Don't treat based on benefits!

Dec. 1, 2002
As the S&P 500 has lost more than 10 percent annually, bond investments have produced returns of more than 7 percent.

Tom Limoli Jr.

It is not uncommon in today's marketplace for both the dentist and the patient to prefer a resin-based or composite restorative material overtraditional amalgam. Amalgam has been around since the dark ages. For you historians of early alchemy, the composition specifications of dental amalgam are approximately 65 percent silver, 25 percent tin, 6 percent copper, and 2 percent zinc.

Trituration is the process of mixing together these alloys with mercury to produce the amalgam compound. If and when the composition is properly placed, polished, burnished, and cared for by the patient, these restorations will last a lifetime.

As a whole, the benefits industry still considers dental amalgam the benchmark of its dental-plan designs. This is not to say that amalgam is in any way superior to the many hybrid resins and composites of today's technology. It simply is the standard of plan reimbursement.

I can hear G.V. Black screaming from the grave, "How dare those insurance companies only pay for amalgam! Sounds to me like an insurance company conspiracy. Quick, someone notify the tooth fairy. We need her help U we have to get some new laws passed." Sorry, HIPAA is not going to solve this problem.

I laugh in utter amazement at the number of useless legislative proposals that intend to place treatment blame on anyone other than the doctor of record. Both Democratic and Republican political forces are looking to do nothing more than try to please their constituents by redirecting the wayward finger of blame. How is it that legal documents (benefit plans) are now rendering care? Let's face it — they aren't! Dental professionals are rendering treatments! Corporate entities and benefit plans are nothing more than money managers and administrators.

As the dentist, you are the captain of the ship. It is your responsibility to diagnose the clinical condition and treatment needs of the patient. Diagnosis cannot be delegated! Without you and your clinical expertise, dentistry becomes a craft of smoke and mirrors, rather than a healing art.

Staff members need to emphasize to patients that their individual benefit plans address only the very basics of restorative care. The patient is responsible for paying the difference between the fee charged for individual services and the benefit amount reimbursed by the insurer. Exceptions to this payment policy should be noted with the participatory plans, such as Delta Dental, Blue Cross /Blue Shield, MetLife, etc.

You need to communicate not only with your team, but also as a team. To be both competitive and cost-effective in this evolving marketplace, your office needs to deliver superior quality dentistry. — no "HMO dentures" allowed — no "gross scaling" — no inferior care. Poor-quality work with shoddy materials is nothing more than an invitation to malpractice litigation.

Understand the realities of a free- market economy. It's just like that rental car I had last month in Houston, Texas. The client paid for and provided a two-door Chevrolet sedan, but I opted for the upgraded SUV Oldsmobile Bravado. Who paid for the upgrade in service? Was it the client? The airline? The rental car company? General Motors? No, I paid for the upgrade! It is no different with today's generation of benefit-plan designs. Quality is your most important product!

Tom Limoli Jr. is the president of Atlanta Dental Consultants and the editor of Dental Insurance Today, a bimonthly publication that addresses third-party reimbursement in the dental office. He also is the author of Dental Insurance and Reimbursement Coding and Claim Submission. He can be contacted by phone at (404) 252-7808. Visit his Web site at

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