One Way to Improve Dental Insurance…
Opinions vary widely on the effectiveness of the Affordable Care Act (ACA), or Obamacare as it is commonly called. One side declares that the ACA has been a huge success, adding health insurance coverage to millions of Americans. The other side declares it an abject failure and is pushing for it’s repeal. In trying to find the truth, one learns that most everything published nowadays tends to lean towards the politics of the writer and/or news source. The true worth or failure of the legislation will only be seen in hindsight, many years from now.
Disclaimer: I do not claim to be an expert on politics, insurance law, economics, the U.S. healthcare system, or which political party is right or wrong. I did not even stay at a Holiday Inn last night. As a dentist, I took an oath to help my patients. Under our current system, that promise often means that dental offices are tasked with helping patients to utilize and maximize dental insurance benefits by acting as an intermediary. Being stuck in the middle obviously affects my opinions. On any given day, our team would much rather spend our resources fixing teeth and caring for our patients than waiting on-hold to a call center in Chicago.
The ACA has few provisions that directly affect dentistry. There has been expanded coverage for pediatric (childhood) dentistry. We can all agree that, at least the intent to help kids, is a good idea. Let’s prevent cavities, teach children how to take care of their teeth, and keep them healthy and free of tooth pain. The implementation and effectiveness of this intent can be debated. See above about hindsight being the true measure of success someday.
Unfortunately, the law of unintended consequences has led to the ACA having an effect on dentistry. One rumor is that insurance companies are struggling and looking for ways to cut costs. Over the past six months or so, our office has seen a backwards revolution in dental plan coverage. Reimbursement for previously routine preventive procedures, such as x-rays, preventive screenings, and healthy gum cleanings have gone silly. All of a sudden, procedures that used to be covered fully are coming back partially paid or even denied. More and more, insurance plans seem to be trying to dictate the amount and the quality of care that patients receive.
What happened to physicians years ago is slowly creeping into the dental profession. Without positive change, we may be headed in a bad direction.
All is not lost, though. Professors and policy makers smarter than me have proposed one solution. That solution is called direct reimbursement. Under direct reimbursement, your employer pays for a certain amount of healthcare spending every year. That gives you, the consumer, freedom to go to whichever doctor or dentist you want and receive the type and quality of care that you decide for yourself and your family. No provider lists, no deductibles, fewer hassles. It cuts out the middle man and allows you to direct your own healthcare dollars.
Under this system, many argue that healthcare costs will actually be reduced due to pressure from informed consumers. Capitalism at it’s best.
There are certainly drawbacks to direct reimbursement. It fits dentistry well, but what happens when someone needs tens or hundreds of thousands of dollars in medical treatments? That is a situation where some type of insurance would still need to thrive. Actually, that is the very reason insurance evolved in the first place. To protect one from catastrophe.
Until next week, keep smiling.
-Please send comments to Drs. Parrish at www.ParrishDental.com.