Ask any dentist why they went to dental school, and most will say something like, “because I wanted to help people.”
Taking care of patients and providing them with the best treatment possible is what any good dentist strives for. Dental insurance companies are a thorn in a dentist’s side because they interfere with patient care and cause many frustrations.
History of Dental Insurance
Dental insurance started in California in 1954 and quickly gained popularity across the country. HMOs were the first on the market. When dentists signed up with HMOs, they received a flat fee per patient under their care. Dentists received this monthly HMO check regardless of the number of HMO patients that were seen that month.
By the 1970s, dental insurance PPO plans had grown in popularity. These insurance plans covered about $1000 worth of dental treatment per year. The first plans did not have in-network or out-of-network providers like today but paid rates based on usual, customary rates of the area. Once a dentist signed with the PPO plan, they were placed on a “list,” and patients were referred.
How Dental Insurance Companies Affect Patients
- Maximum annual limits have not changed since the 1970s (at about $1000- $1500). Of course, nothing still costs the same as it did in the ‘70s. For example, the average cost of a car has gone up ten times. Since the annual limit for dental insurance is so low, and the cost of dental treatment has increased since the ‘70’s most patients cannot get all the prescribed dental treatment they need quickly. Their oral problems get worse with time and patients end up dealing with pain, missing work or school and, higher costs since extensive treatment costs more.
- Stockholders, equity firms, and investment bankers own dental insurance companies, and their sole purpose is to make money. Most of these investors are dentists, and their primary focus is maximizing profits.
- A dental insurance company can choose not to cover certain services such as orthodontic treatment. They set age limits on sealants and fluoride and dictate how many times per year a patient can get dental cleanings. Some dental insurance companies down-grade dental treatment services, e.g., down-grading a bridge to a partial denture. This is not done based on clinical exam findings, actual patient needs and the best treatment option available to the patient. It’s all done putting the “investors” interests first.
- Patients have to see specified dentists thus limiting their options.
How Dental Insurance Companies Affect Dentists
- Dental Insurance Companies “dictate” the treatment patients get; most patients will refuse to get treatment because their insurance does not cover it. Just because dental insurance doesn’t cover a dental procedure doesn’t mean it’s unnecessary. Patients do not always understand this.
- Reduced Fees, Dental insurance companies constantly lower the fees they pay dentists for services rendered despite increasing costs to provide these services year over year. This makes running a dental practice unsustainable.
- Denied or Delayed Payment, dental claims sent to insurance companies are denied for frivolous reasons. The dentist and their team spend countless hours writing narratives and going back and forth with insurance companies just to get paid. Simply put, Insurance companies make it difficult for dentists to get paid, which leads to write-offs. Write-off’s plus heavily discounted rates lead to decreased dental office revenue.
- Unhappy Patients. Patients are upset with the dentist when insurance companies refuse to cover treatment or get an “unexpected” bill after treatment. Patients lose trust in the dentist.
Benefits of becoming a Fee-for-Service Provider
- Dentist will have higher production numbers doing less procedures. Lowering burn-out rate.
- Dentists save time since they do not have to spend countless hours with insurance companies just trying to get paid.
- Dental offices become more profitable since insurance companies will no longer be take 30% of the profits. Profits will then be used for marketing to bring in new patients.
- Dentists no longer share profits with insurance companies, these cost savings are passed on to patients as discounted fees.
- Patients are happier since cost and estimates are accurate. No surprise bill after.
- Patients get the treatment the dentist prescribes without insurance influencing what dentists (who are the trained professionals) can and cannot do.
- The patient will have the flexibility to choose a dentist based on trust, comfort and ability of the dentist to meet his or her needs.
Studies show an increase of dentists who will only take fee-for-service jumping to 15-20%. With this shift, dentists will not automatically get patients sent over to them by insurance companies and compete for patients like any other business. This will be good for patient care and the dental industry.
