From outdated coverage models and reimbursement hurdles, here’s what five dental leaders have told Becker’s about insurance in the last three months:
Corey Anderson, DDS. Affordable Dentures & Implants (Bridgeport, W.V.): Medical loss ratios for dental insurance nationwide will make everyone’s life better. The AI claim processing for insurers and the AI claim appeal processes for dentists is mostly a standstill for claims payment and improper denials.
Sarah Cottingham. COO of Dental Design Studios (Phoenix): A major misconception [about dentistry] is that insurance defines the standard of care. It doesn’t. Insurance defines a benefit and often a minimal one at that. Too many people believe if insurance doesn’t cover it, it must not be necessary. But clinical excellence should never be dictated by reimbursement tables. Patients deserve care based on diagnostics, not on what a third party decides to subsidize with nothing more than a coupon. That’s a mindset shift our entire industry is still battling, one that impacts everything from treatment acceptance to how practices are run.
Krista Kappus, DDS. Fitch Mountain Dental (Healdsburg, Calif.): Looking at insurance, in the ’60s, insurance was truly just, you’d go to the dentist [and] they would reimburse. It’s just shifted and shifted and shifted to where now, we’re getting everything preauthorized before we do treatment. We have a whole separate department just for dealing with insurance. We have different companies we work with for insurance, and it’s just gotten so complicated. Insurance maximums haven’t changed … I don’t know what the changes are going to be, but it’s not going in the right direction for dentists to be able to function.
Emily Letran, DDS. CEO of Sea Breeze Dental (Huntington Beach, Calif.): One of the biggest misconceptions about dentistry is, unfortunately, still insurance plans. Patients are pre-sold on the ideas that their policy covers a lot, making it more difficult for dentists to present comprehensive treatment plan, where we may recommend correcting the crooked front teeth, the worn down back molar, the gingival graft for esthetics…all of which do not “hurt.” As a group, we need to establish excellent communication with the patients so they understand that we are diagnosing their health and not their wallets. This is where we avoid the car salesman comparison, and that should not be the case if we establish trust with the patients.
Samson Liu, DDS, CEO of SOHDental (St. Louis): Many practices are often frustrated with third-party dental payers putting in perceived roadblocks throughout the entire claims process to slow down or deny payments. In recent years, we have encountered several payers adding new policies to make the overall process more cumbersome.
A recent example is the downgrade of payment of two surface restorations to single surface restorations on posterior teeth by certain payers. Another common example is network leasing or sharing. Payers are forcing practices who signed up to automatically enroll in other networks without asking for permission. This forces practices who are already participating in these other networks at a higher reimbursement rate already, to now unknowingly accept a new lower reimbursement rate.
As a result, we have taken several measures to proactively address these issues. For example, when we credential a new provider, we will proactively include letters notifying them to opt out of all other networks. We have also developed an internal audit process to review EOB’s (explanation of benefits) for fee discrepancies. Lastly, regular cadence in negotiating higher fees with payers is also key to maximizing reimbursement rates.
