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Dentists need to break the chains of dental PPO plans
Dentists need to break the chains of dental PPO plans
Dentists need to break the chains of dental PPO plans
Dentists need to break the chains of dental PPO plans
Dentists need to break the chains of dental PPO plans

Break the chains of dental PPO benefit plans

Feb. 8, 2024
It's high time we free ourselves and our patients from the shackles of dental benefits. This is where medical billing for dental procedures comes to the rescue.

Wake up to reality, dental professionals! We’ve handed the reins of our practices over to this thing called “dental benefits.” These benefits dictate the care we provide, the fees we charge, and even when or how often we charge them. Does the word free evoke any reaction? The sad part is we've accepted this norm without a second thought. We’ve been brainwashed by this benefit model, and it’s not a comprehensive insurance plan. Each CDT code has a benefit attached to it, nothing more, and many codes have no benefit at all.

Patients have unknowingly become a part of this vicious cycle. They base their health-care decisions on what their dental benefits cover, often settling for subpar care spread over years. How many patients do not seek your care at all because they don’t have a dental benefit plan? It's high time we free ourselves and our patients from the shackles of dental benefits. This is where medical billing for dental procedures comes to the rescue.

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Medical billing can help you meet your goals

How billing to medical can protect your practice from inflation and decreased dental reimbursements

The many benefits of medical billing

With medical billing, you can reclaim your independence and offer the personalized, high-quality care your patients deserve, without worrying about the limitations of dental plans. Patients get the best treatment, while you regain control of your practice and its profits. It's about time you started dictating your practice's terms and stopped letting dental benefits call the shots, don't you think?

The overhead costs of a dental practice are skyrocketing. From pricey dental technology to the high cost of supplies and increasing demands for employee compensation, it can be daunting and stressful, leaving many dentists wanting to throw in the towel. This heavy financial burden is made even more challenging by the constraints of dental benefit-led dentistry, where reimbursement rates are often insufficient to meet escalating costs. The maximum allowed per patient, per year, has not increased in years.

The business of dental will not be able to sustain if there’s not a shift in our business model and mindset. We are medical specialists and should be reimbursed as such. This higher reimbursement model will never happen with the current dental benefit model, and as you’ve noticed, the reimbursements have only decreased. Dental carriers have a business to run, and their goal is for patients to not use the limited benefits they have, which leads to more profit for the insurance company. CEO salaries at the largest dental insurance companies can often exceed $1 million per year, particularly when including bonuses and stock options.1 Who’s holding the reins and winning this rodeo, and at whose expense?

This model, dictated by dental benefit plans, is becoming increasingly unfeasible. It forces practices into a high-volume, low-margin approach to care, necessitating more patients being squeezed into the day to ensure financial viability. Everyone loses in this scenario: dentists cannot provide the high quality, personalized care they aspire to, and patients receive rushed, impersonal service. No wonder there’s so much talk about burnout these days.

While the transition to medical billing offers numerous benefits, don’t underestimate the stresses that dental health-care professionals face, stresses that can contribute to alarming statistics around dentist mental health. The statistic that dentists face a suicide rate nearly twice as high as the general population has yet to be proven and needs to be studied further, yet is still a concern in our profession.2 This underscores the incredible pressure dental professionals are under and highlights the importance of steps to alleviate that pressure. Medical billing provides the opportunity to serve patients at a higher level that’s reimbursed at medical rates. This leads to less financial and mental burdens and more personal and professional fulfillment.

A lifeline that’s a winner

Moving toward a model focused on patient medical benefits offers a lifeline. By using medical billing for everyday procedures, practices can step away from the restrictive dental benefit model, cutting the chains of financial stress and enabling a focus on quality and patient-centric care. After all, the reason most of us got into this profession was to help patients, so let’s move toward being more patient centric. We need to do what patients want and need and not base care on the constraints of dental benefit plans. Doing the right thing for your patients, your practice, and your team will organically increase growth and satisfaction. Isn't it time to consider a sustainable future for your practice?

Medical insurance is broad and comprehensive. It covers a range of procedures performed in dental practices, including exams, consults, panoramic x-ray, lateral cephalometric, CT, extractions, implants, bone grafts, cyst removal, biopsies, frenectomies, home sleep studies, sleep appliances, TMJ orthotics, Botox, and more.

