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Letters: Insurance

August 20, 2012

I really appreciate the effort and the "My View" by Dr. Michelle C. Dziurgot in the April 23 ADA News. Her story reminds me of just how insurance has seeped its way into many offices. The ADA News seems to carry many stories that have underlying themes of how insurance companies do one egregious behavior or another. I just wanted to help clarify dentistry’s relationship with insurance as I see it after 30 years in practice.

Dr. Dziurgot’s patient thought dentistry should be lumped into the medical policy and not be separated. That sounds good on the surface if health care was administrated by a third party that was altruistic. However, in our current culture, the further we are from unorganized, chaotic medicine the better. Physicians are taking home less each year and often end up working for large corporations that can better manage their business side. The problem with dental reimbursement is not that it is treated differently than medicine; that is a good thing in my eyes. The medical world is a total failure of health care delivery, because they have allowed profit-making insurance companies to run the program of medical procedure rationing. Insurance companies have an inherent conflict of interest.

The real problem for dentistry is that many dentists are unknowingly training their patients to think of insurance as their friend. Some dentists even think insurance is the dentist’s friend. Some go as far as signing contracts with the very insurance companies that tell them what to do. Then those very same dentists attend local and state meetings and spend the evening complaining about … you got it, insurance companies.

Insurance companies care about taking in as many dollars as possible and paying out as few dollars possible to maximize profit. They are some of the most profitable businesses in the USA, at your expense. Insurance companies don’t diagnose, treatment plan or render care. They just want patients (and some doctors) to think they are looking out for the patient. They confuse patients with TV commercials that suggest that they are health care companies. They are looking out for their bottom line.

Insurance companies have limited payments to about $1,000-1,500 for decades, while costs to purchase benefits have gone up. Benefits have been restricted to crazy concepts (no tooth colored fillings or crowns on back teeth, no fixed bridge if a removable appliance will do, etc.).

Insurance companies routinely down code procedures to their own benefit. The insurance company costs haven’t gone up; they set their maximum risk up front. It doesn’t matter if your crown fee is $500 or $2,000; they will quit paying when the patient’s limit is reached. The percentage utilization I recently read for one company with Snoopy on their airship was that only 3 percent of policyholders received their maximum benefits in a given year. There is a lot of money paid in that never goes toward dental care. That allows them to buy airships. Nothing wrong with profit. But in my industry, I prefer it to be my financial profit and my patient’s health.

The reality is that dental insurance does not exist. By definition, patients cannot insure against the need for hygiene care or X-rays. They can only pre-pay some third party and then hope to get their own money back. Insurance does not cover catastrophic problems; only a very small part until the limits are reached, often not enough to fix even one tooth (root treatment, core and crown). That third party then tries to dictate what doctors can do, contracted or not, what the patients are entitled to based on some contract, and then reduce the amount they pay based on some hidden usual, customary and reasonable tables that they create themselves.

It is time for a look in the mirror. I completely agree with Michelle that we do treat the entire patient every day in our offices. We screen for hypertension and more. Oral health as we all know affects the entire patient. You enjoyed the Navy dentistry because no one had their hand in the cookie jar taking cash out for third-party profit. That was a wonderful example of socialized medicine managed by a government entity. Insurance-based care is fragmented socialized medicine managed by many private companies. Insurance is a failed method of money management (for the patient and doctor). This recent push to "privatize" government-run entities has its place, but dentistry and medicine are failing examples of privatization gone bad. Best wishes, Dr. Dziurgot, and thank you for sticking up for all that dentistry is doing for our patients.

Stephen G. Blank, D.D.S.
Port St. Lucie, Fla.