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30 Years of Dentistry: Lessons Learned
Lesson #8: Dental Insurance is Not All That Bad Joe Steven Jr., DDS

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You have to admit, most dentists take great satisfaction sharing their dental insurance horror stories with each other at cocktail parties or dental meetings. We all have them. How about the one where the insurance company decides not to pay a claim after they had previously approved the predetermination? We complete the work and the patient ends up having to pay the full amount. Don't you just love 'em? But, you know what? I sure wouldn't want to practice without the availability of dental insurance. Think about it! There are not too many businesses out there that have a third party to help pay the bill. We are a business, and it helps. This lesson will help you understand that dental insurance isn't all that bad!

Now, before you start putting together a lynch mob because you think I'm a dental insurance company sympathizer, let me say something. Some of you might recall about 10 years ago I helped organize a national movement originated by Dr. Woody Oakes, to help small groups of dentists run full-page ads in their local newspapers that promoted direct reimbursement while not speaking too highly of traditional dental insurance. Needless to say, I've had my tirades with dental insurance companies and I'm sure I will continue to have my complaints with them. But, having said that, I sure wouldn't want to practice dentistry without them. For most general "bread and butter" practices, we wouldn't be nearly as busy if we did not have these patients with dental insurance benefits.

As much as we get upset with insurance companies, some blame should also rest on employers who don't select or negotiate for better dental benefit options. About 10 years ago, Blue Cross threatened to sue me when I sent letters out to my patients explaining why I wasn't going to be a participating provider anymore. One point of the letter explained how the annual benefits have been $1,000 since its inception. Blue Cross informed me that they have plans with an annual coverage up to $5,000. I guess I just don't see those patients in my practice.

Of course, the ideal thing would be to work at positioning your practice to where you can be insurance independent. That's one of those great "buzz phrases" in our profession today that gets many dentists very excited – become insurance independent. It sounds appealing to eliminate dealing with insurance companies and collect your fees up front. It can be done because we see various doctors doing it all over the country. However, we all can't have a Mercedes dealership. Putting things in perspective, I believe those dentists make up a small minority of offices. For most of us, it's simply not that easy. I could relay numerous unfortunate stories from dentists who tried and failed miserably when trying to eliminate insurance from their practices.

In today's economy, following that advice could be sudden death to some practices. While speaking in Minnesota recently, my friend, Bill Rossi who runs Advanced Practice Management, told me that he was on his way to meet with one of his clients in order to get their office to sign up with Delta. That is a 180- degree turnaround from his traditional advice to his clients. He understands that until this economy turns around, some of us will have to play the insurance game.

Not all of us can, or should, eliminate insurance and only offer the more expensive procedures. There is a growing concern with many dentists that we are headed in the direction of medicine. My wife's uncles started the Wichita Surgical Group in Kansas many years ago, which is the largest surgical group in the Midwest. For the last 20 years, they've cautioned me about letting our dental profession fall into the same trap that crippled medicine. They explained it was the doctors' own greed that priced them above insurance and government standards. That's when managed care really took over and also when the government started with their medical cost containment programs which directly affected everyone's income. And now we have ObamaCare! Dental services must be available and somewhat affordable for the average American, otherwise Uncle Sam will see that it gets that way.

We need to understand one thing about dental insurance companies. We are competing with them. They are in business to make a profit, regardless of what some of them may say! Many doctors are very astute when pointing out to their patients that insurance companies are in business to make a profit. I have had that conversation many times with some of my patients. If we know that they are in business to make money, why shouldn't we expect them to run a very tight operation while consistently trying to lower their overhead? Have we bought into their marketing hype that they are only in business to help people? Of course they are a business and will compete for every dollar possible. Sure, we don't like many of their tactics but, welcome to the real world. Don't get angry.

The worst thing a dentist can do is attend a seminar about dropping insurance and follow the speaker's advice. Insurance needs to be phased out gradually if you're going to do it, and the process is only successful if the timing is right. I'm not sure the time is right with our current economy the way it is.

Years ago when we stopped participating with Blue Cross, it didn't hurt us a bit. We continued and still participate with Delta because we're just not prepared to take that big of a plunge yet. Do I have any complaints with Delta? Sure I do, but I wouldn't want to practice without them. Delta and many other companies have made it possible for patients to accept our services that would otherwise not have been able to do so. When my daughter and one of her classmates joined our practice three years ago, we signed back up for the Blues to keep us all busy. I believe that was a good and necessary decision.

In my practice, I could say that at least 95 percent of our covered patients are very concerned about what their insurance pays and that dictates what type of treatment they will have done. A recent report from the U.S. Health Care Finance Administration reveals that more than half of the money spent on dental services in this country comes from third-party payments of one form or another. If that's where the money is, I'm going to be like Sam Walton and play the game.

Please don't misunderstand me and go out today to sign up for every fly-by-night dental insurance plan that comes across your desk. It does take a lot of consideration and the decision will be different for each practice. The only plans we are currently signed on with are Delta and Blue Cross. At our monthly staff meetings while reviewing the office numbers, I often cringe when I see how much money in insurance write-offs we are taking. On the other hand, we have more money in our account than ever before, which means we will keep playing that game.

Dental insurance benefits allow many patients to undergo comprehensive dentistry who would not otherwise be able to do so. Granted, it may take several years; but they can get it done. When patients ask what their insurance pays, we have to be aware that this is a very serious consideration. "Creating value for our services," doesn't put more money in our patients' checking accounts. It sometimes helps them prioritize what they want, but it doesn't always close the case with most patients. With many of our patients, we lay out a treatment plan that may extend over several years taking care of urgent needs initially. We stay busy, and our patients are happy.

Over the past 30 years, I have witnessed that patients are gradually becoming more informed about dental insurance benefits. Sure, there are still many who come in thinking insurance is going to pay for it all, but not in the numbers they used to. I think our profession is doing a better job at informing our patients about the shortcomings of dental insurance policies. Every new patient who comes into our office who has dental insurance is informed thoroughly with an easy-to-read brochure called Dental Insurance: The Facts (available from KISCO). The primary points that are contained in the handout brochure are first, insurance is a contract between your employer and the insurance company, and second, insurance is meant only to supplement financial assistance and is not designed to pay for everything. Many problems associated with dental insurance can be eliminated when our patients are properly informed.

Many dentists are too insurance dependent and really should be formulating a plan to become less dependent. Phase insurances out gradually, eliminating the worse compensating plans first. Once you do that, you can take a hard look at the big boys like Delta and the Blues. It's not necessary to go all the way; you need to find the ideal balance for your practice. Before you bite the hand that feeds you, you may want to reconsider your attitude about dental insurance companies as it relates to your specific practice. They're not perfect and some of them may not play fair, but I wouldn't want to practice dentistry without them!
Author’s Bio
Dr. Joe Steven graduated from Creighton Dental School in 1978 and has been in solo practice in Wichita, Kansas up until June 2007 at which time his daughter, Dr. Jasmin Rupp, joined him. He is president of KISCO, a dental products marketing company, providing “new ideas for dentistry,” and is the editor of the KISCO Perspective Newsletter. Dr. Steven along with Dr. Mark Troilo present “The $1,000,000 Staff" & the “Team Dynamics” seminars. Dr. Steven also presents three other seminars: “Efficient-dentistry,” “Efficient-prosthetics” and “Efficient-endo.” Dr. Steven also provides the KISCO Select Consulting Program to dentists in the form of a monthly audio cd recording. (Contact info: jsteven@kiscodental.com, 800-325-8649, www.kiscodental.com)

This story, originally published in the KISCO Perspective Newsletter, is reprinted with permission.
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