford has dental coverage for herself and her daughter, Karmen, who is 1.

"It's needed," Bradford said. "Good dental care starts early."

But insurance industry officials say most health and dental policies already are sold separately, which lets people choose whether they want to pay for additional coverage. And they argue that it would be too complicated to combine two different plans under one set of premiums, deductibles and co-pays.

Evelyn F. Ireland, executive director of the National Association of Dental Plans, said in an e-mail that her group, too, is concerned about keeping dental coverage affordable. She was not available to answer questions about the federal guidance.

In a December letter to the federal health department, Ireland said the group supports the separate out-of-pocket costs for dental plans. Combining health and dental plans under one price tag, she argued, "is administratively complex and cost¿prohibitive and should be avoided to keep premiums low."

Robert Zirkelbach, a spokesman for America's Health Insurance Plans, the health insurance trade group, described the idea of merging health and dental plans on a broad scale as a nightmare.

The group also sought the $1,000 per-child maximum, arguing that the threshold was actuarially "reasonable and achievable."

Advocates worry the price might be too high and the process too complicated. Leigh Cobb, health policy director for the Maryland-based Advocates for Children and Youth, said legislation pending in the General Assembly would require a study to determine how many people are buying pediatric dental coverage.

If enrollment is low, state health officials could adjust the out-of-pocket maximums, Cobb said.

"The first mistake was saying there could be plans without pediatric dental coverage — it was a slippery slope," Cobb said. "We're very concerned …that this is really going to cost too much."

john.fritze@baltsun.com

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