BCBS-TX Dental Insurance is Rude to Everyone

Why the Long NPI – BCBSTX?

[By Darrell Pruitt; DDS]pruitt5

More than a year ago, Dr. Robert Ahlstrom, an ADA [American Dental Association] and NHII (National Healthcare Information Infrastructure) task force member, told attendees to the ADA’s 3rd International Evidence-Based Dentistry Conference that the NPI number is

“Critical to the future of dentistry.” 

But, to this day, he refuses to reveal why. Even though I have learned that he is a very shy man on the Internet; on that Sunday in May in ADA Headquarters, he confidently added,

“It is only voluntary unless you want to get paid.” 

His case-closed proclamation shut down discussion cold in a Soviet manner. Did I mention that this occurred at an “Evidence-Based Dentistry” conference? Soviet East Germany was also called the German Democratic Republic.

NPI Harmful to Dentists and Patients

There is nothing evidence-based or otherwise about the NPI number – that benefits anyone but healthcare stakeholders. In fact, the number actually harms both dentists and patients. Like Ahlstrom, the irreversible NPI number is simply un-American. However, the NPI means profit for sleazy dental insurance companies like BCBS of Texas – especially when dentists’ reimbursements for work done long ago are delayed by NPI-NPPES screw-ups.  Some physicians’ payments have been delayed for a year or more because of NPPES crosswalk difficulties. Who needs that?

Veteran’s Example Scenario

A new patient called my office this week wanting an appointment to start a crown. We don’t normally block off two and one-half hours for a patient on the first visit, but the Veteran told my office manager that before he was recently discharged, they did a root canal, post build-up and temporary on a tooth that still needs a crown. I like to think other dentists would also risk big holes in their schedules for Veterans. We owe them at least that much.

BCBSTX Dental Insurance

When he showed up with his BCBSTX dental insurance information, my office manager had to tell him that even though his boss was promised by the BCBSTX sales representative that the dental benefits package he bought for his employees was good anywhere, it cannot be used in my office because I do not have an NPI number. I am licensed to practice dentistry in the state of Texas, but that is not enough for BCBSTX. Capricious qualifications are certainly their choice if they prefer to do business that way in Texas, but why does BCBSTX leave it to my office manager to inform their clients about their deception?  If a client who pays premiums to BCBSTX likes a dentist who does not have an NPI number, those premiums are pure profit for BCBSTX. It is easy to understand that the more obstacles BCBSTX can put between their clients and obligations to cover their dental bills, the bigger are the bonuses for executives. What’s more, BCBSTX’s leaders’ lousy work ethic permeates the entire dental insurance industry. Compared to BCBSTX executives, AIG executives who kept bonus money should be honored as national heroes. 

BCBSTX Rude to Everyone 

As the Veteran who almost became my patient works to fit him-self back into society, perhaps the next opportunity he has to break away from work for a few hours, he will be lucky enough to come across a dentist who has an NPI number. If things go well, BCBSTX will not have wasted a Veteran’s time twice – and wrecked a dentist’s schedule – for what? BCBSTX has nothing against Veterans in particular, they are rude to everyone.  Since nobody from the company can be held personally accountable, tyranny is as natural as Ponzi schemes.

Attention Texas Employers: 

I wish deceptive business practices which insurance companies use to cheat their clients were against the law in Texas. Attention Texas employers; as a dentist who has witnessed harm from BCBSTX, I warn you not to waste money on their dental plan. BCBSTX’s sales reps cannot be trusted to tell the truth and will aggravate your employees as well as neighborhood dentists. 

Assessment

If BCBSTX gets away with this dishonesty, what other senseless, but profit-enhancing hoops will they demand next year?  How many more dentists and patients can an Attorney General allow them to cheat before speaking up? Come out and fight for your honor, BCBSTX … or not.  I bring more than your best attorney can handle and I am waiting.

Conclusion

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22 Responses

  1. NPI number update

    I began asking ADA leaders about the NPI three years ago, and was stonewalled in the regular way with committee-approved talking points (including mind-numbing chapters, pages and line numbers) and other lame forms of evasion instead of straight-forward honesty. My questions are simple – such as: “How many dentists in the US have NPI numbers?”

    As a member of the ADA, I assume the dues I have paid for the last 27 years entitle me to responses from ADA employees who should be happy to have jobs these days. In addition to the raw anger caused by unconcealed disrespect, I am curious what reason the national leaders of my professional organization could possibly have for hiding information from me with in-your-face unresponsiveness. I followed up my lack of success with the national leaders by sending this and other simple questions concerning the NPI to the executive officers of every state ADA organization in the nation – including Ms. Mary Kay Linn, Executive Director of my own Texas Dental Association. Only California honored me with a response. A representative from the CDA apologetically told me that they could not help because they don’t keep information about the NPI.

    So why did 49 executive directors of state ADA organizations (employees) fail to respond to an ADA member’s questions? Do they not check their email? Do they like their jobs?

    I do not feel that I must file a request under the Freedom of Information Act to force this information from CMS. I actually think that eventually the ADA Department of Dental Informatics will graciously and apologetically begin providing me every little piece of information I respectfully, but firmly request, no questions asked and without delay.

    This too will be settled one way or another, friends. Transparency rules. Let me show you.

    On March 25, Wednesday, I sent an email to the ADA Library Services and asked how many dentists in the US have NPI numbers. I was referred to Mr. Patrick Cannady of the ADA Department of Dental Informatics. Mr. Cannady and I have a history. Nevertheless, I played it straight and professional when I sent him the following email.
    ________________________________________
    From: pruittdarrell [mailto:pruittdarrell@sbcglobal.net]
    Sent: Thursday, March 26, 2009 8:30 AM
    To: ‘cannadyp@ada.org’
    Cc: (library services)
    Subject: NPI number

    Dear Patrick Cannady:

    I am trying to find out how many dentists in the nation have NPI numbers. Can you help me with this?

