Insurance game-playing

I am writing regarding Carol Tekavec`s column in your December 1998 issue. She states, "Some offices have become so irritated by the constant need for patient explanations (of insurance) that they have discontinued accepting patients` insurance payments." I have two very strong philosophical problems with the implications of this statement and the remainder of her column.

Stephen G. Blank, DDS

Port St. Lucie, FL

I am writing regarding Carol Tekavec`s column in your December 1998 issue. She states, "Some offices have become so irritated by the constant need for patient explanations (of insurance) that they have discontinued accepting patients` insurance payments." I have two very strong philosophical problems with the implications of this statement and the remainder of her column.

First, the implication was made that patients may not be able to accept dentistry unless the dentist accepts third-party payment on their behalf. I know this is not true because my practice has not cashed an insurance check for over five years. The total payment made by the patient remains the same; the only change is who cashes the insurance check. If a dentist cashes insurance checks, he works for the insurance company. I know because I used to have a second front-desk person just to manage the insurance transactions. I used to have accounts receivable that were quite old. I used to have patients question my fees vs. the insurance company`s EOB.

If a dentist accepts insurance money, then insurance becomes more of a focus than dental health. At least, it becomes very hard not to think in terms of money or insurance.

Second, I did not stop taking insurance as a form of payment because it was "so irritating." I stopped getting in the middle of the insurance issue because I wanted my patients to respect my care and dentistry and to begin seeing themselves as the ultimate decision-makers of their dentistry. In medicine, the physicians have been reduced to "providers." Procedures are reviewed by third parties and the doctor/patient relationship has become, in many cases, nonexistent. The less insurance in dentistry, the better! Patients are giving up freedom to have many dental plans. They are being told who to see, in return for a promise of cheaper care.

I have elected to stay far from that level of care. The entire concept of Carol Tekavec`s column on insurance game-playing should be a concern to all of dentistry. I am sure that she is hoping to provide a good service, but it seems to me more like room service on the sinking Titanic. Better to jump ship! The more some dentists play the game, the deeper the level of dependency on insurance. It is only then that dentists have to explain EOBs to patients.

I seldom hear any patient ask, "How much does insurance cover?" Insurance is not an issue in my office. I live and work in a very average community with patients who have to count their dollars, yet they find a way to get the care they need.

Carol Tekavec responds: The primary focus of my insurance column is to provide practical advice for dentists trying to help patients obtain their insurance benefits. My December 1998 column, as all of my columns, stressed diagnosing and performing only comprehensive treatment. I never advocate treating patients based on their insurance coverage or engaging in any "game-playing." I agree with Dr. Blank that restrictive managed-care network plans can encourage patients to give up freedom of choice for a promise of cheaper care. Fortunately, traditional insurance plans typically allow patients to see any dentist they wish, with the dentist charging his or her usual fees. Many patients greatly appreciate the help their dentists provide them in working with their insurance. Even if eliminating insurance is a goal, dentists often find that helpful service with insurance is a good practice-builder.

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