Gulling because the insurance industry with their money and lobbying power again trumped the will of the policyholder



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It was a typical early weekday morning in my dental office, preparing for the treatment of the day’s patients. Reviewing treatment plans, assembling the appropriate instruments in the designated treatment rooms, checking the monitoring systems to be sure the sterilization equipment was functioning properly. And yes, dealing with dental insurance. One of today’s issues I find especially gulling.
It’s been just over a week since the Indiana State Senate failed to pass a measure protecting a patients’ right to instruct their dental insurance to send benefit payment directly to the dentist. A measure that failed to pass even though there were more votes for it than against it. Twenty-five votes for and twenty-four against. It failed to pass because it takes a constitutional majority of twenty-six votes to pass and one senator, Lindel O. Hume, was excused from voting, thus the required twenty-six votes could not be reached.
Gulling because the insurance industry with their money and lobbying power again trumped the will of the policyholder.
How can I make such a statement? As evidence, I offer the fact that every one of our patients who were going to be directly affected by this law signed a petition in favor of its passage.
Passage of the law would protect the policyholder’s right to decide to whom the insurance company should send the payment of benefits check. This law would have allowed the patient to decide if they wanted the check sent to themselves or to the dentist. This is what the policyholder has always been able to do until about a year ago. At that time, Delta Dental decided to only send the check to the policyholder even if the policyholder wanted the check sent directly to the dentist.
So why is this a big deal? Because if the check is being sent directly from the insurance company to the dentist, the patient can continue with any additional treatment they or their family may need without having to pay the insurance companies portion of the treatment and then wait on the insurance company to pay the policyholder.
So what is the reason the insurance industry would oppose a measure that would make it easier for their policyholder to receive dental care? To oppose a measure that every policyholder in our practice supports? The reason, their representative Dr. Jed Jacobson, senior vice-president and chief service officer for Delta Dental of Indiana gave in his press release to the Fort Wayne Journal on January 30, 2009, was “Assignment of benefits refers to a non-participating health care provider’s ability to collect directly from an insurer without having to meet the insurers quality standard or patient cost protection requirements. Such a proposal will eliminate the chief reason many providers participate with an insurance carrier.”

There are three falsehoods here.


1: Delta Dental of Indiana doesn’t care at all about the quality of dental care their policyholder

receives. Whenever Delta Dental of Indiana or any other insurance company has contacted me, or any other dentist I have talked to, about joining their network, never has one of them ever asked me about the quality of my care, requested references about my character, required me to pass a test to demonstrate my skills.


2: Delta Dental’s cost protection requirements are a secret. They don’t make public what

they are and how they calculate them. They don’t have to, but they do let you know when you’ve exceeded one of them. I get suspicious when people do things in secret.


3: Falsehood number three is neither of the first two reasons are a reason dentist joins a provider network. The incentive dental insurance companies use to recruit dentists is a promise of more patients and the implied financial benefit of joining, and the implied consequences of losing all those potential patients. I know it sounds hard to believe that your friendly neighborhood dental insurance is primarily interested in making money and not your quality of care.
Which finally brings me back to the dental insurance issue of that March morning where this all started. It’s that quality thing again. On this morning, after waiting for a month on this insurance company to decide if their policyholder was in legitimate need of a crown, the response was good and bad. Yes, they agreed the patient needed the crown, but they decided a crown made from a material that doesn’t fit as well and may cause irritation to the gum tissue around the crown and cost about 8% less was a better choice. Their reason for not paying for my recommended procedure? I quote, “Another procedure could have been performed which would have provided a satisfactory dental restoration. An allowance has been made for that procedure.” So much for insurer’s quality standards.
If a company, who is paid by someone to protect their dental health, treats that person in this manner, is it any wonder why those companies have to try heavy handed tactics to force dentists to join their network. Would you want to be treated by a dentist who works for these people or by a dentist who works for you? Someone who will inform you of your real condition, your options, and then fight your insurance company for your benefits?
Over the next two (2) weeks, I’d like to try to make some sense of the dental insurance industry, their practices, and a much better alternative. I’ll also give you some resources in the future for additional help and information.


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