It is not uncommon in today’s marketplace for both the dentist and patient to prefer a resin based or composite restorative material rather than traditional amalgam. Amalgam has been around since the dark ages. For you historians of early alchemy, the composition specifications of dental amalgam are approximately 65% silver, 25% tin, 6% copper and 2% zinc. Trituration is the process of mixing together these alloys with mercury to produce the amalgam compound. If and when the composition is properly placed, polished, burnished and cared for by the patient - these restorations will last a lifetime.
As a whole, the benefit industry still considers dental amalgam the benchmark of plan design. This is not to say that amalgam is in any way superior to the many hybrid resins and composites of today’s technology. It is simply the standard of plan reimbursement.
I can hear G.V. Black screaming from the grave. “How dare those insurance companies only pay for amalgam? Sounds to me like an insurance company conspiracy. Quick, someone notify the tooth fairy. We need her help…We have got to get some new laws passed”. Sorry, HIPAA is not going to solve this problem.
I laugh in utter amazement at the number of useless legislative proposals that intend to place treatment blame on anyone other than the doctor of record. Both political forces are looking to do nothing more than trying to please their constituents by redirecting the wayward finger of blame. How is it that legal documents (benefit plans) are now rendering care? Let’s face it, they aren’t. Dental professionals are rendering treatments. Corporate entities and benefit plans are nothing more than money managers and administrators. Nothing more.
As the dentist you are the captain of the ship. It is your responsibility to diagnose the clinical condition and treatment needs of the patient. Diagnosis can not be delegated. Without you and your clinical expertise dentistry becomes a craft of smoke and mirrors rather than a healing art.
Your entire office needs to let the patient understand that their individual benefit plan addresses only the basics of preventive and restorative care. All services charged above the scheduled amount as designated by the plan of benefits are to be paid by the patient. Acceptation is noted with the participatory plan.
You need to communicate not only with your team but also as a team.
To be both competitive and cost effective in this evolving marketplace your office needs to deliver superior QUALITY dentistry. No “HMO dentures.” No “gross scaling.” No inferior care. Poor qualities with shoddy materials are nothing more than an invitation to malpractice litigation.
Understand the realities of a free market economy. It’s just like that rental car I had last month in Houston, Texas. The client paid for and provided a two-door Chevrolet sedan but I opted for the upgraded SUV Oldsmobile Bravado. Who paid for the upgrade in service? Was it the client? The airline? The rental car company? General Motors? No, I paid for the upgrade. This example is no different than today’s generation of benefit plan design.
Tom Limoli, Jr. is the author of “Dental Insurance & Reimbursement Coding and Claim Submission Manual" to order click here. Tom can be reached at 404-252-7808 or at www.limoli.com.