Dental Clinics and Insurance Networks
Like their patients, clinics can choose to be in network with insurance companies. In an insurance network, clinics receive “‘free advertising’ on the insurance plan’s provider directory,” potentially attracting new patients with insurance plans (Ellis 2017). However, participating in more insurance networks does not cause much more patients to come to the clinics (Hatch 2017). Rather, “[dentists] ended up seeing more of their current patients but at a reduced fee because of being ‘in network’ for their plans” (Hatch 2017). Despite the benefits of being in-network, it contains flaws due to its costs and effect on patient decisions.
Being in network for insurance plans, such as PPO plans, may be pricey and cause patients to reject certain treatments due to lack of coverage. Based on clinics’ contracts with insurance companies, clinics cut costs of some of their treatments for patients (“Dental Insurance: How does it work and who can you trust?” 2015). While these reduced prices relatively benefit patients, clinics must still “make enough money to pay for office overhead and make a profit” (Ellis 2017). Unfortunately, according to Timothy McNeely, “CEO of The LifeStone Companies,” “Surveys by the ADA, 3M Dental Products, and others show that a large percentage of dentists are highly dissatisfied with the business practices of PPOs, DMOs, and dental insurance in general. They feel fee schedules are unrealistically low and that managed care can deny patients the best course of treatment” (2017). Additionally, reimbursements from dental insurance companies may be low for some clinics (Walters 2014). Dentists could negotiate fees and reimbursement rates with these insurance companies, but some of these companies might not want to discuss changing their contracts with them as an increasing number of dentists join their networks (Burniston 2015; Walters 2014; Weber 2014). Clinics also have to “[explain] to patients why their plan doesn’t cover a procedure and ‘selling’ them on getting the procedure and paying out of pocket” (Ellis 2017). Otherwise, patients might reject necessary treatments in order to save money.
Instead, some dentists run their clinics without being in a PPO network. Dentists would then offer their treatments and services without reduced costs, attracting “‘fee-for-service’ patients” (McNeely 2017). Before dropping out of a particular PPO network, clinics should review “how many patients have this insurance” and how much money they accrued from being in this network (Kaiser 2013). According to Benjamin Tuinei, “president of Veritas Dental Resources,” clinics could save money by handling advertising themselves instead of “taking the 30% to 70% PPO discounts through PPO participation” (2016). Dropping insurance may cause patients to leave for another clinic that accepts their insurance plans, but dentists could talk to them about why they are leaving their insurance networks, “[help] patients with insurance claims,” and promise to continue taking excellent care of their oral health (Kaiser 2013; McNeely 2017).
Being in-network and out-of-network have their benefits and flaws. In the end, dentists still must know how to manage their finances and take care of their patients well.