NMDA Journal Winter 2019-20

6 New Mexico Dental Journal, Winter 2020 MAPPINGYOURCOURSE THROUGHTHEWORLDOF DENTALINSURANCE In today’s world, patients with dental insur- ance account for as much as 90% of a prac- tice’s income. Dentists approaching retire- ment have witnessed a significant evolution of payment forms over the decades. Indemni- ty plans, direct reimbursement programs and preferred provider organizations (PPOs) have largely replaced the “old fashion”method of paying for dental work. Dentists entering the workforce today can only dream about a practice with 100% fee for service patients. Although dreaming can be enjoyable, a dentist must live in a reality where understanding how they get paid is nearly as important as doing the dentistry. Independent practitioners that own and run their own business frequently consider how to expedite payments, how to get paid more, and how to keep A/R from getting out of hand. With dental insurance having a pro- found impact on each of those considerations, it’s no surprise that dentists often ask: • Why is dental insurance so much different than medical insurance? • How is this form of reimbursement evolving in the dental industry? • Who in my practice understands these changes and is ahead of the game? • Am I maximizing my relationships with all third-party insurance carriers? Knowing where your patient pools are drawn from is not always clear. Similarly, under- standing your listing on a particular panel and how you got there is difficult to sort out. It has never been more critical to understand the various dynamics of what is known as “dental insurance” to make sure you are being reimbursed correctly. The following content provides clarity on the past, present, and ongoing evolution of reim- bursement programs and dental insurance. For some, this will be a quick refresher course and a reminder of how complex things have become. For others, this information may trigger meaningful discussions with key members of your team. Ultimately, knowing the right questions to ask will be paramount as you seek to strengthen relationships with your dental insurance partners. Let’s begin with knowing the difference between indemnity insurance, PPOs and the insurance companies themselves. Indemnity Insurance Indemnity insurance is traditional insurance. There is no contract with the insurance com- pany or contracted fee schedules. The patient is free to seek care at any dental practice. Providers bill their UCR fee, with the patient obligated for the portion not paid by the insurance company. Because the insurance company does not control the fee schedule it’s difficult for them to control costs. Indem- nity insurance is a shrinking portion of the dental insurance market. Prominent dental speakers such as Roger Levin, Charles Blair and others are predicting that eventually this traditional form of insurance coverage will cease to exist. If your practice only partici- pates in indemnity insurance this will be a constantly shrinking source of patients and income. Andrew Eberhardt, Dental Cooperative, COO Dr. Steven Peacock, Dental Cooperative, Director of Special Projects