    Sincerely,
    D. Kellus Pruitt DDS
    ———————————————————-

    Since shortly following Healthcare IT cheerleader Newt Gingrich’s visit to ADA Headquarters over five years ago, Cannady’s department was given the responsibility to persuade ADA members to quickly sign up for voluntary NPI numbers. Surely someone outside the department has been monitoring and reporting their progress to ADA officials who are cleared to be told such information. Even the ADA Department of Dental Informatics has to be accountable to someone. Don’t they?

    D. Kellus Pruitt; DDS

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  2. Dr. Pruitt,

    I am the office administrator for a small medical practice. When they call, we always ask new patients about their insurance and related information.

    To avoid the situation you described above, why don’t you just ask folks; and/or tell your prospects about the NPI situation? It seems like a simple “win-win” solution for all concerned.

    Madison

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  3. Thanks, Madison

    You are correct. Normally, when my office manager provides someone an estimate of the cost for a procedure, either the prospective patient mentions their dental insurance or my office manager simply asks.

    However, in this particular instance, she had someone on the other line when the Veteran called, and he slipped through our protocol – in part because he was told that his BCBSTX dental insurance was good anywhere – and he believed the lie.

    Since insurance reimbursement follows completion of dental work, misunderstandings naturally favor insurers (They prefer to be called “payers” these days, as it sounds more benevolent). Both calculated and unintentional insurance-related errors happen in even the most efficient dental offices. Sleazy companies like BCBSTX have no ethical incentive to be honest and straightforward with their clients, and Texas Attorney General Greg Abbott just does not care. I assume that BCBSTX is too big and too politically entwined to regulate. This means that for Texans, as long as complications increase profits of insurers, the cost of dentistry will rise to cover BCBSTX executives’ bonuses and campaign contributions, and more children will go to bed with toothaches. BCBSTX causes dental infections.

    Let’s not lose the perspective here. Why is it my job to educate BCBSTX clients about the deception in their dental benefits plan that their uninformed employer purchased? I don’t pay their premiums and I have no contractual agreements with BCBSTX or any other third party.

    Do you know that not one BCBSTX client has yet asked if I have an NPI number when they call for appointments? It is always left to my office manager to take several minutes to assume the insurer’s responsibility to explain the arbitrary bureaucratic requirement. Inevitably, when told that BCBSTX will not process their claims if the dentist does not have an NPI, they decide to find another dentist. BCBSTX stinks.

    As always, I invite BCBSTX to send their very best PR specialist to defend the honor of their company. That would be fun for me and entertaining for readers.

    In the meantime, I am looking forward to hearing from Mr. Patrick Cannady, an ADA employee in the Department of Dental Informatics. He is expected to report to us how many dentists in the US have NPI numbers. That will be a start of a series of questions for ADA employees in his department.

    D. Kellus Pruitt; DDS

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  4. In principle I agree with Dr. Pruitt that the NPI number appears to have been created to allow dental insurers to have one number to track health care providers with. We had (and still have) Social Security Numbers, Taxpayer ID numbers, Federal Narcotics Registration Numbers (Don’t get me started on THAT one … when they raised it to its present $500 level and I protested, they said “It’s to fight the war on drugs!” – my claims of innocence went unheeded!), State Dental License numbers, State Narcotics license numbers … have I forgotten any?

    No, I don’t think that there is any question that this was done purely to make it easier for the insurance companies. I would have no argument with that except that I am recently seeing some of the most idiotic insurance payments, ever.

    OK; one example: I did a 5 surface buildup on an upper molar that was previously root canal treated and had fractured at the level of the gum, and below in places. I placed a post in each canal, bonded with Panavia. But before that I adapted a copper band around the tooth, such that I had a dry and heme free field subgingivally. This is a lost art I doubt any dentist under age 40 can do in 2009. Now this patient had Delta AARP insurance. Do you know what they paid me for my hour of hard, close work; my 34 years of experience, my high priced posts and Panavia and Clearfill Majesty Composite… my nice computer programmed steam sterilizer, my front desk’s time, my time, my chairside’s time? They paid me $8.50.

    I can tell you that today I can’t get any insurance companies to pay for perio scalings. I take photographs of the calculus with the patient’s name and a millimeter scale in the photo, and you know what? The insurance companies ignore them. The insurance companies are practicing dentistry today. They are telling patients not to have restorative, preventive, and periodontic care.

    Has the NPI number emboldened them? I think so.

    Is the ADA and are the State Dental Associations doing anything to fight this trend? I think not. They are all too busy playing ball. While I have not gone as far as Dr.Pruitt (I have an NPI) I do call it like it is. I tell patients: “If your insurance company was a dentist, you could sue them for malpractice!”

    Allright, I’ve said enough.
    Back to the rubber room.

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  5. This thread on the ME-P has attracted an impressive amount of attention. It restores my hope in information technology and social networks for effecting significant social change in our nation.

    Let me show you what I mean: When someone shopping for dental benefits for their employees performs a simple Internet search of “BCBSTX,” it brings up “BCBS-TX Dental Insurance is Rude to Everyone” as the number 11 hit (second page) on Google.

    Wouldn’t it be swell if this thread becomes so popular with readers that it makes an enduring appearance on BCBSTX’s first page – where employers shopping for dental benefits just might come across truth? Look what we did for Trajan King and ADA/Intelligent Dental Marketing (oops, I did it again! Sorry, Trajan).

    Once our work is done with BCBSTX, we can start on the next deserving National Association of Dental Plans member. Who should that be? Maybe Delta Dental again? Or perhaps we might have more fun if I blind-side a fresh, unsuspecting company … like United Concordia. I’ve got the goods on them as well.

    This is a target-rich environment, friends. Lots of slow-moving, fat and defenseless dinosaurs to choose from should you too find a desire to poke a sharp, carbon-tipped stick in a tender spot or two.

