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The
History of Dental Insurance
Dental "insurance"* had its beginning in the early
1970's. It appeared that indemnity "insurance" would encourage
those patients who needed or wanted dental treatment to have these
services performed. Some dentists began to warn those in leadership
positions within our profession of the possible perils to quality
that might occur if dental "insurance" companies began
to determine diagnosis, treatment and fees for a particular service.
In retrospect, these warnings were lightly heeded by many dentists.
Could the "insurance" industry actually exert that much
control over the dental profession?
Dental
Insurance As It Is Now
Like so many encroachments
we experience in life, the "insurance" industry was not
satisfied with its influence on treatment plans and fee determinations.
Eventually, a larger piece of the pie was requested by the industry
in the form of "managed" care. This is where dentists
who enlist, agree to reduce their fees by as much as 20% to have
patients placed in their chairs. Managed cost, not managed care.
Current American Dental Association data show that the average dental
office overhead is over 70%. What type of care can those offices
deliver given this arrangement? It's definitely lose/lose/win for
patient/dentist/"insurance" company.
There
are three primary reasons for the metastasis of managed care into
dentistry:
-
Profit potential for "insurance" companies.
- Oversupply
of dentists
- A
generation of people who have been conditioned to believe that
all health-care coverage is a "right".
Our
Relationship with Dental Insurance
Our practice was required
to make a decision a number of years ago as to whether we would
be an "insurance" dependent practice. What precipitated
the need for this decisiveness?
- The
mounting "ill will" we were experiencing resulting from
being caught in the middle between the "insurance" company
and the patient. We offer only high-quality care which was being
denied due to the companies' "LEAT" (least expensive
alternative treatment) policies.
- Countering
the inflammatory information sent to the patient, stating that
our fees were higher than usual and customary. All my colleagues
have experienced this. Since "insurance" benefit maximums
have not changed within the past 25 years, their profit level
is dependent upon the dentists not adjusting their fees according
to normal inflationary processes.**
- The
fact that "insurance" companies typically reimburse
the patient more quickly than the dentist.
-
"Insurance" companies change mailing addresses and phone
numbers often, and we were not provided updated information. The
flip side of the coin is that employees change "insurance"
companies, and again, we were not notified of the change. In many
insurance dependent offices, you will find at least one full time
employee dedicated to the engendered "red tape".
- Many
patients develop expectations that shift their responsibility
to the dental office to find out their benefits (annual maximum,
remaining benefits, deductible amounts, etc.)
Our
primary objective is to provide dental excellence at a fair fee;
the "insurance" company's primary objective is to earn
a profit for its shareholders. We will gladly assist our patients
in obtaining their full benefits, but we will not allow "insurance"
companies to dictate the standard and quality of our care.
* The
word insurance is defined as "protection against a loss".
The term has been used in medicine, as catastrophic loss can occur
as a result of sickness or accident. This term has been used in
dentistry, but it is a misnomer. "Benefit" more aptly
describes the allowance which is negotiated for an employee between
his/her place of employment and "insurance" company. All
dental "insurance" companies have a table of benefit allowances
which rarely exceeds $1500 per calendar year. This amount is very close
to the benefits of the 1970's.
**If dental benefits were to have kept up with inflation such as
they have with true insurance, they would amount to over $10,000
per year.
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