With the right knowledge and strategy, practices can claim significantly higher reimbursements from medical insurers than from dental benefit plans. If dental practices employ medical billing for procedures, they’ll have a much greater chance of receiving true reimbursement that covers the full cost of their services. We often see many of these procedures written off or billed out at such low fees that not only is the cost of the procedure not covered, but the expertise achieved by continuing education and advanced technology puts the practice in financial jeopardy.

Comparing dental and medical fee schedules, side by side and for the same exact procedure, medical reimburses two to 12 times more than dental. Do I have your attention now? Would this impact your practice?

Patients win

Medical billing is equally beneficial for patients. By using their medical benefits, they can access more of the care they need at a lower out-of-pocket cost than through dental benefit plans alone. Medical billing for dental procedures offers an exciting opportunity for both dentists and patients. It enables practices to offer better quality treatments, ones that are tailored to individual patient needs. And it makes receiving care easier, more accessible, and more cost-effective for patients.

Every year, practices implement strategies to increase the number of new patients. Accepting medical insurance will allow patients who do not have a limited dental benefit plan to be seen in your practice. Many patients fear coming to the dentist because they don’t know how they’ll pay for the services. They don’t realize their medical can be used just as it is in their primary care provider’s office. This alone is a huge opportunity to serve more patients.

More patients have medical insurance than dental benefits

To further illustrate the significance of medical billing, I’ll compare dental insurance coverage versus medical insurance coverage in the US. According to the National Association of Dental Plans, about 77% of Americans had dental insurance in 2016.3 However, when we compare this figure to medical insurance, the discrepancy is stark. The US Census Bureau reports that as of 2019, nearly 92% of the US population had medical insurance.4 This substantial difference in coverage underscores the potential for dental professionals to help their patients by billing medical insurance for applicable procedures. It's an avenue that is yet to be explored by most practices, and one that could revolutionize your practice while immensely benefiting your patients.

When considering a shift from dental benefit plans to medical, many medical carriers will not allow a general dentist to be in-network. This means you’ll need to home in on patients who have a PPO plan that allows them to see any provider they choose. PPO plans dominate over HMO types in the US.5 HMO plans are closed network type plans, and a patient cannot see a provider outside of that network.

According to a report by the National Committee for Quality Assurance, 58% of insured Americans are enrolled in medical PPO plans, compared to only 26% in medical HMO plans.6 This means that most of your patients likely have PPO for their medical plan, which provides them with a greater level of choice and flexibility when it comes to who can provide their care. By adding medical reimbursements to your reimbursement options, you can better cater to these patients’ needs and preferences, providing them with more options for treatments and a smoother, more efficient process for accessing and using their benefits, all while decreasing their out-of-pocket costs.

Make it a win-win

Medical billing isn’t just a trend or fad; it’s a way for dentists to truly revolutionize their practices. Medical billing is about more than just making money; it’s about serving more and providing better care for patients, with fewer restrictions. When you switch to medical billing, you open a world of possibilities and create a win-win environment for everyone.

Editor's note: This article appeared in the February 2024 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.


References

  1. Rosanes M. Insurance CEO salary: How much do executives of the top insurers earn? Insurance Business. November 20, 2023. https://www.insurancebusinessmag.com/us/guides/insurance-ceo-salary-how-much-do-executives-of-the-top-insurers-earn-467192.aspx
  2. Alexander RE. Stress-related suicide by dentists and other health care workers. JADA. 2001;132(6):786-794. doi:10.14219/jada.archive.2001.0278
  3. Understanding dental benefits. National Association of Dental Plans. https://community.nadp.org/whydentalorg/about/understanding-dental-benefits
  4. Keisler-Starkey K, Bunch LN. Health insurance coverage in the United States: 2019. United States Census Bureau. September 15, 2020. https://www.census.gov/library/publications/2020/demo/p60-271.html
  5. Employer health benefits. 2019 summary of findings. Kaiser Family Foundation. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://files.kff.org/attachment/Summary-of-Findings-Employer-Health-Benefits-2019
  6. State of health care quality. NCQA. https://www.ncqa.org/report-cards/health-plans/state-of-health-care-quality-report/

Kandra Sellers, BA, RDH, is creator and CEO of TIPS Medical Billing, which focuses on medical billing as the gateway to dental-medical collaborative success. Kandra is now viewed as a predominant educator in the field of oral-systemic health intertwined with medical dental billing. Having been a successful executive coach for the nation’s largest practice management company, she is a sought-after coach who will ensure successful implementation of medical billing into your practice. Contact her at [email protected] or visit tipsmedicalbilling.com.