    D. Kellus Pruitt; DDS

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  6. Check out what was just posted on ModernHealthcare.com

    http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090410/REG/304109965

    Texas Blues agrees to drop physician-rating program

    By Jessica Zigmond
    Posted: April 10, 2009 – 6:00 pm EDT

    Blue Cross and Blue Shield of Texas has agreed to stop using its risk-adjusted cost index to rate physicians as more or less affordable in providing medical treatments to patients, following an order from Texas Attorney General Gregory Abbott. The insurer has also agreed not to terminate—or threaten to terminate—physicians for making referrals outside of the Blue Cross and Blue Shield network.

    According to the order, the Consumer Protection & Public Health Division of the attorney general’s office began an investigation in January 2008 into Blue Cross and Blue Shield of Texas’ use of its risk-adjusted cost index methodology to conduct and publish “affordability” quality assessments of healthcare providers, as well as the company’s communications that threatened to terminate those physicians who referred patients for treatment outside the network.

    Josie Williams, a physician who serves as president of the Texas Medical Association, called the order a “huge victory for patients” because, he said, patients and their doctors should make decisions regarding patient care. He said Blue Cross and Blue Shield of Texas is not the only insurer that has ranked hospitals using claims data.

    After listening to the concerns expressed by the attorney general’s office and other constituents, Blue Cross and Blue Shield of Texas voluntarily modified certain business practices related to (the) provision of consumer information several months ago,” Margaret Jarvis, a company spokeswoman, said in a written statement. The statement also said the company recognizes that employers and consumers who purchase network-based products count on health plans to limit their exposure to unregulated costs from out-of-network providers. As a result, Blue Cross and Blue Shield of Texas said it “changed its language to more clearly state that physicians have the right to discuss all available treatment options.

    Submitted by,
    Darrell K. Pruitt; DDS

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  7. Trapping BCBSTX – One officer at a time

    I found an opinion piece on TheSunNews.com titled “’Medicine’ needs to be defined,” written by Jim Landers.

    http://www.thesunnews.com/opinion/story/856800.html

    The article is an argument for consumers’ rights to alternative medicine. Landers points out that in France, not only are a wide variety of cultural and fad cures integral to their “free” healthcare system, but the French are also entitled to expensive pharmaceuticals as well – enabling them to take more prescription medications per capita than Americans, for free.

    Even though that particular bone has a lot of meat on it, the comment I submitted in response to Mr. Landers’ article has little to do with the controversial topic of entitlement to superstitions. I am attracted by the scent of a bureaucrat who was quoted in his article – Dr. Eduardo Sanchez, chief medical officer of Blue Cross Blue Shield of Texas.

    Now, please sit back and watch me help the man define himself forever. My pleasure.

    Darrell
    ———————————————–
    Does your employer ever make you feel dirty, Dr. Eduardo Sanchez?

    This week, Texas Attorney General Greg Abbott demanded that BCBSTX stop using its risk-adjusted cost index to rate physicians. It turns out that your employer’s system is rigged to favor BCBSTX profits at the expense of their clients’ health – similar to UnitedHealthcare’s sleazy system using Ingenix. UnitedHealth’s deceit was recently crushed by NY Attorney General Andrew Cuomo. Up until this moment in history, bureaucrats like you had little reason to worry about accountability. Today, in part because of your example, future successful bureaucrats will be motivated to quickly respect consumerism.

    Keep it clean. Don’t mess with Texas

    Have you personally received bonuses from blood money, Dr. Sanchez? You are, after all, the Chief Medical Officer of a company that harms patients by design. That makes you at least partially responsible for this crime.

    Here’s more news that makes Texans ashamed of Blue Cross Blue Shield’s Texas name: According to Abbott, BCBSTX threatens to terminate contracts with your colleagues if they refer their patients out of network for treatment by another doctor. How proud does that make you feel, Dr. Sanchez? Where were you raised, anyway? I can tell you’re not from my neighborhood. Move on down the road, Doc.

    As long as you work for a sleazy company, I don’t like you, Dr. Eduardo Sanchez. I sincerely suggest that you heed the Hippocratic Oath and resign. Stop bringing shame to your profession, your family and my state.

    D. Kellus Pruitt

    PS: A response is neither expected, nor necessary. This will be posted as part of the thread “Why the long NPI, BCBSTX?” To find it, simply googlesearch “BCBSTX.” The article appears on their first page. Soon it could be on your first page as well, Dr. Eduardo Sanchez – for a long, long time.

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  8. Dear Dr. Eduardo Sanchez [BCBS-TX Employee]

    I owe you an apology, Dr. Sanchez. In a previous comment, I asked where you come from. I hastily guessed that you were from somewhere north of here a few hundred miles. That was an unfair and ugly assumption.

    Today, I came across evidence that before going over to BCBSTX, Texans used to be proud of you. Here is a statement Governor Rick Perry released on June 6, 2006 upon your departure from service to the citizens of Texas:

    “In his nearly five years of service as Commissioner of the Texas Department of State Health Services, Dr. Sanchez has served the people of Texas with an unwavering commitment to improving public health for all Texans. Dr. Sanchez efficiently directed the consolidation of public health agencies to better serve the needs of citizens and communities, with a strong commitment to diabetes prevention, promoting healthier lifestyles for Texans and ensuring Texas is prepared for a pandemic flu event. Dr. Sanchez also led the public health response to hurricanes Katrina and Rita, ensuring the compassionate care of nearly 400,000 evacuees who sought refuge and comfort in our state. I commend Dr. Sanchez for his service to Texas, and wish him well in his future endeavors.”

    You served us with compassion. So who are you serving now, Dr. Sanchez? I stand nose-to-nose with you and say far too loudly that you sold out both physicians and patients in Texas for the benefit of BCBSTX. What do you say to that, Doc? “Nothing” works just swell for my intentions.

    If you are too deeply committed to BCBSTX profits to defend abandonment of the Hippocratic Oath, and if you no longer sport ethics or pride in the core of your character, we all truly understand. After all, you work for a sleazy company now, and they probably pay better than the state. Nevertheless, I will go through the motions of challenging you to defend BCBSTX’s policy regarding their system for rating physicians, just to document it on your Internet history.

