02/23/2022
The Real Deal with Dental Insurance
The dental insurance industry is a dynamic and fickle landscape. Deductibles and co-pays are costly, waiting periods are counterintuitive, pre-approved dental treatments are restricting and provider networks are inflexible. I think it is safe to say navigating the dental insurance landscape is a frustrating and confusing undertaking for anyone involved.
Most dental insurance companies follow the 100-80-50 payment structure; meaning they cover 100% of preventative care, 80% of basic procedures and 50% of major procedures. This coverage can of course vary depending on your insurance provider, but also differ depending on the specific plan you have, further complicating the matter for stakeholders.
After practicing dentistry for decades, I’m familiar with the insurance company’s ability to determine access to quality dental care. Often times, this leverage forces dental practices to make adjustments to their business, which may not maximize quality of care. Most adjustments are cost cutting measures, which include terminating employees or reducing employee benefits, finding cheaper suppliers overseas for bulk order lower-quality dental equipment and materials, or eliminating philanthropic endeavors. In addition to cost cutting, practices will employ dental sales to boost revenue. Practices will sell teeth whitening products to patients who may not be ideal candidates for whitening or push unnecessary antibiotics to hygiene patients. Many practices will also reduce their time per patient by trying to churn in as many patients in a day as possible. I can confidently say that the insurance companies have incentivized a corporate form of dentistry, which leads to lower quality health outcomes because many of those patients thereafter visit me to fix poor dentistry.
The aforementioned still does not represent the worst of the insurance effect. In many cases, insurances dictate treatment planning, a good dentist’s nightmare. Every patient that sits in my chair is unique, with differing dental profiles and varying needs. My treatment plans are tailormade to my patients unique needs to achieve the best health outcome, which is why I take so much time during new patient exams and comprehensive exams. Unfortunately, many people will only elect to receive treatments covered by their plans, which means they may not be doing what is best for their dental health.
Dental insurance drives down the cost of dentistry, increasing access to dental healthcare, which is theoretically a great thing. Nevertheless, the overall social utility may not be as high as we believe. Many days, when I was working in corporate dentistry, I was expected to see 20 patients a day. Regardless of how experienced a dentist is, this model will never allow them to practice their best dentistry.
To reiterate, when dental insurance companies continue to reimburse dentists at lower and lower rates, they force dentists to spend less time with their patients, buy cheaper equipment, pay their employees less, sell products, and worst of all indirectly dictate how to treatment plan patients. These are all factors leading to worse health outcomes. In some cases, dentists are left no choice but to drop the insurance altogether. This actually represents the largest obstacle I’ve faced thus far after purchasing my practice. Before I started my practice, I was a Delta provider and the practice I purchased was a Delta provider. Unfortunately, when I started my new practice I was considered out-of-network with Delta. It was never my intention to drop an insurance, but I was forced to drop Delta after being considered out-of-network even though days before I was considered in their network. As a dentist I was taught a hard lesson in the business of dentistry.
I purchased a dental practice to escape the corporate structure. I am now able to dictate how much time I spend with patients and how they should be treated in order to achieve the best health outcomes. Nevertheless, I have to be creative. If you are out of network with my practice, I will send an out-of-network claim to your insurance company and you will then receive their allowed reimbursement directly to your home. Another work-around being implemented soon is our own in-house membership plan. If you love the quality of care you receive here, you will soon have the opportunity to receive incentives and discounts on all our procedures. Our goal is to maintain top-quality dentistry by the best practitioners using high end supplies while increasing access to our community of patients. Send us an email or give us a call to learn more and we look forward to seeing you soon!
