Uninsured Americans are turning to emergency rooms nationwide to manage the pain from dental problems, according to a 2010 Health Resources and Services Administration report.

The same report reveals that dental emergencies make up between 1.3 percent and 2.7 percent of all ER visits.

USAToday reports the reason is a lack of dental coverage for under-insured and uninsured patients as emergency rooms are treating toothaches, tooth abscesses and other dental care emergencies.

Although that number might seem like only a small percentage, Alan Sorkey, a Louisiana emergency physician, pointed out to USAToday that he treated 226 of the 6,336 patients for toothaches last year.

These dental care-related ER visits create higher costs for taxpayers because many of these dental patients return to the ER two or more times per dental problem to manage their symptoms, according to the ADA. And, while the Affordable Care Act addresses dental care for children on Medicaid, the requirement doesn’t exist for adults, ADA spokesman Robert Raible told USAToday.

The ADA is currently working with the Centers for Disease Control and Prevention to devise an approach to get “broader and deeper numbers and look at key indicators for solutions,” ADA President William Calnon said.

What are your thoughts on this growing dental insurance issue?

For more: Lack of dental coverage sends patients to ER for pain

69% of dentists report that insurance, as a dental marketing tool, brings in new patients to their dental practice, while only 18% disclose that dental insurance doesn’t bring them new dental patients.

Only 13% said that they don’t accept dental insurance in any form.

“Dental insurance lets me give the patients what I want to do without concern for payment. I give a higher level of care than they would have other wise,” shared a New York dentist.

The U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics states that a the primary indicator of access to dental care in the United States is dental insurance. Studies have shown that persons with private dental insurance have more dental visits in the previous year than persons without private dental insurance.

The Wealthy Dentist asked dentists if participating in dental insurance plans was an effective dental marketing vector to bring new patients in to their practice.

Definitely a provider of new patients . . .

“Yes! With better and faster payors than there used to be.” (California dentist)

“Yes, but it is not insurance …it is a defined plan of benefits that dentists agree to accept at a huge discount!” (Pennsylvania oral surgeon)

“Yes, because we found that a number patients of record for many years suddenly disappeared. When finally contacted (many who avoided post cards, letters, phone calls) said they switched to someone who was an insurance provider. Not because they found fault with anything we had or had not done, but stated the economy as the reason they switched. We found that the patients did not value all that we did/had done for them over the years. We sent them a letter welcoming them back if they felt they were not satisfied with the treatment they received at their providing (cattle call) practice.” (Florida dentist)

“More new patients but at a reduced fee (PPO).” (General dentist)

“It has provided us with new patients and kept some patients who might have gone elsewhere had we not become a provider.” (Texas dentist)

“If you treat everyone to the highest standard, no matter their social economic status, type of dental insurance, or depth of their pockets then you will be rewarded with new patients. Some may refer others, fee for service or with “better” insurance coverage. Never judge a book by its’ cover. Treat others the way you would like to be treated and you will have a very successful and rewarding career.” (Top New York dentist)

Dental insurance brings patients at a cost . . .

“It brings in patients that are insurance-driven and may not have high value for quality dentistry.” (California dentist)

“Dental insurance brings patients that do not necessarily value good dental care.” (General dentist)

“Metlife has such a large number of clients in our area, so it would be a much slower new patient flow as a non-provider. The large discount stinks. We do get some non-plan patients referred to us though. I find that in general, plan participants don’t have much loyalty.” (Tennessee dentist)

“With so many dentists on the PPO provider’s lists, it proves not to be a source of new patient generation like the insurance companies promise it to be.” (California dentist)

“It brings in new patients, but at a “cost”. The fee schedules are terrible. I currently consider the write-off as a marketing expense.” (Kentucky dentist)

Two things to note –

Dental insurance plans are really not “insurance” in the classic sense. These are really “ discount benefit” plans.

Second, for an advanced dental marketing strategy on maximizing your profitability from dental insurance plans watch the quick video tutorial at www.dentalmarketingintelligencereport.com/advanced-marketing-strategies

Deborah Lynn Kessler, 45, pleaded guilty to four counts of grand theft over charges that she embezzled more than $100,000 in dental insurance payments at the dental practice where where was manager.

The Orange County Register reports that Kessler signed dental insurance payments over to her personal bank accounts over the course of about three years. Investigators initially said she may have used the money to pay for an RV, boats and trips, and to cover her personal bills.

She was sentenced to two years in jail, plus an additional two more years of community supervision.

According to a 2010 Association of Certified Fraud Examiners report almost one-fourth of all embezzlement cases report losses of at least $1 million with smaller businesses being the most susceptible to fraud.