    Who knows? It could make your first search page some day.

    Darrell K. Pruitt; DDS

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  9. “Suffer, BCBSTX, Suffer!” said the flea.

    Since huge, fat businesses are traditionally slow and insensitive for natural, earthly reasons, how can potential customers be forewarned these days if such a dinosaur is in pain, or perhaps even on the verge of collapse? Lots of top-heavy giants are falling flat these days. Here is my suggestion: Watch for the cold-blooded reptile to bleed expensive, high-quality ads – profusely. Stoic, command-and-control leaders who have reason to fear their customers go to great efforts to avoid accountability. If one is paying attention though, the sudden appearance of old school PR tricks is as good as a squeal. For example, about five years ago, Dell Computer drastically increased their advertising budget just before giving in to Jeff Jarvis and his special “Dell Hell.” Dell finally conceded that they had deceived customers as policy. Because their silence prolonged the explosion of damaging publicity, Dell barely survived, but nevertheless emerged from the PR disaster a more compassionate player. In the end though, their ad campaign was wasted money because Internet transparency ruled that day, and consumers won.

    It seems to me that the more serious the threat to comfortable jobs in the health insurance industry, the more expensive the ad campaign. Therefore, from the sudden TV and radio spots I’ve witnessed in the last few days, I’d say Blue Cross Blue Shield of Texas is in deeper PR trouble than ever before in the organization’s history. And like Dell Computer, they can’t advertise themselves out of their problems because they cannot control forums like the one you are reading. Though the giant is still too proud to utter a peep, did you see the knees wobble?

    We aren’t as easy to fool these days, BCBSTX.

    “Image is everything” is a vestigial marketing strategy dating back a few years when corporations with huge advertising budgets enjoyed control of limited media resources. Their shelter from accountability behind superficial PR is now their very source of vulnerability. Because of forums like this, BCBSTX officials provide us entertainment as they painfully learn that transparency cuts smooth through superficial and punctures deep quickly.

    Since virtually all Texas employers prefer honesty in health care for their employees, I suggest they avoid BCBSTX products until the officials, including Chief Medical Officer Dr. Eduardo Sanchez, accept accountability in the marketplace we all share. I invite Dr. Sanchez to respond publicly to accusations of malfeasance by his employer, BCBSTX. We could discuss that and other issues right here if you like, Dr. Sanchez. What do you say? I bet you and I could attract a big audience.

    I feel confident that Dr. Sanchez is not the only BCBSTX executive whose face is turning red while reading these words. Those working for BCBSTX who understand the modern developments in marketplace conversation know exactly what I mean when I point out to authoritarians everywhere that there is simply no place to hide any more. Working together, friends, we have pulled a reclusive BCBSTX into the wide open spaces. This scares the water from shy officials.

    How’s that for an introduction to an adventure? Please sit back, sports fans. My fervent desire is to entertain you with even more details about BCBSTX’s stretch scars, gas emissions and other public relations problems.

    To catch readers up on recent developments, about a week ago, Texas Attorney General Greg Abbott announced that he had reached a settlement with BCBSTX concerning their scheme to not only mislead their clients by using a biased physician rating system, but he also accused BCBSTX of threatening physicians who refer patients to out of network providers. In the last three days, I have noticed that BCBSTX is busy purchasing both TV and radio spots in an effort to counter the bad publicity. I imagine that the two BCBSTX PR specialists mentioned previously on this forum are working overtime to repair the damage as well. If Dr. Sanchez does not have the time or confidence to face BCBSTX consumers, it would be wonderful to hear from PR experts Ross Blackstone or Becky Kenny once again if they are available (See “Don’t Rush Into eHRs”).

    https://healthcarefinancials.wordpress.com/2009/03/04/don%e2%80%99t-rush-ehrs/#comment-3241

    BCBSTX on Twitter

    For a reason that I still don’t understand, someone at BCBSTX thought it would be a cool to have representation on an Internet social platform, and picked Twitter. What a bonehead.

    http://twitter.com/BCBSTX

    I read the 57 comments that have been posted on the BCBSTX Twitter site since it started in December, and did some rough statistics on their types. Most of the short responses were posted by “web,” with a few by “TweetDeck.” I predict from the nature of their comments that both are BCBSTX employees. I’ll go a step further. I think “web” is female and “TweetDeck” is male, and that one has a degree in public relations, while the other almost has a degree in fashion design. I can fantasize about details like this because the absence of transparency conveniently gives story-tellers like me artistic license to build characters. What are web and TweetDeck going to do? Come out and tell me I’m wrong? We should be so lucky.

    In December and January, there were a total of 17 comments posted on the BCBSTX Twitter site. 47% of them were BCBSTX ads or other PR pieces, 24% were responses to visitor compliments, and one (6%) comment at the last of January was a response to a client by web – promising to personally help with the client’s BCBSTX preferred provider list: “It looks like the doctor isn’t in our network. Is there a time today we can call you? We may have some options to help.”

    In February and March, the BCBSTX Twitter site became busier with 33 comments. However in these two months, there were no compliments from visitors and only 15% of the comments were BCBSTX ads and other PR pieces. The majority of the comments, 55%, concern problems BCBSTX clients are having with their plans. More and more often, web asks them, “When is a good time to have someone call you?” Web, bless her heart, has become a handy complaint compartment for BCBSTX. I hope she is paid well. Apparently TweetDeck no longer gets involved.

    If as a client or provider, you have ever tried to speak to a BCBSTX representative on the phone, you understand how nice it is to find a friend like web. Here’s one of my experiences: A year ago, while pursuing still unanswered questions about the NPI number, I waited two days to talk to a supervisor named Wilma Jaimes, who finished eating a juicy peach while I waited just a few minutes longer. I caught her slurps and more on a microcassette audio tape. With employees like Wilma, it is no surprise that BCBSTX clients are attracted by web’s personal attention.

