Many dentists want to see changes to reimbursements, benefits verification and claims processing to increase efficiency and improve patient care in 2024.
Eight dentists recently spoke with Becker's to discuss the changes they would like to see from insurance companies this year.
Editor's note: Responses were lightly edited for clarity and length.
Question: What changes are you hoping to see from insurers in 2024?
Corey Anderson, DDS. Affordable Dentures & Implants (Bridgeport, W.V.): Better payment ratios, faster claims processing and payments, fewer bad faith denials, fewer bad faith requests for information already provided, fewer bad faith requests for needless and irrelevant information, less administrative hassles, less administrative overhead at insurance companies and demonstrated actual value added to the entire dental healthcare system from dental insurers.
Usha Hecht, DDS. Hecht Family Dentistry (Carmel, Ind.): I would love to give insurers my thoughts on ways to improve their transparency of coverage to their patients and their providers. I see many patients who say they have transferred because they get blindsided with bills for services they thought were covered.
I would love to see all insurers have an online portal where the provider could have easy access to get all breakdowns of coverage and eligibility of all services with provisions and exclusions. There are some insurers that do this, but for some we still have to call archaically and speak to someone to get this information. It is a big time waster. Even better would be a collaboration of insurers to have a secure way to have all information in one place. I have looked into several companies that say they offer services to do this, but they too can't get a full breakdown of coverage.
Second, the unethical leasing of networks without provider knowledge needs to stop. I know there is legislation to work on this but insurers should never have started this sneaky tactic.
If providers could work with insurers, we could make this process more pleasant for everyone. Many patients don't want to deal with surprise costs, so it's easier to just not go to the provider. Unfortunately, they don't understand their insurance. Many think it's like medical, but dental has many more limitations. For example, in medicine you could visit your doctor several times a year, maybe for strep or sinus infection or a pulled muscle, and each of those visits would be covered. In dental, they usually only cover two exams, so those cover your six-month maintenance visits. If an emergency arises between visits, then that visit is out of pocket. With all the technology and [artificial intelligence] out there, we should be able to solve this issue.
Bertram Hughes, DMD. Family & Cosmetic Dentistry (Gainesville, Fla.): Thank you for contacting me. If there is one thing that dental benefit companies should do in 2024, it would be reimbursing a fair amount toward dental services. They should be reimbursing dentists equally within geographical areas, and doing this at minimum according to Fair Health data.
William Hunt, DDS (Forest City, N.C.): Faster turnaround and increased reimbursement rates would make things much better. Explaining the policy plans to the patients would also save time by them understanding what is covered. Many think that dental insurance covers everything. The fees are not rising to offset the rising supply and salary demands. Working harder for less income and more headaches will drive many to search for other employment.
Huzefa Kapadia, DDS. Kapadia Dental Care (Waterford, Mich.) and Detroit Sterling Dental: They need to make it easier to find a dentist in their network or even offer coverage for online dental consultations. Let's make dental care more accessible.
Dental care shouldn't break the bank. Insurers should offer plans that won't leave us choosing between our teeth and our wallets.
Who's got time for paperwork? Insurers need to modernize and make the claims process a breeze for everyone involved.
People want dental insurers to be more transparent about their coverage policies, including details about what is covered, what isn't covered and any limitations or restrictions.
I'm sick and tired of dealing with rejections and trying to get paid for work that was already approved and prior authorized. It's actually very stressful and takes the fun out of dentistry.
Larry Moray, DDS. Founder and President of MyOrthodontist (Chapel Hill, N.C.): What I’m hoping to see and what will actually happen are two totally different things. Given the cost of doing business and the current staffing issues we are all going through, I anticipate the insurance industry will leverage AI to a greater extent to evaluate claims and prior approvals. I do know that both Pearl and Overjet are moving in that direction as well, which will streamline the insurance approval process. I do wonder if this might allow the insurers a way to slide their approval process up or down depending on their desired profit margin. This rising cost of doing business and limited supply of talent might tend to decrease reimbursements and cause companies to cut corners on staffing talent, both in claims review and customer service. If this happens, it will frustrate both providers and patients alike. As a patient, my experience with medical insurance customer service has been excellent of late, so I am hoping that insurance companies are in fact upping their customer service game.
What we desperately need is a good universal dental insurance plan that anyone can sign up for and that covers most, if not all, procedures to a significant extent. The limiting factor in getting dental work done remains cost, with many patients still not wanting to do any more than that which their insurance covers. Consider the patient who needs a lot of crowns and bridges but also has periodontal disease and a yearly insurance benefit of $1,000. The benefit is exhausted by the periodontal therapy, and then the patient wants to wait on the crown and bridge until the insurance benefit renews, at which time they require more periodontal therapy and so on and so on. This clearly is more the exception than the rule, but I feel there’s a lot of dental treatment that goes undone due to the cost of dentistry and the poor reimbursement of too many dental insurances.
Michael Perpich, DDS. Northland Smiles (Deerwood and Little Falls, Minn.): Dental insurance drives both patients and dentists crazy. It is really not insurance, but a predetermined amount patients can spend to pay for their dental treatment. You are involved in an accident, you go to the emergency room, they fix your broken arm and leg. You bite down on a hard piece of food, you break a tooth, the patient has to decide what their insurance will pay for, and with a yearly limit of approximately $1,000, many decisions need to be made.
In 2024, I would like to see faster claim payments, working with medical insurance to provide healthy mouths, which will make patients healthier, and I would like annual maximums to increase, which they haven’t done in 40 years.
Duc Tang, DDS. Promenade Center For Dentistry (Charlotte, N.C.): While some insurers are making strides, in 2024 the industry as a whole should urgently prioritize comprehensive online verification of benefits and claims history. It remains problematic that many dental offices still have to call and wait on hold for this basic information. A standardized online portal accessible to all providers would dramatically increase efficiency and reduce costs by minimizing redundant inquiries from staff.