A New Survey on Dental Insurance

Posted on March 22, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Come on out Kim E. Volk – CEO of Delta Dental

By Darrell K. Pruitt; DDS

Today, Julie Frey posted “Dentist & Dental Insurance: No Love Lost” on Jim Du Molin’s Blog.

http://www.thewealthydentist.com/blog/1186/dentist-dental-insurance/

Frey hosts dentists’ frank criticism of dental insurance – their harsh sentiments backed up with fresh results from yet another of the blog’s timely studies that nobody else can compete with. Frey writes “Half of dentists have mostly or completely stopped accepting dental insurances, according to this survey.”  One dentist captured the mood of the dentists with the statement, “Do the math … somebody is making hell of a lot of money on these plans, and it is not the dentist!” I smelled blood and posted the following comment.

Bloody Sunday

Anonymous members of the obscure National Association of Dental Plans (NADP) are losing the fat, collective thumb they once oppressed us with – even using our own ADA News to present their non-negotiable terms. Apart from common sense appearing in the marketplace about the same time as transparency, multiple other interconnected factors are causing dental insurance companies to lose business. The bad economy, corporate greed and pride are a few of their more serious handicaps that come to mind. Wasteful, deceptive insurance practices have aggravated my patients and me for decades before modern networked recourse became available on the Internet through progressive Websites like Jim Du Molin’s Blog. I’ll go out on a limb and say it is not unprofessional for us to enjoy protecting those we serve by showing no mercy to unfair stakeholders like the NADP.

There. I said it. In fact, as US citizens and taxpayers I think blowing the whistle on unneeded expense and danger in the nation’s healthcare delivery is the least we can do for meaningful healthcare reform. I say do your part. Make an insurance CEO like Delta Dental Plans Association’s Kim E. Volk feel discomfort on the Internet. Do you know that Kim E. Volk is the only person who has ever refused to accept me as a friend on Facebook?

http://www.jbpub.com/catalog/9780763733421/

Assessment 

We really don’t want to allow Delta Dental, UnitedHealthcare, United Concordia and others to dictate fees for non-covered dental services, do we? I also don’t think they deserve continued protection from FTC anti-trust litigation. I say we punish the NADP hard every chance we get until the repeal of the McCarran-Ferguson Act and finally make such in-your-face collusion illegal for crying out loud.

Conclusion

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Filed under: Career Development, Ethics, Health Insurance, Practice Management, Pruitt's Platform | Tagged: , , , , , , , , , , , , , | 13 Comments »

Direct Reimbursement [DR] and RiskManagers.Us

Posted on April 6, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Transparent Dental Benefits versus Confusion

[By Darrell K. Pruitt; DDS]

pruitt

“If you are not a part of the solution, there is good money to be made prolonging the problem.” 

Company slogan- www.riskmanagers.us

Meet Mr. William Rusteberg

Today, I met William Rusteberg on the PennWell forum when he replied to the thread, “Why the long NPI, BCBS-TX?” which I copied below, along with my response which includes a plug for Direct Reimbursement [DR].

http://community.pennwelldentalgroup.com/forum/topics/why-the-long-npi-bcbstx?page=1&commentId=2013420%3AComment%3A26976&x=1#2013420Comment26976

Mr. Rusteberg represents a company called RiskManagers.Us, whose specialty involves the benefits market, yet it is not exactly an insurance company – just like there is no such thing as true dental insurance.  RiskManagers.us is a firm that works directly with businesses to identify and develop cost-effective benefits packages – emphasizing transparency and fairness.  Now that is refreshing, friends! 

Defining RiskManagers.Us 

Here is how RiskManagers.us describes itself: 

“We do not work for an insurance company, we work for you. As an independent brokerage, and consulting firm we can represent any licensed insurance company in Texas, Colorado, Mississippi, Louisiana, Alabama, Illinois & Florida.”

If one visits the Web site’s “Reference Library,” here are some of the topics offered:

·         Self Funding – Need a second opinion?

·         Texas leads in transparency issues

·         Can’t get claim information? HB 2015 May Solve Your Problem

·         Medical Stop Loss Through a Captive

·         PPO Discounts – Games People Play

·         PPO Networks – Shell Game

·         Can Hospitals waive Deductibles in Texas?

“What is a NPI number?” 

Mr. Rusteberg’s initial question on the PennWell forum simply asked, “What is a NPI number?”  Following my explanation, he wrote: 

 “It seems that many of those in your profession would do well in accepting cash only, or directly working with employer groups who sponsor dental/medical plans on a direct pay basis. We have had good success in doing this for our clients – we have one employer in San Antonio who pays medical care providers directly and quickly – providers like it and the plan pays a fair and reasonable rate, not relying on a PPO network to “re-price” claims. We have done the same on dental plans, eliminating the insurance company, PPO network and paying dental care providers submitted charges directly and quickly. We see little or no trend increases on dental charges using this method. In my view, insurance companies interfere in patient – provider relationships in a financially detrimental way.”

Thanks for your reply.

My Response:

I like you, William; 

What you describe sounds like my all-time, personal favorite dental benefits plan. It is called Direct Reimbursement {DR}, and it not only gives the employer the unlimited capability to design a plan which reflects the level of commitment desired by the company, but most importantly, it naturally preserves quality of care by allowing employees unlimited freedom of choice in dentists.  And that’s as good as the market gets. 

http://www.directreimbursement.com/

In addition, since there are no NPI requirements for DR, employees are also permitted see dentists who decline NPI numbers for ethical reasons. That increases employees’ choice by 50% over BCBS-TX clients, according to recent information provided by the Healthcare IT Transition Group.

http://www.npidentify.com/stats.htm#states

Little Management Needed

Just like the benefits plans you mention, with DR, very little money is spent on management because such policies are so simple and transparent that there is no room for profit-enhancing (wasteful) confusion used by unethical companies like BCBSTX, Aetna, Cigna, UnitedHealth, Delta Dental, United Concordia, and so many other members of the National Association of Dental Plans (NADP).

Assessment

Without transparency and the invisible hand of freedom-of-choice, free-market competition for healthcare dollars disappears as fast as executive bonuses rise. We’ll see where it goes from here. It would sure be swell if a Direct Reimbursement representative takes interest in the conversation; anyone home? 

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Filed under: "Doctors Only", Breaking News, Career Development, Ethics, Health Economics, Health Insurance, Managed Care, Op-Editorials, Practice Management | Tagged: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | 12 Comments »