Dentist, what are your thoughts on shrinking reimbursements on Insurance policies?

This is a multi-faceted issue. Once again the ADA has dropped the ball and not addressed the #1 issue for practice health and profitability to be able to insure staff salaries, technology and the ability to continue to deliver quality patient care and customer service. Insurance companies are trying to force Dentistry in to a Physician practice model of large organizations and hospitals with decreased ownership( and they are being successful). They are also attempting to create an environment to force Dentists in to accepting or supporting mid-level providers in both hygiene and doctor services. Many practices are not helping by balance billing their services in that they bill the insurance companies for only what they know they will be reimbursed instead of a reasonable fee, insuring the reimbursements will not rise. Insurance companies use this information to justify not raising fees and in fact to reduce reimbursements. As practitioners we need to advocate with our state organizations and the ADA or let them know we will resign from their organizations. It is time the ADA stood up for us instead of special interests. We also need to bill for what we do at a reasonable fee, even if we need to do a write off later. We all need to have in-house membership or benefit plans as an alternative to insurance and for those that do not have access to dental insurance. Their are many templates out there to use. I will willingly provide any doctor with our template if they so desire. We rise or fall together as a profession.

Thank you for listening! Dr. Morrison

Hi Jon. I am not a dentist, I own and operate a dental lab.  I see it as kind of socialized dentistry.  Instead of government control it has been replaced by the insurance company mandate. No options for the patients or the dentist.  I feel for the dentists who has to rely on dental insurance and the patients who really needs extensive treatment.  Must be stressful. 

Interesting thread here. While you're north of the border, the same I believe is true in Canada. As a benefit advisor I can tell you clients rarely change their plan once it's set in place and too often any changes that are made are usually in response to a bad renewal, which means they typically cut the coverage. We have clients with a maximum of $1,000 or $1,500 and it's rare that you'll see them increase that number because of the corresponding spike in premiums. This means that while costs of procedures goes up, max payable stays the same, for an overall lower percentage of reimbursement. Most of our plans use current dental fee guides, which means that at least procedures are not capped at the previous year's maximum. Dentists in Quebec have their own system (Dentaide) and the association is asking its members to stop assignment of benefits to put pressure on insurers to adopt it. Many dentists are not rallying to the association's call as that would mean clients would have to pay all out of pocket then submit paper claims to their insurers. Would be interested to hear more from dentists on the subject. I mostly hear about it from the insurer side and that information may be one-sided.

Yes shrinking reimbursements have put too much pressure on small business’s that provide quality personalized care especially for fearful patients. Dental insurers seem to still have huge bonuses for executives high in the company. Not at least keeping up with inflation/ cost of living increases is just not acceptable and it’s a travesty that politicians allow this to occur and deteriorate dental and health care delivery. 

Yes, shrinking reimbursement has put the pressure on dentist and patients.  The quality of treatment goes down because people can't afford it, some opt to go to Mexico and some opt to extract the tooth rather than save it due to high cost.  It is unfortunate when a patient comes in thinking they have insurance and can have everything fixed, only to realize their limit doesn't cover much.  Employers have plans but most of them are not great, and many of them cover fee guides that are from previous years.  Dentistry isn't what it used to be.

This is a very difficult subject. We as dentists understand the economics of running a business and attempting to provide top quality dental services. Dental insurance (the patients coupon) can disrupt that reality. 

Employer groups look to have an insurance policy that suits their economic needs without conferring with the dentist. They look at having a benefit package that is within their budget. The employees (our patients) are at the mercy of Human Resources. Often they scramble from office to office due to participation with that particular plan. They don’t understand the insurance policy can dictate the quality of their work. Many perspective calls will come through the office asking, “do to take my insurance.” The true question is, “are you in network” with the insurance. This simple difference is missed on many, dentists included. Our office attempts to clarify to the caller up front only to be hung up on. The patient winds up being no more educated on their insurance policy and puts themselves in potential harm. Either harm from a provider cutting corners to provide services at the reduced remuneration rates or by a provider that is out of network but does not clarify that they will take their insurance and bill them for any unpaid portion of service from insurance. 

Until dentists independently begin to remove themselves from the insurance portfolio’s no changes will occur. Therefore, as I have seen in the thread, the dentist needs to separate and create a quality driven practice versus insurance driven practice. The quality of service will help keep the Dental Board from taking action against a license. The potentially lower standards of care due to insurance reimbursement being so low will not.

Shrinking insurance reimbursements affect large clinics as well as independent dentists.  Good business practices enable the independent dentist to strategize how they want to spend for technology and get a return for the investment while clinics can not justify the spending of their dentists are inexperienced right out of dental school.    They are not the ideal practitioners for a profitable practice.  

We are preaching to the choir here. I just had a lengthy conversation with a practice management consultant at the California  Dental Association. He was pleasant but the conversation was depressing. Our Government will do nothing to help dental care providers since they want us to provide care at lower and lower rates to make it accessible to more and more people. They won’t have me providing my quality of dentistry and time given and quality of relationship with my patients on any less than the measly Delta PPO rates  and no hedge against inflation! However I did show my overwhelming appreciation for the CDA’s supply buying cooperative! That absolutely saved me and kept me some what profitable to allow me to chug along until I retire. Support buying co ops and make dental supplies and equipment more reasonably priced because we are not going to get any more  money from the insurance companies! Also we will begin an in-house benefit plan as well this year.

I have a plan that might help you in that area. Contact me and let me know if you are interested