    A test

    As you might expect, I have my own question for web and/or TweetDeck. This is what I submitted a day ago on the BCBSTX Twitter.
    ”Do dentists have to have NPI numbers to use your dental insurance?”
    D. Kellus Pruitt DDS”

    BCBSTX may have settled things using $80,000 worth of employers’ premiums and a half-repentant conversation with Texas Attorney General Greg Abbott, but they haven’t settled things with me.

    So what can we do that will that will bring a special hell to BCBSTX? We’ve already done it, friends. Even reticent BCBSTX officials are aware that when potential customers googlesearch “BCBSTX,” this thread, “BCBS-TX Dental Insurance is Rude to Everyone,” and/or “Why the long NPI, BCBSTX?” is one of their top ten hits.

    Together, let’s continue to improve health care in Texas. Let’s take apart BCBSTX as an example to show UnitedHealth, Delta Dental and others that old tricks no longer work. Consumers win today.

    Texas need not secede. Let’s simply send the bozos home. I hear the governor is planning ferry service across the Red River at every official point of entry.

    D. Kellus Pruitt; DDS

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  10. Here’s some sporting news. As of this morning, BCBSTX is following me on Twitter.

    I give readers my word that I will do everything possible to make our conversations both educational and captivating. I should warn you ahead of time, BCBSTX is really slow in responding on the Internet. It’s that committee thing. Wouldn’t it be nice if the ADA opened a Twitter address?

    Remember … only you can stamp out talking points.
    They call me Proots.

    Darrell K. Pruitt; DDS

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  11. Proots loses a dollar

    BCBSTX responded within hours instead of days. I lost my bet, so I owe the kitty one dollar. It will go toward the cast party if I don’t win it back.

    It surprised me when Sid “TweetDeck” Jones from BCBSTX responded, but he actually failed to answer the question: “You are saying that your insured’s are limited to dentists with NPI numbers. Correct?” I accidentally discovered Sid’s response in a private “Direct Message” on Twitter. He sounds like a busy and important man when he warns me: “Last one, and then I have work to do. If you really want help, let me know. If you are just using this as a forum to rant, I’m out.”

    As a professional, what else could I do? Within minutes of being secretly scolded by the sometimes bald and sometimes gray office dude, I shared what he said with everyone in the theater:

    Sid followed his exasperated comment with a link to some Website where I suppose I might learn something new that will make everything about HIPAA make sense in dentistry. That way, I wouldn’t keep busy BCBSTX employees from their work … My thoughts wander to one or four times when a BCBS client in my dental chair is waiting on me, while I wait on hold for a BCBS employee to finally and suddenly buzz by me with“ … You mind waiting a minute. Thank you .” Oh and the music! Sweet, merciful Jesus!

    I think I speak for almost everyone attending this impromptu neighborhood gathering when I announce to anyone who works for BCBSTX – or anyone related to someone who works for BCBSTX – that we would really rather hear the details about the NPI number from Sid and Barbara of BCBSTX – the secret lovers.

    It will be a short wait while the scenery is being changed for Episode 3 – and then someone (yours truly) will have to round up the characters again and get them back in the mood for putting on a show. I think the BCBSTX team has scattered for the weekend or the summer. Enjoy your meal, and I will return with more backstage gossip as it occurs to me.

    Proots

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  12. Since we’re all in this together, and since I am a big fan of open-source solutions, here is a Web 2.0 idea that might be worth some consideration. This could be a community project if others are interested in perhaps carrying some weight. I have my hands full.

    It occurred to me this morning that I may be close to inadvertently providing a platform for an unprecedented impromptu forum on Twitter – where dentists and other health care providers across the nation are free to openly voice their complaints about tyranny from not only insurance giants like BCBS, Delta, and all the other NADP members, but other non-productive parasites who would love to come between us and our patients – both public and private. If we don’t complain, friends, who’s going to know? Think about this: universal healthcare.

    If there is significant latent interest in improving our neighborhood that is waiting to be tapped – which I think there is – where would be a good place to gather volunteers? How about a rating system for dental insurers on Twitter some how? Why not? It’s more productive than a lynch mob (Plan B).

    Please voice your ideas here … or not. If interest catches on, we can move the discussion to one of the PennWell groups. I think it is time for us to give something back to the neighborhood. It is time to clean up our streets. The garbage is interfering with traffic.

    Darrell K. Pruitt, DDS

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  13. Darrell,

    Sadly, your idea is good but won’t work. Why? Most people hate insurance companies anyway, and care even less about the doctor.

    Sally

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  14. Sally,

    Perhaps I was not sufficiently clear in my description. I envision a rating system in which the providers, not the insurers’ clients’ beneficiaries, give their opinions of insurance companies.

    As you imply, I agree it would be very difficult to persuade patients to put their hearts into rating the insurance companies their bosses purchase on their behalf based on a slick sales presentation. That is exactly at the core of a wasteful healthcare problem with most, but not all employer-based benefit options.

    If an employer had a meaningful way to choose between a plan which doctors (patients) prefer, and sleaze, which plan would he or she want for employees if the company has any compassion at all? Here is the part I like: If BCBSTX receives the lowest rating of all dental insurance companies, will they learn to treat dentists better or worse? Adam Smith would have approved of the Internet.

    Simply put, if BCBSTX cannot be held accountable by doctors, how can they possibly be trusted with patients’ healthcare dollars? BCBSTX only answers to employers who are not paying attention because there is no convenient rating system that they can refer to, for one thing.

    Why is the transparent conflict of interest that is built into our insurance system so hard to accept? Because, as you said Sally, doctors are not well liked for a reason. Distrust serves stakeholders’ interests.

    Want to know how little BCBSTX respects providers? Here is their last post on Twitter:

    @Proots You can treat the member. But if you want to get paid you’ll need NPI to submit the claim. Do you know why we went to NPI?
    2:01 PM Apr 30th from TweetDeck in reply to Proots

    I asked why they went to NPI, but Mr. Sid Jones (an assigned name for an anonymous employee) has not yet answered. It could a day or 15. BCBSTX is very, very slow. But then, unlike an employer who has no idea what his money is purchasing, I’m a dentist without a contractual relationship with BCBSTX. That gives Sid the freedom to show me disdain. Sid likes freedom.

