Insurance reimbursements, revenue cycle management and verification are three aspects of the dental insurance industry that five dentists feel needs an update.
The leaders featured in this article are all speaking at Becker's 2024 dental conferences. This includes our Spring Future of Dentistry Roundtable, which is set for June 19-21 at the Swissotel in Chicago, and the Fall Future of Dentistry Roundtable, which is set for Oct. 30 to Nov. 1 at the Hyatt Regency in Chicago.
If you work at a DSO or dental practice and would like to be considered as a speaker, please contact Randi Haseman at rhaseman@beckershealthcare.com.
Note: Responses were lightly edited for clarity and length.
Question: What is something in the dental industry that you feel is outdated or needs to be changed/updated?
Gabriela Hricko, DDS. Partner Orthodontist of Great Expressions Dental Centers (Southfield, Mich.): One thing in the dental industry that needs to be updated/improved is dental revenue cycle management. There have been great improvements, and there are many new software systems and technologies to help streamline the process. However, it can be better, and the dental insurance companies need to modernize and collaborate to make this happen. There are still insurance companies that require monthly manual paper claims to be mailed in for orthodontic reimbursement. We, as an industry, can do better, so let's make it happen!
Johnny Joseph, DMD. Owner and Pediatric Dentist of Pediatric Dentistry Asleep (Aliquippa, Pa.): What is outdated in the dental industry is insurance verification and benefit breakdown. One still has to call the insurance company and wait several minutes to speak with a representative. Additionally, oral health maintenance. The current oral hygiene given to patients is simply not working. We need to take into account all factors that lead to dental disease. What should be addressed are, but not limited to, oral hygiene (well-known brushing and flossing), diet, genetics, oral microbiome, social determinants and socioeconomic status.
Raj Puri, DDS. Owner of Smiles Dental Center (Wood Dale, Ill.): Being an owner of three dental offices that are 60% to 70% PPO participation, I think the entire dental insurance industry needs an update. I have multiple team members who still have to call the insurance companies to verify insurance, check benefits, follow up on missed claims/payments, argue about denials and a multitude of other issues. We feel that a patient or dental office should be given "real time" benefits and balances as well as accurate estimates online or through an app. All of a patient's information and dental insurance IDs should be accessible on their smartphones by now. We shouldn't be waiting on a fax back for weeks for payment. This antiquated way of doing business needs to be updated and changed for the patient and doctors.
Robert Trager, DDS. Dentist at JFK Airport (New York City): One of the items that should be changed is the reimbursement for consultation. Many of the vendors will only pay for a consultation if that's the only treatment done at the time services are rendered. Some vendors don't pay for consultation at all. Patients want to know what you anticipate and plan to do for their oral health on their next visit. You have most of the information on their initial visit, and it should be given an overview on their oncoming visits. Why waste time so you can plan their treatment for the next visit? The next situation should be when you research when reimbursements are due, they will give you a date when a payment is forthcoming; they will tell you when a check is cut but they don't send it out until at least 10 or more business days later. The reason they do this is to collect interest on the float; but if we don't pay our credit card bills on time, we are charged a late fee and interest. They should be mandated to mail out reimbursements within five business days after the check is cut.
James Willis, DDS. CEO of Willis and Associates Family Dentistry (Fisherville, Va.): Many dental insurance companies operate as nonprofit organizations, which allows them to benefit from tax-exempt status. However, there's a growing concern that some of these organizations prioritize profit over public service. This manifests in several ways that affect both patients and dental practices negatively. These issues suggest a need for regulatory reform in the dental insurance sector to ensure that nonprofit insurers truly operate in the best interests of their patients, providing more comprehensive, accessible and timely dental care. Changes could include more stringent requirements for maintaining nonprofit status, such as clearer reinvestment of profits into patient care, updates to coverage limits in line with inflation and technological advancements and simplified administrative processes.