Dr. Chris Salierno, chief editor of Dental Economics, says dental insurance is not going away, so we must act together as a profession and as individual practices to protect our interests and our patients.
It's hard not to portray private dental insurance as the bad guys.
If you are in-network with any plans, no doubt you've had your share of shock and disappointment when a third party attempts to interfere with your ability to provide dental care. Reimbursement fees may be cut, legitimate claims may be bogged down in red tape, and absurd policies may arise that make you question your sanity (e.g., core buildups are no longer covered unless there is a post).
Organized dentistry has done a remarkable job of fighting the good fight. Just last year, the American Dental Association ramped up its efforts against Delta Dental regarding its new disallow policy. According to this policy, contracted dentists would be prevented from billing a patient for services that Delta deems to be unnecessary. It's one thing for a third-party payer to deny reimbursement for a service, but contractually preventing a provider from billing the patient directly in these cases is grossly overstepping boundaries. Standing up to an insurance Goliath is one of the feats best accomplished when we stand together with our dental associations.
But a Goliath can also be taken down by a David. Benjamin Tuinei uses the same metaphor in his article, "Policing illegal or unethical insurance practices." He shares an action plan for our individual offices to monitor and defend the rights of providers. I am sure you will find his story inspiring.
I believe some third-party payers deliberately seek to test our patience and fatigue our front desk, all the while hiding under the rhetoric of protecting patients. In reality, these companies are far more interested in their bottom line than patient well-being. But dental insurance is not going away. Despite a slight downward trend in the mid-2000s, the number of working-age adults with private dental benefits rose to approximately 58% in 2014. (1) I wish dentists' relationships with private dental insurance could be more collegial, but that does not seem to be the case. We must act together as a profession and as individual practices to protect our interests and our patients.
Chris Salierno, DDS
1. Nasseh K, Vujicic M. Dental benefits coverage increased for working-age adults in 2014. American Dental Association Health Policy Institute Research Brief. http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1016_2.pdf?la=en. Published October 2016. Accessed January 26, 2017.