    The way I see it, we either play or we get trampled – and that will be the worst thing that can happen to our patients who trust us to be unbiased in our decisions about their care. Did you know there is a shortage of primary care physicians, and in Maine, physicians are being trained to pull teeth because of the extreme shortage of dentists?

    Bad things happen when numerous powerful segments of society profit from promises of the highest quality health care at the lowest price. Health care disappears. What did you think would happen?

    How much longer can the US afford to allow mere stakeholders like BCBS to rip off the principles – the doctors (patients)? Is Wall Street really more important than life itself?

    D. Kellus Pruitt; DDS

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  15. Darrell,

    Sadly, and with all due respect, I still think you got it wrong.

    The providers give their approval by joining. And, like you, they have the choice of not joining. So, actually the pain you, and they, may complain about is just not onerous enough to reject insurance cos in the true capitalistic, and Adam Smith-like, fashion you champion.

    It hurts … but just not enough if you are mature, affluent or a dinosaur. Maybe the current generation of physicians has the valid excuse of “never knowing it any other way” [FFS], but not the rest.

    The bottom line is doctors have abrogated their responsibilities decades ago, and we all are now paying the price. Medical professionals of all types lost their leverage and will not soon get it back. Still, I have hope in the next-generation; or the next. Disruptive change [evolution] and innovation always comes; just not always when we wish. Some win, others do not.

    Me, I like the change in status quo; others are free to move to China or Cuba.

    Sally MBA

    Like

  16. Sally, we half-way agree completely.

    I think it is safe to say that you and I are in strong agreement that there is calculated interference in doctor-patient relationships and that the arrangement is less than optimally beneficial for patients as well as doctors.

    We differ sharply in optimism and solutions. I am optimistic and you have no solutions.

    You say that providers allowed loss of control of medicine to happen long ago, so now patients as well as doctors will just have to live with the deteriorating health care mess for a generation or two – and if one does not like it, the only other choice is to move to a communist country where I assume doctors are more fairly treated.

    In contrast to your depressing opinion, I am certain that we will all recognize positive changes in the way dentists as well as physicians are treated by both the insurance industry and the Department of Health and Human Services, not following decades, or even years. Without a doubt in my mind, I foresee that within months most will agree that there is recognized improvement in the way doctors (patients) are treated – about the time the Red Flags Rule goes rumbling into effect – give or take five days. What’s more, I may be terribly naïve, but I think all that is required to turn this bus around is one really pissed off dentist who just does not know when to quit. So what if I’m wrong? My embarrassment for looking oh so foolish will not be that big of a deal. Really.

    You also say that the situation is not quite oppressive enough to cause providers to leverage their indisputable and natural advantages in negotiating for the welfare of our patients. (Forgive me for grafting some of my ideas onto yours). I know doctors well. I think generally, physicians are just not paying attention to much beyond their practices because they are simply too busy providing rushed managed care for patients, and are constantly fighting against time limitations – even before spending even more time to adopt new eHRs that most do not want no way.

    Just because very few physicians kvetch like I do (yet), it would be a mistake to think someone has the upper hand against any group of Americans – much less those who the nation cannot live without – and who on the average are nobody’s fools. There is already a shortage of primary care physicians. Just how hard can the rest be pushed before they start paying attention to decades of grossly unfair business practices in the health care industry aimed at directly at them (and their patients – us)?

    In the healthcare microcosm of dental care, managed care brokers have clearly shown that markets can be made to look confusing and complicated in order to hide unfair actuarial advantages that have been effective at skimming money from employers for at least three decades. In spite of poor business ethics that have become tradition in the healthcare stakeholder industry, I contend that 18th Century Scottish economist Adam Smith’s ghost has never left the soul of our nation. Stick around and we just might see him spank a brand new tax-paying HHS Secretary with that invisible hand of his.

    Here are two blunt truths that very few doctors feel the freedom to publicly declare: 1. It is always in the patient’s best interest that their provider feels adequately rewarded for the service provided, and 2. Ethics are not free. I confidently challenge anyone to argue the counter-point to either declaration. Managed care dental insurance supervisors are especially welcome, but they better pack a lunch I’ll like, and don’t forget the milk money.

    D. Kellus Pruitt DDS

    Like

  17. Hi Darrell,

    “Not paying attention” is the same thing as acquiescence, IMHO. And, I may offer solutions down-line, but just not on this forum. Otherwise, well said, but the battle ship won’t turn around too easily – not depressive – just realistic.

    PS: The docs are very depressed with three-fourths not even “paying attention” enough to join the AMA.

    Finis
    Sally

    Like

  18. You see, we’re not far apart after all. I guess I just feel more secure in saying what I think.

    Thanks.
    Darrell

    Like

  19. Today, Randy Duermyer posted an article titled “How Do YOU Use Twitter?” on his business blog, so I told him. I submitted the following comment to be posted.
    Darrell

    http://homebusiness.about.com/b/2009/05/14/how-do-you-use-twitter.htmHow%20Do%20YOU%20Use%20Twitter?

    They call me Proots

    Randy, I am so glad that you invited me to describe my experience on Twitter. I personally find the conversational potential for the new social network platform fascinating, and I doubt that you will read another amateur PR success story quite like mine. The neat thing is, like you, it thrills me to share my knowledge of things that captivate every ounce of my interest. This would be a good time to warn that if you have things around the house that you need to repair in the next month or two, you’d better go ahead and do those chores before joining Twitter. I forget to eat.

    I doubt you will find my tale boring. If so, skip-reading is a wonderful tool.

    It seems that the majority of those on Twitter who are not selling something, are using it as a benevolent, bland and polite extension of text-messaging among acquaintances and characters – bringing with them txtng habits (LOL!) along with more fad enthusiasm for communication technology the nation has seen since CB radios became a hit in the Texas panhandle in ‘75 (Gt yer ears on, gd buddy?)

