Dental Insurance is Changing
“Brian Watts, Vice President of First Dental Health and a featured speaker at the ADA’s 2010 Dental Benefits Conference, pointed out some interesting statistics. Dental PPO plans have grown 61% in the last six years and now represent 63% of the dental benefits market. In contrast, traditional (non-networked) fee-for-service dental plans have declined 55% and now only represent 17% of the market, Dental HMO plan have declined 40%, representing just 9% of the benefits market and dental discount plans have grown 30% and now represent 10% of the market.”
Dental discount plans are membership plans that allow the patient to get discounted dentistry if the dentist is participating in the program. There are no claims, no deductibles and co-pays, no maximums and no frequency limitations. In other words, none of the typical trappings of dental insurance that are necessary to know in order to determine the patient’s out of pocket expense. The patient joins and pays a membership fee, goes to the dentist and pays the discounted fee at the time of service. It is prudent for the dentist and the administrative staff to analyze the discount plan’s fee allowances to make sure that the practice can cover operating costs with these plans.
PPO plans have increased, but the standard for them has changed. With evidence based dentistry looming in the near future, we will no longer be able assume that there will be coverage for two exams per year, two prophys a year, or a yearly bitewing allowance. In the future, high risk individuals may get coverage for treatment not paid for in the past, and patients with no or few dental problems may qualify for fewer benefits at a reduced premium. Documenting risk factors and a formal diagnosis for the most basic procedures will be necessary to get paid by insurance companies. The cross-over to medical coding may include using a diagnosis code and a procedure code to be paid for some services.
No matter what products are available to our patients, we as dental care providers will have to be knowledgeable about the programs in the marketplace and know which ones will ensure practice growth and provide dental care according to the goals and philosophy of the dental practice.
If your practice decides to accept discount membership plans, remember that in order to be profitable you must manage these plans carefully. Do not offer any other discounts such as senior discounts or incentives to pay at the time of service. Accepting these plans stipulates that you are to be paid in full at the time of service. The patient is not to profit from postponing payment when they are already paying for discounted dentistry.
To be prepared, have a fee analysis performed by a reputable company to give you confidence that your charges are marketable as usual and customary for your demographic area. If your fees are in the low range, don’t assume that you will attract more patients. Most patients come to you by word of mouth and will assume your fees are fair. If you have further training and have great results in a given area of your practice, you may choose to charge more for your services based on your reputation and skill level. Market your special skills to patients who will be interested in these types of services even if you have to go outside of your immediate area. Purchasing a Community Overview Report every five years is a good idea to see how your neighborhood is changing in demographics and psychographics. It is recommended to have this valuable information before embarking on any marketing or advertising venture as it will help you identify buying habits and dental implications of the people that live within a ten mile radius of your practice.
With the technology available to check insurance eligibility and benefits for every patient prior to their visit to your office, there is no justifiable excuse to not be able to collect the deductibles and co-payments at the time of service. It is the patient’s responsibility to give you the correct subscriber information. If you have not been able to access plan benefit coverage and eligibility information before the patient arrives, the patient should be informed that they will have to pay for the service and you will have the insurance company reimburse them.
As the statistics show, dental insurance is here to stay but will be changing shape and scope over the next few years. Stay current and your practice will grow and thrive. Need more help with how to implement insurance systems in your practice? Call McKenzie Management today and sign up for one of our business courses.
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