Increasing reimbursements often sit atop the wishlist for dentists and dental providers when it comes to dental insurance changes.
But there are other improvements that could be made, such as digital and automated claims, fixing unreasonable claim denials and mandating dental loss ratios, according to dentists.
These eight dental leaders recently connected with Becker’s to weigh in on what changes they want from the dental insurance industry, as well as from Medicaid and Medicare.
Editor’s note: Responses have been lightly edited for clarity and length.
Corey Anderson, DDS. Dentist of Affordable Dentures & Implants (Bridgeport, W.Va.): Medicaid already knows what will drive patient dental care consumption. Roadblocks are presumably in place to control costs. Mandate medical loss ratios for organizations running Medicaid programs. Medicaid could improve the provider experience by paying for missed appointments, expanding the scope of covered services to create a baseline of covered adult services, reduce preauthorization requirements, accelerate provider payments and allow balance billing for non-covered services.
Vahid Bashi, DDS. Dentist of Best Care Dental (Colorado Springs, Colo.): Start covering implants, especially for patients who have lost all their teeth.
Mike Davis, DDS. Dentist of Smiles of Sante Fe (Albuquerque, N.M.): Medicare/Medicaid and dental insurance plans are different programs, both of which have different problematic issues. Yes, paltry reimbursements are the primary negative issue facing providers from both types of programs.
The dental insurance industry has become beyond unacceptable for unreasonable denial and delay of claims payments. These companies continually and falsely assert “no X-rays were submitted” when the opposite was true. These disturbing companies repeatedly claim, “no evidence of necessity for treatment”, when the necessity for patient treatment is clearly documented. The fee schedules for both Medicare/Medicaid and dental insurance carriers are often highly lopsided. For example, the fee for a crown recementation may be so low, that it barely covers the overhead cost of only infection control. Some doctors are tempted to add in additional services which should be included such as a limited occlusal adjustment. Providers may be financially forced into unethical “unbundling” of dental services.
Medicaid and/or dental insurance exclusions and limitations on patient care may be extremely deleterious to patients’ health, to the level of the ridiculous. For example, a plan may cover for initial periodontal therapy of scaling and root planing in four quadrants for an adult patient. Thereafter, the plan may limit coverage to annual dental prophylaxis. Such patients require follow-up periodontal maintenance visits three or four times per year. Such a plan limitation is contributory to dental disease.
Nels Ewoldsen, DDS. Dentist of Nels Ewoldsen DDS MSD (Cedar Rapids, Iowa): A dentist for 47 years now, I’ve been in and out of the Medicaid Provider Network many times. I leave because it’s not a level playing field, I return because I genuinely care about patients. As a small player (one dentist, one hygienist), when I submit a claim that is denied, the burden of proof falls on me. When Medicaid miscodes or revises a claim incorrectly, the burden of proof falls on the dentist to set the record straight. When Medicaid makes a mistake, it’s the dentist’s responsibility to correct the error; and God forbid, if the dentist makes a mistake, it’s viewed as fraud! Give providers a level playing field, be accountable and together let’s share the responsibility of bringing dental care to the underserved.
Colleen Holewa, DMD, MD. Oral and Maxillofacial Surgeon of Redeemer Health (Jenkintown, Pa.): Improved workflows, [or], less paperwork and more efficiency.
Mike Kang, DDS. Dentist of AppleTree Dental (Anaheim, Calif.): One major change that I would like to see from Medicare/Medicaid, aside from reimbursement increases, is streamlined administrative processes and reduced claim denials.
Like many dental providers we face challenges with complex prior authorization requirements, frequent claim rejections and lengthy processing times, which can delay patient care and administrative burdens. Simplifying the approval process, improving transparency in coverage criteria and ensuring faster reimbursements would encourage more dental offices, including ours, to participate in these programs, ultimately improving access to care for patients.
Charles Schlesinger, DDS. CEO of Comfortable Dentistry4U Rio Rancho (Albuquerque, N.M.): I would like to see them not try to dictate treatment and when it is appropriate. For example, if I am doing a full-mouth edentulation, they will not pay for alveoloplasty done at the same time. They want it as a second procedure done on another visit. That is ridiculous!
Kai Weng, DDS. Dentist of Dental Designs of Maryland (White Marsh): One thing that would benefit the dental industry greatly is developing some type of standardized claim processing interface on the insurance company side. Many businesses, including mine, are already in the process of automating their entire RCM cycle using AI. The complex but rule-based logic of insurance claim processing lends itself very well to leveraging AI to get claims paid faster, more accurately and more efficiently. However it takes two to tango, and instead of embracing this change in paradigm, many insurance companies have been directly working to make data extraction more difficult for dental practices utilizing AI for their RCM. My hope is that with future dental loss ratio legislation, it will encourage insurance companies to develop matching interfaces that would make dental claims entirely digital and automated. This leads to more profitable dental businesses with less administrative burden, which results in the ability to divert more investment into clinical and patient experience initiatives which will ultimately be what separates an average dental business from an excellent one.