The average embezzlement scheme lasts for 18 months before detection.

The U.S Chamber of Commerce estimates that employee embezzlement costs American companies $20 billion to $40 billion a year. A long-term employee is 15 times more likely than a stranger to steal from a company.

Some of the best ways to prevent dental office embezzlement is by implementing a segregation of duties, keeping petty cash to a minimum and requiring dual signatures on checks.

Has your dental practice ever been the victim of employee embezzlement? What happened, and how did you handle it?

For more on the Orange County Register story see: Dental worker guilty of stealing more than $100,000

The report complied data from the CSHP’s 2001 and 2009 New Jersey Family Health surveys on children ages 3 to 18 who received no dental services within a year.

The study found that children with employer-sponsored or privately purchased dental insurance were much more likely to receive dental care than children without dental insurance or even those covered by publicly insured programs like by Medicaid/NJ Family Care.

According to Rudgers University news, the report also pointed to well-care doctor visits as an important indicator of the likelihood of a child receiving dental care, possibly because of efforts to increase dental referrals in managed care plans and the expansion of dental care in federally qualified health centers.

“The odds were three times as great for children who did not have a well-child doctor visit in the past year to not receive dental care as those who visited a doctor,” said José Nova, research project coordinator and lead author of the study. He noted that care for under-served children could be improved with expanded health coverage under the Patient Protection and Affordable Care Act.

Reuters estimates that 45 million Americans do not have dental insurance.

To read more on this report see: Rutgers Study: When it Comes to Use of Dental Services, not all New Jersey Youngsters are Equal

The Wealthy Dentist conducted a survey asking dentists if they actively target new insurance patients as part of their dental marketing.

69% of the dentists who responded do not target new dental insurance patients, while 31% do target them.

Location was not a factor in this survey.

Here’s what the dentists had to say about targeting dental insurance patients -

“How do you target new insurance patients?” (North Carolina dentist)

“We choose to remain fee-for-service even in this economy.” (New York dentist)

“We belong to few networks. We do advertise that we take and file most insurance coverage. It makes no difference in our treatment plans.” (Texas dentist)

“We did not participate in any dental insurance plans until very recently, but had too many patients calling to say that, although they didn’t want to leave the practice, they were forced to, as they couldn’t afford to pay the difference for “out of network” any longer. In Illinois, thanks in part to higher taxes on individuals and much higher taxes on businesses, the economy is as bad (or worse) than ever. Even the CHICAGO Mercantile Exchange is talking about leaving Illinois!” (Illinois dentist)

“Yes. If they are in a difficult contracted insurance benefit company and are a business owner or an executive who can make decisions on plans, we encourage them to look at other plans that are less expensive for the employer, better benefits for the patient and better reimbursement for the provider. If they are employees, we strongly encourage them to discuss changing to another plan that benefits the employee, the employer and the Dr. There are many benefits that work so much better. Why should an employer and employee contribute their monies to a insurance benefit that is primarily interested in taking money out of the middle rather than benefit the employer and the employees?” (Minnesota dentist)

Asked one dentist, “At 1,000 per year in benefits , sometimes hardly paying for one tooth, how can you even call it insurance?”

But another dentist disagrees, “Dental insurance is wonderful. People who would never attend the dentist now have good care. The fact that some dentists charge more than the plans pay is their problem. I make my living from dental insurance.”

These are the kind of statements made by dentists when The Wealthy Dentist conducted a survey asking dentists if they think dental insurance is just as broken as medical insurance.

Click on Play to hear more of what dentists had to say about the state of dental insurance -

What are your thoughts?  Is dental insurance not meeting the needs of dental patients?

Let me repeat…The dental benefits trade organization is spending $1,000,0000 to hire a lobbying firm to convince the Obama administration to fix the provision by the end of 2011.

Is this a good thing? Click here for a 92-page white paper “Road Map” with Delta Dental as a co-sponsor.

The NADP is concerned that, starting in 2014, the almost 44 million people who receive pediatric dental coverage through small business employers will also have to buy coverage through the new health insurance exchanges. It is asking regulators to clarify that their existing coverage meets the law’s requirements.

“Truthfully, this is the No. 1 issue for our industry,” said NADP executive director Evelyn Ireland. “It is the most crucial thing for us to get done.”

NADP wants to ensure that people will be allowed to keep their existing dental insurance coverage under the new health care, a promise President Obama repeatedly made during the heath insurance reform debate.

For a multitude of reasons I have never been a big fan of Delta Dental. However, after reviewing the 92-page white paper I think there may be some merit to this $1,000,000 argument.