    It’s not the daily tedium of even the rich and famous that interests me about Twitter, and PR is hardly my profession. In fact, it simply tickles me giddy that as a dentist, my patients have no clue about my secret, unshaven alter ego who is blessed with super-powers. So what’s the payback? It’s the surprising peek-a-boo effects of implied transparency that puts lead in my pencil – if you know what I mean.

    Even though I joined Twitter less than a month ago, I have been a prolific and fiercely independent blogger for about three years – writing about long-tail, esoteric issues which mostly involve dentistry and healthcare IT, with a side-interest in Search Engine Optimization. I am currently a guest (read “unpaid”) columnist on both the PennWell dental forum and the Medical Executive-Post – where I also intend to submit versions of this comment. I long ago proved to some who respect interesting content that I reliably bring a special, growing niche crowd with me. I call them sports fans because they are the type of friends who would hang around just to watch the messy results of a burning paper bag on a front porch … from a safe distance, of course. I would be the one who volunteers to ring the doorbell, several times.

    By now you probably find this hard to believe, but the 140 character limit on Twitter demands a nice cadence that compliments my hobby I describe as unconventional and aggressive PR – that is both entertaining and efficient for natural reasons.

    For example, when I gleefully discover a fat, slow-moving, command-and-control entity like BCBS of Texas on Twitter, the poor slobs that make up their PR teams are simply defenseless in avoiding accountability. Like a force-multiplier to my shameless, earthly motivation, the sleazy blue bully has caused me and my patients decades of in-your-face misery. So you can imagine the warm satisfaction I feel each time I publicly ask BCBSTX simple, but tough questions about their bankrupt National Provider Identifier requirement. I imagine that within seconds, the realization of the seriousness of the emerging PR problem caused the anonymous BCBSTX employee (who I named Sidney) to suffer symptoms of acute cognitive dissonance. And like a huge bolus of aged longhorn cheddar cheese, my rapidly expanding intrusion completely shut down all movement on the BCBSTX Twitter site. It eventually lead to piles and other more overt image problems.

    Even now, if one searches “BCBSTX” on Google, the first hit is the last tweet on their Twitter site. it was a frustrated response to a disgruntled client named Kwaadman whom I egged on. Sid told Kwaadman, “If Dr. Pruitt makes you happy, by all means continue seeing him.” (I would be said Dr. Pruitt) That chunk of knee-jerk, regrettable and still undisturbed PR that benefits me more than anyone else on Earth, was posted over three days ago. Just how much more can one BCBSTX PR team screw up before it becomes a reality sit-com?

    If you understand what is happening to the PR business, you just got to love America – where all it takes is either Jeff Jarvis or a random pissed off dentist to foul the machinery of those who resist accountability. What a country!

    D. Kellus Pruitt; DDS

    Like

  20. Ross Blackstone twitters!

    Sports fans, you should already know what that means. Weekend word fun!

    Sometimes in life, no matter how miserable a Monday starts, things mysteriously turn out to be just good enough by Friday. Today, I discovered that the always good looking, former Sacramento TV reporter Ross Blackstone, who is currently a talking head with PR space to rent, has a Twitter site. Perfect. I’ll make no secret about it. I intend to squat on some of his prime vacant space. I could easily leave it a permanent mess. Concerning a loosely related vacant space, I should warn Mr. Michael Graham, head lobbyist of the ADA in Washington, DC, to pay attention to how things can suddenly go down once transparency arrives. Those who hang on to absurdity the longest will lose the most.

    If you recall, Blackstone is the good looking dude who unsuccessfully attempted to persuade the publisher of Medical Executive-Post, Dr. David Marcinko, to censor one of my articles out of respect for the sheer mightiness of BCBSNM. For ethical and possibly genetic reasons, Marcinko has the bozos out-classed. He promptly sent Blackstone’s well-groomed butt on down the road in a glorious fashion. I like David. He, his team and I all seem to be mostly parallel in our ideals and goals. I think I can speak for the staff when I say that transparency is very, very important to all of us.

    Please invite your friends to follow along on Twitter. This could be really fun in an ornery way. I’ve already very innocently asked Blackstone if he still does PR work for BCBSNM. It can only go downhill from there, sports fans.

    I actually don’t think the BCBS pawn will respond. To be honest, if his self-image is as important to the pretty boy as I suspect it is, he probably should not respond at all – unless it is to renounce the horrendous policies of BCBSNM. That would be a gutsy move I could respect forever. Hell, if Ross Blackstone showed that kind of courage, I would immediately and graciously apologize for being such an unfair and hard bastard to him.

    Otherwise, I am not a bit shy about my confidence. I’ve got PR hack Ross Blackstone immobilized simply because I can and will hold him accountable for the insensitivity of the fat, slow-moving, command-and-control monster he works for, BCBSNM.

    That’s not all. Pay attention as I go out on an imaginary limb and declare that in the next few hours, together Ross Blackstone and I will prove forever that conventional PR is bankrupt. Blackstone will not even have to do anything more than he has already done to prove my point. He contributed plenty, and I’ve got it from here.

    I think I’ll make the day or three interesting for Blackstone even if he declines to participate in his own slow roast.

    Darrell “Proots” Pruitt

    Like

  21. BCBSTX – Texas DDS negotiations

    I once knew a really nice man who owned a mom and pop dental supply company in west Texas. Leo was a slow-moving, patient man who was really easy to get along with as long as you showed him respect. A few insensitive dentists who purchased from him assumed he was so nice that he might not mind waiting longer than the customary 30 days for his money.

    Leo’s nephew, Freddy, was fat, smelly man who worked in the stockyards. Around day 37, Herb calls the ungrateful SOB dentist’s office, quickly tells whoever answers the phone that he is sending Freddy by for the check, and immediately hangs up the phone before excuses can blossom.

