Dentists Speak Out on The Affordable Care Act

Dentists Speak Out on The Affordable Care ActPresident Obama’s Affordable Care Act ruffled feathers among dentists.

Most would prefer that the federal government stay out of their dental practice management.

“The Act was conceived way too fast, with very little advice from health care professionals.” complained a California dentist.

“Keep dentistry out of it!” said an Oklahoma dentist. “It is bad enough that dental insurance is attempting to dictate fees.”

The Affordable Care Act requires health insurers to provide dental care for children, but not adults, along with a provision to provide grants for alternative dental care providers.

The Wealthy Dentist conducted a survey that asked dentists if the think the Affordable Care Act will help their dental practice.

It was certainly a controversial health-care survey, and legislation!

To hear more of what dentists had to say on the Affordable Care Act, Click on Play to watch the following short video —

What are your thoughts on the Affordable Care Act?

Will Dentists Find Dealing with Insurance Exchanges a Disaster?

Will Dentists Find Dealing with Insurance Exchanges a Disaster?As of the first of this year, dentists and health care providers have been closely monitoring the changes being implemented due to the Affordable Care Act.

Under the Act, as of January 1 all U.S. states were supposed to notify the U.S. Department of Health and Human Services if they are creating online exchanges for the October 1, 2013, deadline when Exchanges are to be made available to anyone without insurance and small businesses throughout the U.S.

The Exchanges will allow the general public to go online to compare health insurance plans and buy health insurance from the state-operated health Exchanges, as well as insurance plans being offered by the federal government.

Stand-alone dental insurance plans and pediatric dental coverage will be offered by these Exchanges, but it is still not known if adult dental coverage will be offered separately from health insurance on these Exchanges and what the requirements for dental coverage will be within the Exchanges themselves.

The New York Times reported last week that Health and Human Services Secretary Kathleen Sebelius will extend the deadline for any states that expressed interest in creating their own exchanges or overseeing insurance sold through a federal exchange.

Thus far, only 18 states and the District of Columbia intend to run their own health insurance Exchange. In the states that decide not to set up their own Exchange the federal government will implement federal health insurance Exchanges.

According to the U.S. Department of Health and Human Services, the Affordable Care Act will ensure that Americans will have access to quality, affordable health insurance.

To achieve this goal, the law ensures health plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges, will offer a comprehensive package of items and services, known as “Essential Health Benefits.”

Essential Health Benefits must include items and services within at least the following 10 categories:

1. Ambulatory patient services

2. Emergency services

3. Hospitalization

4. Maternity and newborn care

5. Mental health and substance use disorder services, including behavioral health treatment

6. Prescription drugs

7. Rehabilitative and habilitative services and devices

8. Laboratory services

9. Preventive and wellness services and chronic disease management, and

10. Pediatric services, including oral health and vision care

States will have the flexibility to select a benchmark plan for insurance coverage that reflects the scope of services offered by a “typical employer plan.” This approach is intended to give states the flexibility to select a benchmark plan that will best meet the health insurance needs of their citizens.

The health insurance plans must offer benefits that are “substantially equal” to the benchmark plan selected by the state and modified as necessary to reflect the 10 coverage categories.

Health insurance plans will have flexibility to adjust benefits, including both the specific services covered and any quantitative limits, provided they continue to offer coverage for all 10 statutory essential health benefit categories listed above and the coverage has the same value.

Dentists are deeply concerned how these changes will impact their dental practice.

Dentists who in the past have accepted a percentage of Medicaid dental patients understand all too well what it is like to deal with a government-run dental care benefit provider.

Medicaid dental care reimbursements have always been low, even before Medicaid began eliminating adult dental care from its benefit plan. Private employer dental insurance plans have offered dentists more new dental patients with better reimbursement rates.

More than 5 million children will become eligible for dental coverage under the Affordable Care Act and pediatric dentists are concerned the insurance changes implemented by the Act could result in fewer insurance companies offering dental health plans to families, thus leaving dental practices treating children with a state or government-based dental benefit plan.

The National Association of Dental Plans have made dentists aware of the rule that families who buy dental coverage on an Exchange may be subject to an annual out-of-pocket cost-sharing limit (possibly up to $1,000) for dental care.

This could have a very real impact on many dental practices’ bottom line.

The PricewaterhouseCoopers report “Patients or Paperwork” revealed that the Medicare and Medicaid “rules and instructions” are more than 130,000 pages (three times larger than the IRS code and its associated regulations), and “medical records must be reviewed by at least four people to ensure compliance” with Medicare program requirements.

No wonder dentists are concerned about federally-run health Exchanges.

The only thing certain about the Affordable Care Act is that its implementation will bring changes to dental care, dentists and their dental practices.

What are your thoughts on the future of dentistry and the Affordable Care Act?

To read more about the Essential Health Benefits see: HHS Informational Bulletin

Dental Insurance Plans and The Affordable Care Act

Dental Insurance Plans and The Affordable Care ActAccording to the Pew Center report, approximately 5.3 million children are expected to gain dental coverage after 2014 as part of the Affordable Care Act.

The Act includes a plan for pediatric dental insurance plans that will be sold in insurance exchanges, both packaged with adult plans and as stand alone plans, as reported by Healthcare Finance News.

