Dental insurance and reimbursement is an ongoing issue for many dentists, and low reimbursement rates are causing some to drop out of insurance networks.
These six industry leaders give their take on dental insurance companies and the impact it has on the industry. The executives featured in this article are all speaking at Becker's The Future of Dentistry Roundtable, which will take place June 15-16 at the Swissotel in Chicago.
To learn more about this event, click here.
If you would like to join as a speaker, contact Randi Haseman at rhaseman@beckershealthcare.com.
As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at our roundtable. The following are answers from our speakers at the event.
Zerita Buchanan, DDS. Dentist at Dental Dreams (Lithonia, Ga.): Dental insurance companies must provide equitable and standardized reimbursement rates for all dental providers. Published data from the ADA Health Policy Institute shows an annual earnings disparity of roughly $84,000 between white and Black dentists. Furthermore, 2019 data from the ADA Health Policy Institute highlights that Black dental students, on average, have the most educational debt at graduation, $314,360, compared to any other ethnic group. Therefore, transparency on the role dental insurance companies play in the earnings disparity is necessary, as minority providers, on average, earn less and tend to carry a more significant student loan burden.
Richard Huot, DDS. CEO of Beachside Dental Consultants (Vero Beach, Fla.): Dental Insurance companies need to promote the higher limits allowed for Health Savings Accounts, get creative about what to cover and realize that lowering provider reimbursement is not a real popular business decision item, with the higher cost of personal protective supplies post COVID, and the brutal inflation we are experiencing in healthcare.
Voluntarily going to a medical loss ratio of about 80 to 85 percent would go a long way to reestablishing good faith with dental offices, since the Affordable Care Act requires [medical] insurance companies to spend at least 80 or 85 percent of premium dollars on medical care, with the rate review provisions imposing tighter limits on health insurance rate increases.
Gabriele Maycher. Dental Practice Management Consultant of GEM Dental Experts (Vancouver, British Columbia): Too much emphasis is placed on dental insurance support, and this is affecting patient outcomes. Dental insurance was never intended to pay for extensive dental disease, it was intended to make dentistry affordable. It is a benefit provided by employers as a perk for their employees. As a clinical hygienist, and now a consultant, I have 30+ years of clinical experience, and in that time the insurance support per person has remained approximately the same as dental fees have increased year over year. Meaning less and less dental treatment is supported, and although we know we are to plan treatment according to patient needs, this seems to be a struggle for most clinicians. Insurance support seems to dictate treatment way too often. Until such a time that clinicians get comfortable talking about "money," move away from solely selling services (a cleaning, a crown, etc.) and start to sell "outcomes" (overall oral and systemic health), this ethical dilemma will persist. Dental practices need to change their focus to creating "value" in the services they provide. Dental insurance will then become secondary to the overall optimal outcomes we are trying to achieve.
Robert Trager, DDS. Dentist at JFK Airport (New York City): Silicon Valley and First Republic Bank have just failed and were taken over by other banks. Have you ever heard of any dental insurance companies failing? No, because they are not regulated strictly by government agencies. These insurance companies are out to make a dollar like any other company but at the expense of participating dentists. The contracts are written to ensure that these providers receive, in most cases, the lowest allowable reimbursements. Why do some contracts pay 30 to 40 percent more to panel dentists than non-panel dentists?
In the future there has to be more strict regulations as to how these insurance companies conduct business. Massachusetts and some other states have new voting regulations that these insurance companies have to spend between 80 and 85 percent of premiums on patient care and not on administrative fees. Hopefully this will be a mandated regulation from all insurance companies in the future.
In the future I would hope that dentistry gets involved with negotiations with dental benefits with the employees, because we know what services are in the patient's best interest and what are fair and reasonable reimbursement fees.
Dentistry needs to be in control of its profession and not the insurance companies.
Thomas von Sydow. COO of Cornerstone Group (Irvine, Calif.): Dental insurance companies are putting extreme pressure on revenue cycle management and collections. They continue to reduce allowable fees and make many procedures inclusive. Patients don't understand how these plans work, often equating them to medical, which is indemnity based. They also create great interference between the clinician and the patient when it comes to treatments that may be best but are prohibited. They are an important asset for new practices and DSOs. While fear is still the number one reason patients do not access oral care, who takes their insurance is a very close second. New practices and DSOs must have large new patient flows. I am seeing more established private practices go out of network once they have established a solid community reputation.
Mark Whitefield, DDS. Founder of Implant Evolution (Hermitage, Tenn.): Since COVID, many insurance companies have dramatically increased their creative financial attacks on the dental industry, specifically towards individual practitioners. Denying claims automatically for trivial or nonsensical reasons has become the standard practice across the board for many insurance providers, and these attacks have significantly degraded the quality of care my patients deserve. Patients now must consider the fact that their insurance policies are likely to deny benefits due to fine print contract clauses that seem to be illegal in nature, and this obviously has damaging consequences. Unfortunately, this adversarial situation is fast becoming the norm across the entire landscape.
The medical and dental insurance industry as a whole is bureaucracy run amok. The dentist-patient relationship has permanently changed, and this is not a good thing. The insurance companies basically run a "bait and switch" type business model that generates inordinate revenues at the expense of the patient. Without higher up intervention and regulations, the insurance companies will continue to find new ways to screw over John Q. Public.