    Freddy likes the job because he gets paid to read the magazines in a nice, air-conditioned office, and there aren’t any quick and pesky biting flies … other than the few that made the trip to town with him.

    I posted the following on BCBSTX’s Facebook site today.

    http://www.facebook.com/topic.php?topic=8926&post=46462&uid=93487018652#post46462

    Dear BCBSTX: Working together, we can tear down the walls that separate you from Texas dentists. How about it?

    (I wish I had a name to address my comments.)

    I know that you would prefer that I leave you alone, and it is obvious to everyone following that you are simply paralyzed by sudden transparency. But nevertheless, I consider it an encouraging sign for the future of dentistry in Texas that you resisted deleting from your Facebook account my July 3rd question concerning your NPI policy. Even though you have not yet taken the next huge step to finally answer my December 2007 question, you made the right choice by me for the first time in years. I imagine you ultimately came to the conclusion that to continue to avoid me will not serve the interests of anyone – especially BCBSTX.

    I pretend that I’m beginning to win you over. You certainly have to agree that we must talk openly – and the sooner the better. Everyone on all sides of this issue wants resolution of our disagreements about dentistry, and since you haven’t a single vocal dentist on your side, you must be aware that you’ve got serious, modern PR problems that are hobbling your negotiations for your future in my state.

    Make no mistake. These are real negotiations before the Supreme Court of Consumers, and you have had a lousy bargaining position in dentistry for decades. Until the Internet made you accessible, you were so well hidden that dentists and patients could not hold you accountable. Even if the rumor about dentists’ hatred of your company has not yet penetrated the thick insulation protecting the top officers of BCBSTX, you and I have been negotiating ever since you caused several of my satisfied, long term patients to leave my practice for dentists who have NPI numbers. Your side has already lost more than you can imagine because so far, you’re a no show.

    When you are ready to celebrate with me unprecedented, open marketplace conversation, you can start by providing us a name. If you make me continue without you, I’ll be forced to assign one.

    I can confidently tell you that I am not the only dentist in Texas who is impressed with your new-found respect of consumerism. Please don’t disappoint us now. (And please, no phone calls.)

    D. Kellus Pruitt; DDS

    Like

  22. Indirect Reimbursement:
    [Is it a compromise worthy of our support?]

    Do you find it aggravating when well-considered treatment decisions painstakingly made by you and your patients are second-guessed by an anonymous dental consultant working on commission – who may or may not have a dental license or a seeing eye-dog?

    Don’t you hate it when long after your intricate work has left the office in the mouths of satisfied patients you discover their dental plan’s “usual and customary” fee allowances were customary in the 20th Century?

    And lastly, wouldn’t it be wonderful to be paid in full by patients at the time of service – even if they have dental benefits?

    I can’t promise anything at this point, but a friend of mine in the dental benefits industry in Texas might be able to help us with two out of three of these problems.

    What ever happened to Direct Reimbursement?

    If you recall, DR is the dental plan with which patients pay for treatment in full at the time of service to the dentist of their choice and are later reimbursed by their boss according to easy to understand percentages and maximums. Unlike health benefits, dental benefits are predictable and involve far less financial risk for self-insured employers. This allows employers’ financial exposure to be controlled according to the benefits design that best suit the employees’ needs. But unfortunately, that was just not enough to satisfy customers.

    The concept of DR is so straight forward that everyone understands exactly where the money is going – which isn’t to Delta Dental, BCBSTX or United Healthcare executives. In addition, since such a plan eliminates insurer interference in doctor-patient relationships, undercutting healthcare parasites such as Delta Dental, BCBSTX and United Healthcare is actually the Hippocratic thing to do, as well as sport.

    It’s obvious that following years of effort, including substantial support from the leaders and staff of the American Dental Association, Direct Reimbursement simply never attracted widespread consumer demand like so many of us hoped it would. Right or wrong, consumers have learned to expect dentists to accept assignment of benefits (delayed payment) as a courtesy to them (and a gift of power to insurers).

    Ignorance favors tyranny even in the land of the free.

    Even though Direct Reimbursement offers employers shopping for dental benefits a more valuable, transparent product at a lower cost than traditional, intentionally complicated dental plans, DR’s requirement of payment at the time of service simply cannot compete with the prevalence of accepting assignment.

    That’s unfortunate. I’ve always felt the beauty of the DR lies in its simplicity – no usual and customary fees, no dental consultants and immediate payment in full by patients who are later reimbursed by their employers. In hindsight, do you think as dentists, we might have just demanded too much in our marketplace negotiations? Consider this: If Direct Reimbursement had allowed assignment of benefits – which is what our customers want – do you think it might have survived?

    Sometimes, if nobody compromises nobody gains. Have you yet noticed how our inflexibility threatens our goals?

    If a new kind of dental benefit plan similar to DR were to come onto the market sporting transparent advantages for employers and employees, as well as dentists, how much would you be willing to bend?

    How about this: Instead of immediate payment, the new dental plan guarantees payment in full within 10 days – no questions asked. Could you bow to that? If such a dental benefits product were to come on to the market, would you make an effort to bring it to the attention of employers in your community?

    Here is my friend’s note:

    “I would like your opinion on a plan we are developing to market to Texas political subdivisions through an existing risk pool we established in 1998.

    We believe that a direct reimbursement approach but with an assignment of benefits to the provider would be better than traditional insurance plans we typically see in the market.

    The assignment of benefits would enable insureds to seek treatment without having to pay the bill up front and then seeking reimbursement from their employer. The provider would file a claim to a third party administrator – almost like a voucher system. Payment to the provider would be for billed charges, not U&C.

    The plan benefits would work something like this: No deductible, 100% first $200, 80% next $500, 50% next $1000.

    From a provider’s point of view, what is your opinion on this, and what would you like to see in the plan that would make sense to both the insured, the employer who funds the plan, and you the provider?”

    ———–

    A growing number of us want to know what you think. Your opinion could improve dental patients’ health. But until you say something, your opinion will never be heard.

    Darrell K. Pruitt DDS

    Like

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