Assignments of dental benefits

[Joel M. Eichen]

`````````````````````````````````````````````````` S h o u l d a s s i g m e n t s b e a c c e p t a b l e ? `````````````````````````````````````````````````` QUESTION: Can people change our current system of dental insurance reimbursement that more dollars end up in patients' own pockets? If so, then more affordable dental care would follow. What's your opinion of this? Assignment Assignment of benefits. An ideal dental practice establishes the policy that all financial obligations are between patient and doctor. You the patient are responsible for fee X. The insurance company may reimburse you X or (X-Y), but you do owe your dentist X. That's the secret of many great practices. The reality is that many other practices work directly with the insurance companies, so there develops a multi-tiered "fee schedule." The bottom of the barrel includes practices where the treatment is actually dictated by what is or is not covered. If the HMO insurance company wants to provide coverage for a certain fee per month or a certain cost per procedure, then they can go into the market place and honestly hire dentists. There's absolutely nothing wrong with this. This is known as a "closed panel." The company "owns" the dentists. But please be advised that the responsibility for economic loss reverts right back where it belongs: the HMO. There's a simple legislative solution. If legislators state by state, would invoke laws prohibiting the assignment of dental benefits, then every practice would immediately get lots of new fee-for-service patients (just by definition). The patient is rendered treatment, pays for treatment, or is billed for treatment and submits paid bills to the insurance company for reimbursement. No more checks from the insurance company directly to the doctor. This approach can't work in medicine, because there's few folks who could ante up $90,000. for a bone marrow transplant. Dentistry is quite a bit different. That's the key. Medical insurance is an indemnification plan. Dental insurance is . . . . . well, you decide. Dental insurance is a quasi-indemnification plan. More accurately, its really a partial reimbursement plan against voluntary treatment choices. Could it be similar to, "I'll pay you 80% of the cost of painting your house, up to $1,000.00 per year, if you can verify to me that the house needs painting and that it was, indeed painted. And I will even forgo the requirement that requires that your house even needs painting. That's really between you and the house painter." If the insurance company wants to make the maximum reimbursement $1500. next year, or $500. a year later, or even $3. per month, the house painter really doesn't care. His job involves buying the paint and hiring the crew to paint the house. That's it. Its not exactly indemnification. This is dental insurance. Of course, a law outlawing direct payments ends all the problems of collecting deductibles, coinsurance, all of the phone calls back and forth about coverage, all of the paperwork and puts it all back where it belongs. It returns the administration of the details back to the patient, who has the contract with the insurer. No more lists of doctors who take or don't take your insurance. Its simple. As dentists, we all take patients. That's our business. That's why we're here. Any thoughts about this? Do you agree? Cheers, Joel M. Eichen, D.D.S. Indemnification - insures against predictable and measureable future loss. That is, there is a 0.05% chance of your house burning to the ground, providing you yourself don't intentionally light the match. I'll pay you 100% of the replacement value, providing you have in place insurance on 80% of the fair market value. Something like that, more or less. Verified bills: requires the doctor's EIN or SSN. I doubt that many doctors would become co-conspirators and submit their signature on an unpaid bill, or would inflate their legitimate fees. It could get expensive! After all, its too simple to create a 1099 type of document at the end of each month or at end of each year. In other words, paid or not, inflated or not, Doc, you owe the taxes. This could make for some interesting tax audits! For your own sake, better make sure your patients pay first. Or the tax man will get you!

[mru...@webtv.net]

I share in your frustration with dental ins. companies. I have worked in
a dental office for almost 11 years. I'm so sick and tired of these
insurance companies dictating treatment to "our" patients. The bottom
line here is not how to pinch pennies, but what is the best treatment
for this patient? The decision should be between the doctor and "his"
patient. Insurance should not be part of this decision.
I want you to know that there is a dental plan out there that offers
some key components as the ideal one that you described in your posting.
First of all, it is affordable. $9.00 month/individual, $15.00 per
month/household. As a member of this plan, you are entitled for reduced
fee's by participating providers.(there are also many specialists that
are providers) Certain procedures have a set fee, while others you pay a
certain percentage of the Dr's UCR. Patients understand that payment is
due at the visit. There is NO paperwork, no predeterminations, no
deductible, and no limits on visits. Pre-existings are covered. Cosmetic
dentistry, veneers, bleaching, implants, orthodontics for adults and
children, crowns, bridges, partials, dentures.
As a member of this plan, patient will also receive vision and
prescription benefits.
I've never been involved with something like this before. It is my
frustration with dental "insurance" companies that led me here. I stand
behind this plan 100%. This plan is so simple. In my opinion it was way
overdue.
If you would like more information, please feel free to e-mail me at
mru...@webtv.net