Transparent Dental Benefits versus Confusion
[By Darrell K. Pruitt; DDS]
“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
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Filed under: "Doctors Only", Breaking News, Career Development, Ethics, Health Economics, Health Insurance, Managed Care, Op-Editorials, Practice Management | Tagged: ADA, Aetna, BCBS-TX, Cigna, concierge medicine, Darrell Pruitt, david marcinko, delta dental, dental benefits, dental insurance, dentists, direct reimbursement, discount dentistry, doctors, Heal;thcare IT Transition Group, HIPAA, HMO, IPA, managed dental care, MCO, NADP, National Association of Dental Plans, NPI Number, PennWell forum, PPO, private pay healthcare, RiskManagers.Us, self insurance, United Concordia, UnitedHealth, William Rusteberg, www.RiskManagers.Us | 12 Comments »
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