Dentists vs. payers: 4 insights

Dentists are in a constant battle with payers over low reimbursement rates and case denials, causing challenges for practices trying to provide the best patient care and stay afloat financially. 

Here are what four dentists have told Becker's this year about payer relations:

Harold Mendelson, DDS. Mendelson Family Dentistry (Owings Mills, Md.): The ever-increasing power of the insurance industry over the individual dentist [is what I would change about dentistry]. This is both the low fees and the constant having to argue about denials by the insurance companies of medically necessary dental procedures. There needs to be input by organized dentistry to protect the dentist with dental consultants not paid by the insurance companies being the ones who determine the medical necessity of a certain procedure.

Jennifer You, DMD. Lumos Dental (New Haven, Conn.): [What I would change about dentistry] would be the fact that there is no mechanism to hold insurance companies accountable to their subscribers or the dentists that care for their subscribers. Currently, insurance companies are able to increase premiums for their subscribers while simultaneously decreasing reimbursement fees to provider dentists, all without accountability of where the money goes. They are classified as nonprofit entities and yet they are allowed to collect "profits" in the tens of millions of dollars year after year. I truly believe if there was a mechanism, similar to a medical-loss ratio, so that the public can transparently see where revenues are going, it would help hold insurance companies accountable to the people they are supposed to help and support.

Rajdeep Randhawa, DDS. Innovative Dentistry (Colts Neck, N.J.): For most insurance-based offices, the compensation has been stagnant or lowered by the insurance companies if you take into consideration the cost of doing business, the cost of education, the cost of establishing a dental office, cost of human resources and with incoming inflation and supply line disruptions. Many of these offices who are working at low margins will have to resign from insurance networks or be in trouble financially. 

Bradford McLaughlin, DDS. Tend (New York City): My concern right now is that my younger patients often can only afford what is covered by insurance (sometimes not even the co-pay), and insurances are not keeping up with the times on reimbursement to dentists or covering modern standard-of-care procedures. Dental health will naturally get worse as a result without changes.

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