Why dental insurance is the biggest challenge facing dentists, per 3 leaders

Stagnant reimbursement rates, redetermination of Medicaid eligibility and the complex billing process are just a few reasons why these three leaders feel that the biggest challenge in dentistry is the insurance space.

The leaders featured in this article are all speaking at Becker's 2024 dental conferences. This includes our Spring Future of Dentistry Roundtable, which is set for June 19-21 at the Swissotel in Chicago, and our Fall Future of Dentistry Roundtable, which is set for Oct. 30-Nov. 1 at the Hyatt Regency in Chicago.

If you work at a DSO or dental practice and would like to be considered as a speaker, contact Randi Haseman at rhaseman@beckershealthcare.com.

As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at our roundtables. The following are answers from our speakers at the events.

Note: Responses were lightly edited for clarity and length.

Question: What is the biggest challenge dentists, DSOs and/or dental practices are facing today?

Bryan Carey. CEO of Benevis (Atlanta): The biggest challenge facing dentists, DSOs and dental practices today is the significant gap in access to quality dental care for low-income Americans, especially children covered by Medicaid and the Children's Health Insurance Program. The process of redetermination has led to more than 10 million Americans losing their coverage. This coverage challenge is compounded by a scarcity of dentists willing to accept Medicaid patients due to inadequate reimbursement rates and the complex administrative burden associated with Medicaid participation. Additionally, a shortage of dental professionals exacerbates the issue, making it increasingly difficult to provide essential dental care to underserved populations. These factors contribute to a cycle of neglected oral health, leading to deteriorating conditions, increased emergency room visits for dental issues, and a broader impact on overall well-being and healthcare costs.

Alexander Einbinder, DDS. Dentist of Caterpillar Dental (West Babylon, N.Y.): There are many challenges related to insurance, including the complexities of billing, reimbursement delays and navigating various insurance plans. Additionally, the staffing issues and the burden of dealing with multiple insurance companies and ensuring compliance with their policies can be a significant challenge for dental professionals.

Robert Trager, DDS. Dentist at JFK Airport (New York City): Other than the shortage of dental assistants and hygienists, the biggest challenge facing dentistry today is the predatory gimmicks the dental insurance companies are forcing on us. Many states are now passing laws mandating that the insurance companies comply with a loss ratio of 80 to 85%. This means that the reimbursement fees will have to be increased, but how much? The insurance companies will find ways to make it a minimum increase for their own benefits unless statistics show that increases are not being adjusted to the cost of inflation. Another big problem is the forcing of providers to accept reimbursements via electronic and/or credit card processing. They fail to tell you there's a percentage taken out and when you inquire, they conveniently don't know. As dentists we should be more involved with the unions and the insurance companies in advising the parameters and the reimbursement schedules of the dental benefits offered by the employer.

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