"I'm so sorry, but I have to cancel my appointment. I spoke with the insurance company, and it would be much more affordable for me to go in-network. I'm so sorry. I had heard such great things about you and was looking forward to meeting you!"
A very nice email from a disappointed patient.
Sheri B. Doniger, DDS.This woman did a Facebook shout-out to her friends for a dental recommendation. Several of her friends are patients in our office (all are out-of-network). She decided on our office from their recommendations. We always appreciate referrals from our patients.
When she called to schedule the initial appointment, we had a lengthy discussion. She had many phone consultation questions about our philosophy on removing amalgam, composite resins, replacing crowns, and periodontal disease. We obviously passed the interview test, because she scheduled for an appointment this summer. Then, we received that email.
It is certainly a patient's choice to decide to go to an in-network provider. I am sure many of you who are reading this solution are in-network providers for several benefit companies. It was our decision not to join any networks but to continue to take assignment of benefit for all carriers, unless they are a health maintenance organization (HMO) or dental maintenance organization (DMO).
Annual maximums
What we have found is the annual maximum allowed for many companies is the same for in- and out-of-network providers. The difference may be the percentage of "usual and customary" they will pay for services. Occasionally, the in-network provider has a larger maximum than out-of-network ones. Frequently, the plans are essentially the same, with a variation in the deductible.
One definite similarity for all benefit companies is the script to steer patients to in-network providers. When a prospective patient calls their help lines, customer service representatives speak with them and will direct them to network practitioners. They discuss the expense of going to an out-of-network provider.
Even after a conversation with this potential patient, without knowing what her specific dental needs are or seeing her plan benefit documents, there is no way we would be able to discuss affordability. As we know, being or seeking affordable is not always the best way to go.
The other misnomer here is patients do not have dental insurance. Our patients have a dental benefit. A prearranged amount of money, allocated to dental care that their employer (or spouse/significant other/parent/guardian) has purchased to offset the cost of dentistry. It is not -- nor has it ever been -- insurance.
When dental benefits first appeared more than 50 years ago, the annual maximum was a $1,000. Back in the '60s and '70s, $1,000 bought a lot of dentistry. Today, many plans still have not moved away from the $1,000 maximum.
Depending on your area of the country, $1,000 may cover a portion of two preventive wellness visits and a few restorations, but if the patient needs a crown, extraction, or endodontic treatment, the majority of the benefit is gone and the remainder is out-of-pocket. Patients are not told this when they call their companies and are directed to affordable in-network providers. It is up to us and our teams to educate patients on this misconception.
We do try to work with our patients and their dental coverage, although regardless of the plan, if they have several dental issues, there may be more out of pocket in one year or another. For this patient, we wished her the best of luck and said that if at any time in the future she wanted to become a patient in the office, we would love to have her. Never close the door. You never know where your next referral will come from.
Sheri B. Doniger, DDS, practices clinical dentistry in Lincolnwood, IL. She is the immediate past president of the American Association of Women Dentists. She has served as an educator in several dental and dental hygiene programs, has been a consultant for a major dental benefits company, and has written for several dental publications. You can reach her at [email protected].
The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
