The merits of private practices that are free of the influence of dental insurance contracts are evident to the dentists and patients in those out-of-network practices. Yet, a myriad of questions and answers about dental insurance appear every day on internet forums. How to maximize benefits for patients? How to get insurance to pay for quality services? What to do when insurance companies deny claims? What to do when the proposed treatment exceeds the annual maximum? How to explain how much the patient is expected to pay? How to get insurance companies to approve treatment fees? And much more.
Insurance companies have not increased the annual maximum benefit in decades. There was a time when the annual maximum would (help) pay for everything a patient needed. It truly was insurance to cover catastrophic expenses, similar to health insurance. Like nearly everything, the costs of dental services have gone up, but the annual maximum has not. Dental insurance has become more of a limited discount plan that helps pay a percentage of some dental services, but only to a point, and that point is about $1,500 to $2,000 per year, which is not enough to pay for a large treatment plan.
More by the Bernsteins
Dentists and consultants have written many articles about how dentists can make more money by dropping insurance. Maybe that’s true and maybe it isn’t. When we read these articles, we should keep in mind the motto of one of the Mayo Clinic brothers, William J. Mayo, MD: “The best interest of the patient is the only interest to be considered.”1 Making more money is not the best reason to drop insurance. Providing the highest quality care is.
The extent of the problem
Years ago, when we were contracted with the biggest dental insurance carrier, one day we saw an estimate of benefits (EOB) telling the patient that I should have done a large filling instead of a crown on a particular tooth. Even as a young dentist I knew that the dental schools, the State Board of Dental Examiners, the courts, and my own ethics held me to a higher standard than “the least expensive alternative.” I knew that practicing under the influence of insurance would never allow me to be the dentist I wanted to be, the one known for providing the finest quality dental care in an environment of high ethical standards.
Unfortunately, dentists and patients have been programmed to believe that the insurance model of practice is the only feasible model, and that patients are not willing to pay out of pocket for quality care. Patients have been trained by insurance carriers that dentistry is a commodity, that cleanings should be “free,” that their dentist is charging too much, and that the dentist is recommending unnecessary and expensive services.
From the dentists’ perspective, costs have skyrocketed for equipment, materials, rent, advanced education, and skilled labor, while insurance reimbursements have not only not kept up with inflation but have been reduced by double digits. Meanwhile, dentists are in the position of asking patients for steadily increasing out-of-pocket costs for care that is not covered by insurance, and office staff feel guilty asking for payment.
We believe that dentists want to provide the best possible care for their patients. But in the current climate, quality standards are pushed to the limit as they try to figure out ways to make a living while insurance reimbursement rates drop. Can we see a hygiene patient every 40 minutes instead of every hour? Can we find a cheaper offshore lab for crowns? Can we hire unskilled staff for minimum wage? Do we need to take that class? Do we need to throw away disposables after only one use? Do we need to use the good stuff for impressions, fillings, etc? It’s easy to see how quality of care can suffer, even with the best intentions.
Current situation not sustainable for dentists
Ideally, we wish every dentist would get out of all insurance contracts so we can go back to being private practice, fee-for-service dentists, and so our profession can maintain the highest possible standards of care. It takes fair fees and adequate chair time to do this. It takes training so that offices can better communicate with patients about the realities and limitations of insurance.
We’ve found that once someone from our office takes the time to sit down and explain the limitations of insurance, most patients understand and admit they have no idea how dental insurance works. Often enough, patients then choose to schedule with us because they like the way we treat them. As far as the particulars of each claim, it’s easy to give patients the treatment codes and direct them to the phone number on the back of their insurance card to find out for themselves how much coverage they can expect on a given claim.
We believe nearly every dentist wants to provide their patients with the best quality of care, but the limitations of insurance are increasingly causing them to make compromises. The insurance-free practice model is not for every dentist or patient. But for those who value the highest standards of dental care, who are not willing to allow insurance companies to interfere with treatment decisions, and who are willing to invest a reasonable amount for it, there are resources available to them.
Editor's note: This article appeared in the June 2022 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.
- Quotations from the Doctors Mayo. Mayo Clinic. https://history.mayoclinic.org/toolkit/quotations/the-doctors-mayo.php