William W. Oakes, DDS
You`ve heard it many times: "United we stand, divided we fall." It`s a basic concept that has served our country well for nearly 200 years. Why is it that dentistry (as a profession) cannot adopt a similar stand? For example, why do most dentists continue to let the insurance companies run their practices and dictate their treatment plans? It`s time to change that situation!
In my 25 years of private practice, I waged a constant "war" with insurance companies. I chose my battles wisely, and I won most of them. My favorite adversary was an insurance company whose letters usually struck me as particularly "mean-spirited" and offensive in tone.
That particular insurance company claimed I did too many crowns and that my fees were above UCR (whatever that is). I responded that my fees were at, or slightly above, those average fees published by Dental Economics, and that I`d like to see the data that the company used to determine UCR. Of course, the insurer never was willing or able to supply me with that data, even thought the company expected me to supply obscure patient X-rays from years ago before paying a claim.
The "straw that broke the camel`s back," however, was when this insurance company wrote one of my patients and said that I had "overcharged" him. Yes, they used those very words! The patient was a nice man who never complained about my fees or my dental work. But after that letter, everything changed. He stopped paying his bills and went to another dentist! I sent that insurance company a letter stating that if it ever sent out another letter like that to any of my patients, I would sue the company for libel. Well, they never did!
I`ve retired from active practice, but I understand that the harassment continues. It`s gotten so bad that a group of local MDs sent out a letter to all their patients. The letter told the patients that they would no longer accept that particular insurance and, if the patients were covered by it, to get new insurance or find another doctor.
In dentistry, dentists still are being accused of overcharging, overdiagnosing, and overtreating patients. Payments are delayed and valid treatment is denied. The insurance companies dig up obscure ADA Journal technical articles to make their points, yet ignore current research to validate the dentists` point. Some things never change!
The insurance companies have been very successful in creating the "perception" that doctors overcharge, and that the reason premiums are so high is because of these overcharges.The reality is that the insurance "middlemen" and insurance company CEOs are the ones who are getting rich.
In his book, Still Me, actor Christopher Reeves says:
"One of the reasons that insurance companies deny essential equipment and care is because only 30 percent of patients and their families fight back. This allows the insurers to save enormous amounts of money.
"Congress has proposed to reduce overall health spending by $100 million next year and by more than $2 billion over the next five years. That`s why I support Senators Specter and Harkin`s proposal to establish a National Fund for Health Research to provide additional funds over and above the annual appropriations for the National Institutes of Health. The Specter-Harkin bill proposes taking one penny from each dollar paid in insurance premiums, which would result in as much as a $6 billion increase a year for the NIH.
"Some experts say that this bill will never pass because of the strength of the insurance lobby. I have spoken to executives at several insurance companies about this bill and have been told that their profit margin is so small that the donation of one percent of their income is an unreasonable hardship. Personally, I find this about as credible as the tobacco companies` claim that nicotine is not addictive!"
Reeves goes on to say that insurance companies donate zero to research, and that their executives and CEOs all receive very lucrative salaries.
A transcript of the letter I sent to the particularly unpleasant insurance company is above. I know that there are many fine men and women in the insurance industry. We could not do without fire insurance, life insurance, etc. But, we must not let insurance companies practice dentistry, and we must not lose our freedom! Fight back and win - the alternative is extinction!
Dr. Oakes is editor of The Profitable Dentist newsletter and has authored five dental books. He founded the OralVision camera company and guided it to sales of nearly $10 million per year, before selling the company. He is the founder of The Dr. Woody Oakes Lecture Series and currently lectures on intraoral cameras and other high-tech advances in dentistry. For information and dates on his lectures, call (800) 800-9511.