Joanne Fontana, an actuary who tracks healthcare and health insurance for the actuarial and consulting firm Milliman, told Healthcare Finance News, “It’s a very, very big shift from the way dental insurance is currently sold. For the first time, there’s a need for pediatric-only plans. State and federal governments still need to decide benefit levels and cost structures for stand-alone dental plans and medical-dental packages, in and outside of the exchanges.”

Many states have yet to figure out whether or not they will offer exchanges and the details of changes to insurance plan offerings.

There is still a lot of confusion about how the Affordable Care Act will be implemented.

Part of the confusion stems around whether or not health insurers will be able to offer medical plans without pediatric dental plans for individuals and small groups, and through the exchanges.

There is also concern that children will have duplicate dental insurance coverage, or families who have separate dental plans will be forced to have their pediatric dental plan changed to fall under their health insurance plan.

This could mean being forced to change dentists, which is something many parents and dentists alike will not be happy about.

“Another uncertainty comes from ACA rules on cost sharing limits for essential health benefits. Hypothetically, if someone has a medical plan for themselves and his or her child, and has a separate dental plan for the child, somehow the two insurance companies have to co-administer cost sharing limits–a problem without easy solutions.” Fontana advised Healthcare Finance News. “If you’re going to administer that, you would have to have claims accumulators going on the medical side and claims accumulators on the dental side that would have to talk to each other. For that to happen in reality, it’s just not a pragmatic solution.”

ADA members are increasingly concerned about the effects the ACA will have on their dental practices in 2014.

What are your thoughts about dental coverage in the Affordable Care Act? How do you think it will affect your dental practice? Let us know in the comments!

For more on this story see: Dental Insurers Eye 2014, Await Regulatory Guidance

Dentists Believe Affordable Care Act Is Really a Tax Increase

Dentists Believe Affordable Care Act Is Really a Tax IncreaseThe recent U.S. Supreme Court’s 5-4 ruling on the controversial Affordable Care Act upholds the healthcare provisions that established minimum health benefit packages and state health insurance exchanges that include pediatric oral health care.

The American Dental Association fought for increased pediatric coverage as part of the Act, including how the “essential dental benefit” for children would be defined.

But many dentists are also small business owners, and while the health care law offers a tax credit to some businesses with 25 or fewer employees, it will also fine businesses with more than 50 workers if they do not provide health care coverage.

Based on these facts, The Wealthy Dentist surveyed dentists to ask if they believe that the Affordable Care Act will help their dental practice.

“It sucks!” responded one Texas dentist, “Hidden in the 2700 pages are literally hundreds of tax increases by cutting deductions, raising or lowering limits to screw us out of more money as increased taxes.”

72% of the dentist respondents answered no, they think the Affordable Care Act will not help their dental practice. 9% felt it will be good for dentistry while the other 19% believe that it is just too soon to tell.

Percentage of dentists think the Affordable Care Act will help dentistry

Small businesses, like dental practices, are responsible for more than half the new jobs created in the U.S. each year. Included in the implementation of the Affordable Care Act are funds for “alternative dental providers” along with funding for training dental hygienists, which may further impact small dental practices.

Here are the dentists’ concerns —

“Are you kidding me? It may help increase my business expenses by requiring me to cover my employees and it may help to increase my taxes in order to pay for it. While I admit there are some limited ways in which it could help me personally I don’t imagine it could help my business at all.” (California dentist)

“This will put additional taxes on an already overburdened middle class! It will limit access to care as we don’t have sufficient doctors to take care of an additional 30,000,000 people. And seniors who have paid into social security and Medicare will see their benefits cut and costs go up. (If you have paid into social security and Medicare, these are not entitlements for you, but guarantees you were given by the government who is now reneging on their promises.)” (Texas dentist)

“This puts us on a track for all dentists to soon be working as governmental employees.” (Louisiana dentist)

“I believe that the increased tax burden on all Americans that directly results from this Act will significantly reduce discretionary dollars for virtually everyone, and will eventually lead to a single payer system that will be even less efficient and more wasteful than the current system. The shame of it all is that care will be rationed and take longer, just like in Canada and Europe. People in the USA will be shocked to learn that just because procedures and techniques exist to treat their medical and dental issues, the “free” insurance will frequently not cover them. Just like every other country that has adopted a similar system, some bean counter will determine if the correct return on investment exists for the government to “allow” you to be treated. It is still true that there is no such thing as a free lunch!” (Illinois dentist)

“Please keep dentistry out of it! It is bad enough that dental insurance is attempting to dictate fees.” (Oklahoma dentist)

“People will be tuned in even more to the idea that everything should be paid for by insurance. On the other hand, the current system is broken and crazy. I hope we aren’t just trading it for more broken, crazy, and unaffordable.” (Washington dentist anesthesiologist)

“It was conceived way too fast. With very little advice from health care professionals.” (General dentist)

“The most interesting comment was that made by Chief Justice Roberts himself, when he said that the voters choose their elected representatives who pass the laws, and it is not the duty of the Supreme Court to rescue the public from the consequences of their own decisions. In other words, the Chief Justice is telling the public to grow up, take the blame for electing bad legislators, and if we don’t like what those elected officials do, it is our own duty to throw them out of office and elect candidates who will vote in accordance with the public’s wishes. We can’t rely on the Supreme Court to correct our own mistakes; we have to do that ourselves. Chief Justice Roberts’ message is a wake-up call to all of us.” (California dentist)

What do you think will fix the current healthcare system? Dentists, we’d love to hear more from you on this subject.


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