Overcoming dental insurance obstacles

While insurance provides the means to access new patients, dental insurers often create a lot of stress and hassle for office administration teams.

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Many of my colleagues and I believe that dental insurance is too confusing for patients and difficult to manage for dental offices. While insurance provides the means to access new patients, dental insurers often create a lot of stress and hassle for office administration teams. Staff are often not sure what procedures are covered, which can put dentists in a difficult position. My office actually employs two staff members to make sure insurance companies pay us for our services. So, why does it take so many resources to obtain benefit information and estimates? 

Patients also feel the negative effects of dental insurance. The insurance business model lacks transparency and efficiency. For instance, many plans pay less for out-of-network care than in-network care to coerce patients to stay in-network. This behavior adds to the insurer’s profit but diminishes the patient-doctor relationship. It is arguable that we can even call current offerings “insurance” because patients are forced to pay out of pocket the moment their oral care cost exceeds their annual limit. There needs to be a better balance.

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

Option 1: Fee-for-service

Many dentists have chosen to rid themselves of the dental insurance hassle 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 arrange rates and payment plans to cut out the insurance middleperson altogether. In addition, many patients take advantage of their flex spending dollars in a fee-for-service office.

Although many dental offices would like to be fee-for-service, this is not a reality for many. One-third of Americans do not visit the dentist regularly, so removing the option of using dental insurance may hinder some patients’ ability to get dental care. Also, office staff would then have to double as collections officers if patients were unable to make their payments. While it makes sense for some offices, not accepting dental insurance is not possible in all dental markets. 

Option 2: In-house membership or savings plans 

Many patients, especially retired and uninsured, believe that the cost of insurance plans outweighs any benefits. This group prefers the cost savings and flexibility of a plan offered by their dental office or providers, such as Illumitrac or QDP (Quality Dental Plans). It is possible to set up these plans yourself, but you need to be aware of state guidelines and laws. Providers 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 medical care by ditching insurance providers in their employee benefits packages. These companies decided that they could save money by paying for people’s medical bills directly rather than paying a premium to insurance companies. These organizations are in the minority for now, but the model of directly connecting employers, patients, and dentists with no inefficiencies saves everyone time and money. 

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

Instead of using membership cards, group numbers, and member 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 breakdown of benefits. Within 48 hours, payments are made directly from the employer to the dental office once treatment is complete. This is a step in the right direction away from traditional dental insurance, and it helps offices save on staff salaries. 

Traditional dental insurance providers aren’t going anywhere soon, but it’s encouraging to see the private sector try to improve a market sorely in need of disruption. As companies outside of dentistry offer dynamic new business models in heavily regulated industries, we are observing that same ethos in the dental market. If these new business models gain traction, dental insurers will have no other choice but to adopt this new business model. All of these factors are great news for dentists who are looking to be paid for their work quickly and easily. The future can’t come soon enough.  


JILL A. TANZI, DDS, a graduate of the University of Maryland School of Dentistry, has more than 19 years of private practice experience. Dr. Tanzi started The Dentist at Hopkinton in Hopkinton, Massachusetts (hopdent.com), 16 years ago near the starting line of the Boston Marathon. Passionate about 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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