Before, I make up my mind, I would like some pro or con feedback from our readers.

Please post your comments below.

The New York State Association of Counties has endorsed the ProAct Dental Network Card program that provides cardholders with information they can use to locate dentists who have agreed to charge relatively low fees for dental services.

In Illinois, through a partnership with Careington International, a dental discount card can help patients save up to 50 percent on selected dental services, and 20 percent on orthodontic services.

The discount cards typically work through a network of dentists who have agreed to reduce the cost of their treatments to cardholders. This sets a rate of treatments that appear to reduce the cost to patients considerably.

Some dental cards offer a percentage off of the amount the dentist usually charges while other cards set the fees for a specific amount of money. The dental discount cards charge either a monthly or annual fee and will usually last for one year.

The main thing to understand is the difference between a “Discount Dental Plan” vs. a “Dental Insurance Plan.” Over the last three years the Insurance Plans… which have always been marginal as far as benefits are concerned, have lost enrollees as unemployment has topped 9%.

Many people have been forced to enroll in “Discount Plans,” again with marginal benefits.

For the doctor in either plan the issue is dental marketing for new patients. The discount is the dental marketing cost you, the doctor, pays to acquiring the new patient lead. From their it is up to you and your team to screen for financial capability and do an outrageously great job on case presentation on qualified patients.

When asked if they handle dental insurance for their patients, the dentists who responded yes to handling dental insurance were the clear majority in this survey.

On March 23, 2010, the Affordable Care Act became law and as states begin to deal with the implementation of the act, several are looking to adapt their own version of the plan.

California is just one of those states.

As reported in The Sun, Democrats in California have recently revived Senate Bill 810, which would create a public-private partnership to provide every California resident with medical, dental, vision, hospitalization and prescription drug benefits.

The California universal care plan would provide comprehensive dental care – something largely not addressed in the federal plan.

Here at The Wealthy Dentist, we were curious how dentists are currently handling dental insurance in their practices. Many of the dentists surveyed felt handling dental insurance for their patients is an important part of providing superior customer service.

“Not only do we handle insurance claims for our patients, but we also fight insurance companies for our patients until a claim is finally paid,” noted one dentist. “I believe its part of how much do we as dentists want to give customer service.”

In this survey, 85% of dentists handle all insurance claim forms for patients with dental insurance, 8% don’t accept insurance, and 7% don’t handle insurance claims, but do help patients fill out the forms.

Here are some dentist comments:

• “Many of my patients would go elsewhere if they had to pay up front for services themselves.” (General dentist)
• “I think its a matter of customer service to handle insurance for your patients.” (Indiana dentist)
• “I pride myself on customer service and I believe it’s an absolute no-brainer as part of my truly great customer service. My team (including me) file ALL insurance claims for our patients.” (General dentist)
• “As a specialist where one-time emergency visits are common, we find it necessary to research insurance benefits for our patients in order to present and collect estimated co-payments at the time of service.” (Ohio specialist)
• “I would like to see better tools for educating patients about dental insurance benefits and liabilities, as well as setting better expectations with dental insurance verses medical insurance models.” (Massachusetts dentist)
• “Dental insurance is one of the most aggravating things about dentistry. What I would like to do is collect from the patient, then help them submit the claims.” (California dentist)

For more on this survey see: Dental Insurance: Most dentists handle insurance claims for patients

Known as fee capping, this practice has upset dentists nationwide – and legislators have taken notice. According to the AGD, this year, "a total of 28 states introduced 46 pieces of legislation to stop insurance carriers from requiring dentists to accept caps on fees for services the carrier does not cover."

It would seem that more and more dental insurance carriers are moving into the arena of discount dental plans. The insurance companies are trying to negotiate discounts on services they don’t cover. Perhaps they’re getting ready to try both sides of the equation?

It’s important to note that discount dental plans are monitored separately from dental insurance plans. I don’t know what will happen, but I expect it will be interesting…

The AGD provides additional explanation:

Putting Caps on Fees for Non-Reimbursed Services

Several major dental benefits carriers are adding language to provider participation agreements to allow them to set fees for dental services that they do not pay for, i.e., non-covered services. That is, if a dentist agrees to the contract language, he or she will be required to charge the patient what the carrier has told him or her to charge even when the carrier will not pay for the service.

