What are some top phrases that make hygienists want to pick up their full tray of instruments and fling it straight at the wall? Or, get up and walk right out the door and not come back?
“Will my insurance cover it?”
“How much does my insurance cover?”
“I only want what my insurance will cover.”
What if you never had to hear the words dental insurance ever again? No more words like copay, deductible, or waiting period either.
Just think about that for a minute. What would your clinical day look like? How would it affect your patient experience? How would it affect your own experience?
As a hygienist with over 29 years of clinical experience, I have worked in offices that are enrolled with various insurance companies and in offices that are not enrolled with any. These are called fee-for-service (FFS) offices. This means that if a prophylaxis costs $130, the patient pays $130 that day. The end. How easy was that?
Having experience working in both types of offices, I have to say that I much prefer the fee-for-service situation. Below are five reasons why.
1) Cutting out the “middleman” saves patients money
Dental insurance is the “middleman.” The patient is somehow paying for insurance premiums (the amount paid to keep the policy active), even if it’s in an inexpensive plan through their employer. The patient will also have to pay a certain amount of money, the deductible, before any treatment is covered. Once the deductible is met, the insurance will start to pay a percentage of the billed cost.
For the patient, preventative services are typically covered at 100%, so that’s nice, but different procedures are covered at different percentages. For example, many follow the 100-80-50 coverage system: Preventive is covered at 100%, restorative is covered at 80%, and major work is covered at 50%. This is all after the premium and deductible have been met.
In addition, there may be a waiting period for any benefits to start. This means the insurance is getting the monthly payment from the patient, but they can’t utilize the benefits until a designated time has passed. For example, it might be six months. Let’s not forget that there is usually an annual cap, meaning insurance won’t cover anything after a certain amount of money is paid out. That number varies, but $1,500 is not uncommon. $1,500 in 2024… I think we can all agree that’s not going to do a lot.
When you add up the monthly fee for insurance and the deductible being met, then consider that insurance still only covers a percentage of the services, maybe it’s just not such a great idea for the patient after all. Especially if they postponed treatment until the waiting period was over, and that class II restoration has now turned into a crown.
2) Cutting out the “middleman” saves the dental practice money
Many patients don’t realize that when dental practices are in-network with dental insurance companies, offices write off a portion of their treatment costs. For example, if a prophy is $130, the insurance company may only reimburse the dental office $90, leaving the office to write off $40 for every single prophy. This can really add up, especially when you start to consider more expensive procedures like restorative work and surgeries.
FFS practices don’t have to write anything off, and getting reimbursed 100% for the work you do just feels good.
Fun fact: In 2022, the CEO of Delta Dental of California was compensated $5,009,544.1 That’s just over five million dollars! Not to be outdone that year, the CEO of Delta Dental of Michigan was compensated $6,178,337 plus $2,311,371 in “other compensation.”2 That’s in U.S. dollars, not pesos. You can look up other key employees and officers here.
The California Dental Association is currently suing Delta Dental of California for reducing reimbursement rates for offices. This is ongoing, so we’ll see what happens.3
What’s the point? When I see those types of salaries, the mystery is solved. Now we know where all that money from denied claims and reduced compensation for dental offices goes. It also makes me wonder why, on career day at my school, no one listed making a bazillion dollars as a CEO of a dental insurance company as an option.
3) Saves time and energy
Filing claims, tracking down payments, and resubmitting denied claims take time. So much time that many offices have a person designated as their insurance coordinator.
Conversations with patients about coverage, for the 99th time, take a considerable amount of time and energy – energy from the office and the patient. Nobody wants to deal with that.
An insurance coordinator or front office team also determines patient benefits in addition to explaining them to patients. They track payments, and if insurance denies a claim, they determine why and possibly resubmit it with further information. This takes time!
4) Saves frustration
Inevitably, there will be patients who will be upset because they thought their insurance would cover more. On more than one occasion, I’ve witnessed situations where patients call the office and are extremely angry due to a lack of insurance coverage. When I say extremely angry, I mean yelling and cursing. The front office team doesn’t deserve that. No one does. (There could be a whole separate article on patient outbursts.) A friend told me a patient kicked over her potted plant on the way out.
Having someone scream at you is the extreme end of the spectrum. But just having to continually go over and over it with people who are perturbed is slowly soul-sucking. This situation is frustrating for both parties and a total lose-lose situation.
Patients may have to choose a dentist from a list provided by the dental insurance carrier in order to receive treatment reimbursed at a specific rate. If the patient opts to see a dentist who is not on the list or is “in-network,” dental insurance benefits may be reduced. This can be frustrating to patients if they don’t know this ahead of time and have been treated by a dentist or hygienist who is “out of network.”
Of course, we hygienists have all experienced the joy of figuring out insurance coverage for a patient as they are sitting in the chair, typically after arriving late and then needing to use the restroom. Meanwhile, your next patient is the one who always shows up five minutes early and needs to be out on time. It’s totally sweat-inducing and has, quite frankly, shaved years off the back of my life. Again, if dental insurance weren’t involved, we wouldn’t have to worry about any of this.
5) No more dictating patient treatment
I know hygienists have seen this too many times. Patients will sometimes let their insurance coverage dictate their treatment. Yes, I spy with my little eye, your Louis Vuitton bag perched delicately in the extra chair. Sometimes, patients choose not to move forward with periodontal therapy, stating they can’t afford the additional portion insurance doesn’t cover or they want to wait a little longer to have the crown replaced. We’ve heard it all.
Working in a Fee-for-Service Office
When insurance is not involved, you actually get paid what you are worth for your time. I had a dentist early on tell me she would rather see fewer patients but get paid full price. She told me, “I would rather sit in my office and do other work I need to do than sit in the dental chair and work on patients for a deeply discounted price.”
Fast forward to years later, when I worked in an office that transitioned to FFS, I noticed that we lost some patients, but the majority stayed with us. If they had insurance, it would still cover a portion of their prophy, but they were okay with paying a little more out of pocket to stay with us.
Another thing I noticed in an FFS office is that you tend to attract patients who are more dedicated to their oral and overall health. They aren’t just there for their “two free cleanings a year.” They tend to be patients who take their health seriously and are ready to move forward with treatment. They wouldn’t allow any third party to dictate their health and frankly don’t want to “play the game,” so to speak.
If you think only wealthy people can afford to pay out of pocket for dental care, you couldn’t be more wrong. I have personally treated people from very humble backgrounds who pay for treatment without dental insurance. Working with patients who prioritize their health is so fulfilling for a health care provider.
Personally, I think the front office team reaps the most rewards in FFS offices. They no longer have to deal with explaining in detail to each patient their coverage, sitting on hold for 38 minutes waiting to talk to someone from the insurance company, and reexplaining insurance to a frustrated patient after insurance denied the claim. So, so much time and energy wasted.
FFS is a win-win situation for the dental practice and patients alike.
Before you leave, check out the Today’s RDH self-study CE courses. All courses are peer-reviewed and non-sponsored to focus solely on pure education. Click here now.
Listen to the Today’s RDH Dental Hygiene Podcast Below:
References
- Delta Dental of California. (2024, April 12). ProPublica. https://projects.propublica.org/nonprofits/organizations/941461312
- Delta Dental Plan of Michigan. (2024, March 4). ProPublica. https://projects.propublica.org/nonprofits/organizations/381791480
- Ganski, K. (2024, April 10). Dentists Ask Court to Certify Class Action Lawsuit Against Delta Dental. American Dental Association. https://adanews.ada.org/ada-news/2024/april/dentists-ask-court-to-certify-class-action-in-lawsuit-against-delta-dental/
