But I Have Dental Insurance
October 14, 2011
It should come as no surprise that the insurance industry is out to make a profit. It’s a business just like any other business. Any place an insurance company can cut costs or deny a claim is more of a profit to them and that is their goal. Unfortunately, this is not always in the best interest of the patient.
When my son was born 15 years ago he could not keep anything in his stomach. We went through a battery of tests to determine the problem. Not once did I think, “I wonder if the insurance is going to cover this?” When the diagnosis was made and it was determined that surgery was needed when he was only 10 days old, not once did I think to check with the insurance company to see if it would be covered. When all was said and done the insurance company said that we owed $10,000. I had the normal reaction that anyone would have – How could I owe $10,000 when I have insurance?
Dentistry is a little different. There are not too many situations where a life or death threatening has to be made or the dependency on insurance coverage needs to be assessed immediately. Many dental insurance companies suggest that a pre-determination of benefits be submitted prior to any work being done. The reason for this is to control what is being done and to delay the payment of a claim. The longer an insurance company delays a claim the longer they have their money and they know that longer time periods lead to the possibility of the patient not following through with the work.
I recently had a claim rejected by an insurance company for periodontal scaling and root planning (a.k.a. deep cleaning). This is a procedure done on people with periodontal disease to remove calculus (tartar) and bacteria below the gum level. The claim was submitted with the necessary documentation showing clear evidence (in my professional opinion) of periodontal disease and the need for treatment. What does this say to the patient? The patient put trust in the doctor to make the diagnosis and suggest the necessary treatment but the insurance company basically said that the treatment wasn’t needed. Not needed? How do you explain that to a patient?
What happens if I say, “Your insurance company said that you do not need this procedure, so I guess you don’t need it?” Two things happen. One is that the patient does not get the treatment needed, determined by someone sitting behind a desk who has never even seen the patient. The other is a huge increase in liability. When the patient’s periodontal disease continues and the person ends up losing teeth, who is responsible? You would logically think that it would be the insurance company who denied the treatment. This is not the case. The ultimate liability falls on the dentist for not managing the disease.
Patients need to be educated on their conditions. We live in an insurance dependent world. Just remember – your insurance company doesn’t care about you the same way your doctor does.
How To Choose A Dentist
October 13, 2011
One of the many reasons people do not get the care they need is because of lack of trust. Whether it is the dentist, the doctor, the hair stylist, or the car mechanic, we generally seek out individuals who we like and thereby trust to provide a service for us.
I always ask new patients of mine how they decided to come to my office. The responses I get are probably the same for most dentists. The top ones are referrals by a friend or family member, the phone book, and more recently the internet.
I used to think that the only reasonable way to pick a health-care provider was from a referral of a friend or family member. Although, I do not think it is a bad way, I think the best way involves a little more research on the part of the prospective patient. Your best friend may have a dentist that she absolutely loves, but they may not be the right person for you.
So, how do you choose a dentist? Personally, I think it is very difficult. Trusting the dentist tops the list for satisfied patients in feedback surveys. You don’t have to be skeptical of every person’s trustworthiness, but I do think that prospective patients should sit down and have a conversation with any potential dentist or doctor prior to becoming a patient. It doesn’t matter where the dentist went to school or how long they have been in practice. What does matter is that you are comfortable with the people in the office.
It is impossible for a prospective patient to accurately judge a dentist’s technical competency. And although trust is essential, it has nothing to do with technical skills. If it did, then the most competent doctors would always be the most trusted. A key component is always not what was recommended but the approach and emotion behind how it was presented.
If the cost of service is the only thing that is your determining factor in choosing a dentist, you will not learn much about the dentist by asking questions about fees. Fees in any one particular office are based on many different factors. These factors include the level of training of the dentist, the quality of the materials and laboratories used, and the expenditures involved in running a small business. The amount and type of continuing education a dentist takes is very important and often reflects the quality of care they provide.
As a consumer, your search should begin with determining your objectives. Are you looking for a short-term relationship and inexpensive way to fix an immediate concern or a long-term relationship to partner in achieving optimum health? Although many patients choose their dentist based on whether they take their insurance, for reasons I completely understand, it is not the best way to find the most appropriate dentist.
The last step is to make an appointment with the dentist to just talk and discuss your concerns. This can be a 30 minute appointment with or without x-rays, just to get a feeling for the office and dentist. Most dentists will not charge a fee for this visit.
There is no one dentist who is right for everyone. Use the same criteria for choosing a dental office that you use in choosing any other service. You’ll know you are in the right place when you feel a mutual level of respect and your individual concerns are addressed in a caring, non-pressuring manner. Good luck and I encourage any questions you may have.
The Transitioning Practice – Part 2
October 3, 2011
Last week I began talking about what to do if your long-time dentist is replaced by someone new. Having taken over the practices of two retiring dentists, I consider myself pretty experienced at this type of situation. Let me see if I can break this issue apart.
For those long-time patients, change is not easy. My theme of last week’s column was that you owe it to your retiring dentist and the staff to give the new dentist a try. From there you can make the decision on whether you are comfortable or not.
In my last practice transition I was taking over an office that was stuck in the 1970’s in both style and equipment. The patients loved it there….and they loved the “retiring” dentist. Enter me. I went in and replaced all the windows, floors, cabinetry and equipment. I did it for the patients but I also did it for me because I needed to be comfortable in the place I was working.
I got many comments about the new digs. Most people appreciate when things are “state-of-the-art” and in this case desperately in need of an update. However, that is a just a small piece of the puzzle.
Long-time patients of a dental practice grow very attached to their dental office. This includes the dentist and the staff. The transition of a dental practice is often the excuse patients need to switch if they have been traveling a long distance to see their dentist. Patients definitely find comfort in at least seeing the same faces of the staff when they return to the “new” office. Therefore, it is very important for the “new” dentist to keep the same staff, at least for a while.
However, as the leader of a dental practice and a small business owner, the dentist will undoubtedly make changes. These changes, from my own experience, are made for both the benefit of the practice and the patients. This can be difficult for many patients to understand as most only visit the office a couple of times a year. When a patient sees a new face and familiar faces gone, it always raises questions. The entire current staff of the office needs to be comfortable with discussing the changes. Although uncomfortable, patients should not hesitate to ask any questions they have.
I have been very lucky in both of my practice transitions to retain the majority of existing patients. I understand that choosing a health-care provider is a very personal decision. When a practice transitions, the patients are automatically granted a “new” dentist without the initial ability to choose. The bottom line is that you always have the right to choose your health-care provider.
Patients should know that most providers respect a patient’s right to choose. Yes, it is always a little depressing for the staff to see long-time patients leave. However, it is also very gratifying to see a practice family grow as new relationships are made.
In conclusion, give your new dentist and dental staff a chance. You may be pleasantly surprised. If not, move on. If you aren’t comfortable for whatever reason you always have the opportunity to go back “home”. Most offices welcome this.
Next week I will discuss some ideas for finding a new dentist should you decide to transfer. This information will also be helpful for those who have not been to a dentist for a while or are new to the area
