Have you ever discussed insurance-industry practices with your patients?
In August, the ADA filed a class action civil lawsuit against Aetna Inc., the nation’s third-largest dental insurer. Among other allegations, the ADA contends that Aetna has libeled "out-of-network" dentists by suggesting in an explanation of benefits statement that dentists have overcharged their patients.
Ninety-three percent of respondents to October JADA’s Question of the Month said they have discussed such insurance-industry practices with their patients.
"To avoid any misunderstandings with patients, my staff and I talk with patients at great length about their insurance benefits and help them interpret insurance jargon that often is misleading," said one reader.
"Often," said another. "Plus we give patients copies of letters we have had attorneys send to insurers. Sadly, as the industry is so powerful, it is perceived as being truthful."
"Patients think we have overcharged after they read the insurance statements and think we’re ‘ripping them off,’ " replied yet another. "We try to explain, but the insurance companies have already damaged the dentist-patient relationship."
Several dentists gave examples of what these insurance industry practices cost them in terms of time, money, reputation and patients.
"At least once a week I have to ‘defend’ my fees against the abusive insurance companies’ explanation of benefits," said one respondent. "It takes time and money."
"My problem with insurance companies is when they write my patients letters saying my fees are out of line or the treatment I recommend is not necessary," said a dentist.
"I have actually lost patients over the insurance companies’ letters to my patients," said another.
"When patients call to seek an explanation for the discrepancy between our fee and the insurance company’s fee schedule, the carrier often refers patients to a network dentist," said another dentist.
Other respondents said that having a good dentist-patient relationship is key. "I find that if I have a good relationship with the patient, the patient just ‘blows it off,’ " said one reader. "When I have a poor relationship, there’s nothing I can say that makes the patient believe my side of the story."
"For me, it’s really a nonissue," said another. "By providing a high level of customer service, our patients don’t care that it costs more. They expect it."
"I tell patients that the insurance company does not set my fees and that if insurance says UCR [usual, customary and reasonable] rate is $40 and we charge $60, they are responsible for the balance," said a respondent. "And we have no problems. Treat people right, and fees don’t matter!"
Seven percent of JADA readers said they have not discussed this issue with their patients. "I consider this technical insurance inner workings that should not be required knowledge for my patients," said one reader. "Few of them know or care; they want excellent care at no or not much cost to them."
For dentists who want to educate their patients about dental benefits, the ADA offers a variety of materials. Two patient brochures are available from the ADA Catalog and can be ordered by calling 1-800-947-4746 or visiting "www.adacatalog.org".
One of the brochures, "Why Doesn’t My Insurance Pay for This?", helps patients understand their dental insurance by explaining some commonly misunderstood features. It describes UCR rates, annual maximums, preferred providers, pre-existing conditions and more.
The other, "Get the Dental Care You Deserve," explains the pros and cons of different types of dental insurance, why some procedures might not be covered but still should be done and why UCR rates may not be enough.
The ADA Council on Dental Benefit Programs has devised a form letter that can be customized by dentists in their offices and distributed to patients who have insurance. To request a copy, call the toll-free telephone number on the back of your ADA membership card and dial or ask for Ext. 2753, or call 1-312-440-2753.
ADA.org provides a "frequently asked questions" page that focuses on benefits and insurance. It provides patients with information about dental insurance, an overview of dental benefits and tips on understanding them, as well as explains how benefits are determined. It can be found on ADA.org at "www.ada.org/public/faq/insurance.html".