To enact a fee cap on non-covered services, a dental benefits carrier must amend the current contract it has with its existing providers. Here’s an example of such an amendment:

Dentist may bill a Member for non-covered services (which are defined as any service for which no payment is made under the applicable plan or arrangement for any reason, including but not limited to, services in excess of contractual maximums, services not covered under plan design, and services denied due to contractual limitations). Dentist’s charge to Member for non-covered services may not exceed the Maximum Allowable Charge for the applicable CDT code as specified in the most current Maximum Allowable Charge schedule. Fees for all non-covered services will be collected from the Member, and not billed to the Carrier.

Note that this is just one of many variations of such a provision that you may find in your participation contract. The provider then has the choice of signing the new contract, thus accepting the new fee caps, or terminating his or her contract. If the provider elects not to sign, then he or she will be excluded from the provider networks presented to patients by that carrier’s dental plans.

What are the non-covered services?

Non covered services are those services that a patient’s dental plan has chosen not to pay for. Note that a carrier may offer numerous dental plans. Often however, dental plans without coverage for expensive, cosmetic, or other dental services are cheaper for employers to purchase for their employees. This is especially attractive to employers in the current economic climate. Each dental plan may have a different list of non-covered services, and therefore one cannot specify any particular services as universal ‘non-covered services.’

Rationale of carriers enacting such policy

To stay competitive with one another, dental benefits carriers use the argument of market pressure or gaining a marketing advantage as one of the reasons they are implementing this policy. Market need, the carriers assert, is being driven by patients who can save money on services not covered by their dental benefits plan and see value in limiting their out-of-pocket expenses. However, limiting dentists’ charge to patients for non-covered services allows these carriers to market their dental plans as costing patients less without bearing any of the financial risk of the discount; that is, these carriers gain the marketing advantage by shifting the risk to the providers. Therefore, the market trend will drive all carriers to implement similar restrictions in order to avoid a competitive disadvantage. Accordingly, any legislation enacted against the practice of fee-capping for non-covered services must be sufficiently broad to prevent all carriers from engaging in this practice.

Impact to Patients and the Practice of Dentistry

As primary care providers of oral health care, general dentists strive first and foremost for access to quality care for all as the ultimate goal of the profession. However, to serve its patients, a dental office must be viable and sustainable. Today, more patients than ever rely upon dental insurance to be able to afford oral health care. Studies have shown that, without dental insurance, far fewer persons will choose to see a dentist. Understandably, in the present economy, each of us must make cutbacks to our expenses in order to survive. Public awareness and understanding of the impact of oral health on systemic health issues such as diabetes and cardiovascular afflictions is still at its fledgling stages. Therefore, out-of-pocket expenses for oral health are often among the first to be avoided by the public.

Concurrently, businesses including those of dental benefits carriers and employers are also seeking cutbacks. Carriers striving to maintain or increase their revenues and marketshare in this economy offer employers cheaper plans for their employees by covering fewer services and paying less than true market value even for those services they cover. However, by covering fewer services, carriers compel patients to pay for more services out-of-pocket, which they may be unable or unwilling to do. Second, by paying less for the services they do cover, carriers compel dentists to function at a net loss when providing these covered services.

Therefore, today’s dentist must often rely upon billing at market rates for non-covered services to compensate for the loss he or she absorbs in accepting paltry fees from carriers for covered services. However, unlike the carriers’ actions of limiting services they cover, the dentists’ actions do not impose an undue burden upon patients. Here’s why. In the absence of fee-caps for non-covered services, dentists work with each patient on a case-by-case basis to charge what each patient may be able to afford with an understanding that some patients may be able or willing to afford more than others.

Fee capping takes away this opportunity! If fees for non-covered services are capped across the board without regard to what each patient can afford, the practice of the participating dentist may become unsustainable. The result may be two-fold. He or she may no longer be able to offer that specific service to that carrier’s patients, thus limiting the patients’ treatment options. In some markets, providers may feel compelled to stop participating with certain carriers in order to survive. In either case, the patients would face decreased access care.

Call to Action

AGD is currently tracking legislative activity in all states, including fee capping legislation. To see whether your state has a fee capping bill, please click here. The AGD’s Legislative & Governmental Affairs Council and the Dental Practice Council have also approved a legislative lobbying guide called a ‘toolkit’ for AGD constituents. The toolkit will help constituents push the passage of state laws to stop insurance companies from capping fees for services they do not cover. The AGD asks you to contact and work with your constituent organizations to help them use the toolkit to lobby for these state laws. Several states have already introduced legislation to prohibit fee capping by insurance carriers; AGD members are asked to contact their legislators to encourage them to pass this legislation. Click here to see if your state has an action alert on fee capping, or to find your state’s elected officials.

- AGD Advocacy: Caps on Fees

Dentists: what are your thoughts on the subject?