By Dr. Stephanie McGann, DMD FAGD, Columnist, The Times
As the end of a very unusual year comes to a close I have been looking at what changes this has brought to the small business community. Like many independent dental practices I am a small businesswoman. My industry is a bit different however than many other small businesses, in that we have no mechanism to raise our fees when the costs of materials, and staff increase. The same pressures that are causing our beloved Brandywine and Jennersville hospitals to close their doors threaten every medical practice in the area. Watching healthcare businesses being run out of business is frightening, so please bear with me here.
The problem is one thing and one thing only – Insurance Networks. These contracts are inflexible and have one major goal, make the numbers for the stockholders of the insurance companies. Period.
Costs to provide care have skyrocketed. Yet in some cases our reimbursements have been cut. A box of gloves that usually costs $7-12 recently cost me $67. Canisters of disinfecting wipes have the same story. Supplies have seen a huge jump, shipping to get those supplies is more now than it was even a year ago. Then there is the labor shortage. Corporate dental practices are using their bigger buying power and financial muscle to offer signing bonuses to some dental staff that are way beyond the reach of an independent practice. Why do I think it’s important to share this? Simple, Dentists are dropping out of dental insurance networks everywhere. Yet the blame is always on the dentist.
Brandywine Hospital isn’t going to close because they wanted too much money, they closed because the business people couldn’t make it work and the insurance carriers were unwilling to adjust the reimbursement schedule.
You can’t spend 75 dollars to provide a service you are only getting paid 50 dollars for.
Yes, I know healthcare billing is messy. That too, is part of the problem, you have the regular fee, the adjusted fee for the individual network (aka write-off) , the portion that the carrier pays and the portion that is the patient responsibility. And that mess means more employees to sort out the billing and coding and providing obscure and sometimes unreasonable documentation to an insurance company, all increasing the costs to provide care. Imagine as a dentist with decades of experience being told by an insurance carrier I needed to bring in an elderly gentleman to take an xray to prove to them he had no teeth.
Dental reimbursements are calculated using the cheapest materials, cheapest labor and cheapest dental laboratories (often overseas). These calculations were made pre-pandemic when costs were a lot less. These reimbursements in some cases have been cut because of a weird calculation that penalized us for the shutdown. Yet those premiums were collected and CEO’s of dental insurance companies took huge bonuses during the shutdown because there were no claims to pay. And then, there is the truth that makes me want to pull my hair out. The claims processors for some of the larger companies are paid more than most dentists, they are bonused on denied claims. (rant over)
So, what’s next.
Well, if you are fortunate enough to have a dentist that participates in your network, appreciate that they are working with nearly no profit margin. If you like your dentist, when it’s time to renew dental coverage look at their in-house plan if they have one. This is a great compromise as it cuts out the corporate middlemen and allows nearly network like fees for everyone with a lot less hassle and paperwork.
I am a dentist in most major networks. I believe that patients should have access to care for fair and reasonable costs, however the pressure from contracts that don’t cover the cost of care is taking its toll. Here is a list of things patients can do to help.
- Don’t be a no-show. If you can’t make an appointment give us time to fill the slot. The employees are getting paid even if you are not there.
- Statements and billing cost money, please pay co-pays promptly, nothing is worse than sending 3 statements to collect 20 dollars.
- Many offices are adding value added options, take advantage of these upgrades.
- If you can, now is the time to do elective procedures, you may get a great service at a great price.
- Be nice. More and more we have individuals who are angry and frustrated. I understand these are times we live in, but I hate to have employees threaten to quit because the people we serve are sometimes abusive.
- If you aren’t vaccinated, just do it. It’s always a sad day in the office when we have to cancel an appointment for someone who is now hospitalized with Covid-19.
The business of healthcare has changed so much in my lifetime. Once upon a time you could go to your physician or dentist, pay a fee and get care. Now it’s hours of paperwork, claims and documentation just to get your teeth cleaned. Insurance carriers have made themselves more essential than the providers themselves, they are purchasing pharmacy chains, hospital groups and more. I will always fight for my patients but it’s time to understand what the fight really is.
Dr. Stephanie McGann, who has more than two decades of dental practice experience, is a resident of the Unionville area and owns and practices at Rainbow Valley Dental, in Valley. She is a past President of the Chester/Delaware Dental Society and she is a Fellow of the Academy of General Dentistry.
