Overcoming Obstacles To Dental Insurance Dental economics


Many of my colleagues and I believe dental insurance is too confusing for patients and difficult for dental offices to manage. While insurance provides the means to access new patients, dental insurers often create a lot of stress and hassle for office administrative teams. Staff are often unaware of which procedures are covered, which can put dentists in a difficult position. My office actually employs two staff to make sure the insurance companies pay us for our services. So why does it take so many resources to get information and estimates on benefits?

Patients also feel the negative effects of dental insurance. The insurance business model lacks transparency and efficiency. For example, many plans pay less for out-of-network care than for network-based care to force patients to stay in the network. This behavior increases the insurer’s profit but decreases the patient-doctor relationship. Arguably, we can even call the current offers “insurance” because patients are forced to pay out of pocket as soon as the cost of their oral health care exceeds their annual limit. There has to be a better balance.

We live in the digital age, but dental insurance stuck in the 1980s. There are three popular dental insurance alternatives that tackle these issues and are worth investigating.

Option 1: fee-for-service

Many dentists have chosen to get rid of the hassle of dental insurance by simply not participating. They believe the benefits outweigh the threat of cutting off access to new patients. These practices work directly with patients to organize rates and payment plans to completely eliminate the insurance middleman. Additionally, many patients take advantage of their flexibility to spend money in a fee-for-service practice.

While many dental offices would like to be paid on a fee-for-service basis, this is not a reality for many. One third of Americans do not visit the dentist regularly, so removing the option to use dental insurance may hamper some patients’ ability to obtain dental care. In addition, the office staff would then have to double as a collection agent if patients were unable to make their payments. While this makes sense for some practices, not accepting dental insurance is not possible in all dental markets.

Option 2: Internal membership or savings plans

Many patients, especially retired and uninsured, believe that the cost of insurance plans outweighs the benefits. This group prefers the cost savings and flexibility of a plan offered by their dental office or suppliers, such as Illumitrac or QDP (Quality Dental Plans). It is possible to put these plans in place yourself, but you should be aware of state guidelines and laws. Suppliers can help take the guesswork out of administering these plans.

Option 3: New pay-as-you-go models

Amazon, Berkshire Hathaway, and JP Morgan are a few who are revolutionizing healthcare by ditching insurance providers in their employee benefit programs. These companies decided they could save money by paying people’s medical bills directly rather than paying a premium to insurance companies. These organizations are in the minority right now, but the non-inefficient model of directly connecting employers, patients and dentists saves everyone time and money.

There is a new generation of pay-as-you-go dental insurance companies. One of my patients contacted me regarding Bento, a company that gave him more control over his “insurance” dollars.

Instead of using membership cards, group numbers and membership IDs, this type of direct dental benefit plan gives dental offices instant access to estimates, eliminating the need to verify benefits and obtain the dreaded distribution of benefits. Within 48 hours, payments are made directly from the employer to the dental office after treatment is complete. This is a step in the right direction from traditional dental insurance, and it helps offices save on staff salaries.

Traditional dental insurance providers aren’t going anywhere anytime soon, but it’s encouraging to see the private sector trying to improve a market in dire need of disruption. As companies outside of dentistry come up with dynamic new business models in heavily regulated industries, we see the same philosophy in the dental market. If these new business models gain traction, dental insurers will have no choice but to embrace this new business model. All of these factors are great news for dentists looking to get paid for their work quickly and easily. The future cannot come soon enough.

JILL A. TANZI, DDS, A graduate of the University of Maryland School of Dentistry, he has over 19 years of experience in private practice. Dr Tanzi founded The Dentist at Hopkinton in Hopkinton, Massachusetts (hopdent.com), 16 years ago near the start line of the Boston Marathon. Passionate about the issues facing dentists and private practice, she is a founding member of the Massachusetts Dentists Alliance for Quality Care, which advocates for private practice and quality care (madentists.org).


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