Overcoming Dental Insurance Obstacles | Dental economy

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Many of my colleagues and I believe that dental insurance is too confusing for patients and difficult for dental practices to manage. While insurance provides the means to access new patients, dental insurers often create a lot of stress and hassle for office administrative teams. Staff often do not know which procedures are covered, which can put dentists in a difficult position. My office actually employs two staff members to make sure the insurance companies pay us for our services. So why are so many resources needed to obtain benefit information and estimates?

Patients also feel the negative effects of dental insurance. The insurance business model lacks transparency and efficiency. For example, many plans pay less for out-of-network care than for in-network care in order to compel patients to stay in-network. This behavior adds benefit to the insurer but diminishes the patient-physician relationship. Arguably, we can even call current offerings “insurance” because patients are forced to pay out of pocket as soon as the cost of their oral care exceeds their annual limit. You need a better balance.

We live in the digital age, but dental insurance is stuck in the 1980s. There are three popular dental insurance alternatives that address these issues and are worth investigating.

Option 1: Fee-for-service

Many dentists have chosen to get rid of the hassle of dental insurance by simply not participating. They believe the benefits outweigh the threat of cutting off access to new patients. These practices work directly with patients to arrange rates and payment plans to completely cut out the insurance middleman. Additionally, many patients take advantage of their flexible spending in a fee-for-service office.

Although many dental practices would like to be paid on a fee-for-service basis, this is not a reality for many. A third of Americans don’t visit the dentist regularly, so removing the option to use dental insurance may hamper some patients’ ability to get dental care. In addition, office staff would then have to act as collectors if patients were unable to make their payments. Although it makes sense for some practices, not accepting dental insurance is not possible in all dental markets.

Option 2: Internal Membership or Savings Plans

Many patients, especially retired and uninsured, feel that the cost of insurance plans outweighs the benefits. This group prefers the cost savings and flexibility of a plan offered by their dental office or providers, such as Illumitrac or QDP (Quality Dental Plans). It is possible to set up these plans yourself, but you should be aware of state guidelines and laws. Providers can help take the guesswork out of administering these plans.

Option 3: New pay-as-you-go models

Amazon, Berkshire Hathaway and JP Morgan are a few that are revolutionizing medical care by ditching insurers in their employee benefits. These companies decided they could save money by paying people’s medical bills directly rather than paying a premium to insurance companies. These organizations are currently in the minority, but the model of directly connecting employers, patients and dentists without any inefficiencies saves everyone time and money.

There is a new generation of pay-as-you-go dental benefit companies. A patient of mine contacted me about Bento, a company that gave him more control over his “insurance” dollars.

Instead of using membership cards, group numbers and member IDs, this type of direct dental benefits plan gives dental practices instant access to estimates, eliminating the need to verify benefits and get the dreaded distribution of benefits. Within 48 hours, payments are made directly from the employer to the dental office after treatment is complete. It’s a step in the right direction away from traditional dental insurance, and helps practices save on staff salaries.

Traditional dental insurance providers aren’t going anywhere soon, but it’s encouraging to see the private sector trying to improve a market that badly needs disruption. As companies outside of dentistry come up with dynamic new business models in heavily regulated industries, we are seeing the same ethos in the dental market. If these new business models gain traction, dental insurers will have no choice but to embrace this new business model. All of these factors are great news for dentists looking to get paid for their work quickly and easily. The future can’t come soon enough.


JILL A. TANZI, DDS, a graduate of the University of Maryland School of Dentistry, he has over 19 years of experience in private practice. Dr. Tanzi started The Dentist at Hopkinton in Hopkinton, Massachusetts (hopdent.com), 16 years ago, near the start line of the Boston Marathon. Passionate about issues facing dentists and private practice, she is a founding member of the Massachusetts Dentists Alliance for Quality Care, which champions private practice and quality care (madentists.org).

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