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Dental Managed Care
(What you don't know can hurt you)Recently we have had a number of patients ask why our office is not on their insurance company's list of "preferred providers". In this day and age of fast food and managed care, we've chosen to keep our practice just the opposite: relaxed, thorough and comfortable. We treat you the same way we expect to be treated ourselves. What's the difference?
The most recognizable difference between managed care dentistry and the dental office relationships which you have grown to expect is that patients lose their right to choose their own dentist. If your employer sponsors a managed care dental plan for your company, you may be told you have to visit one of the dentists who participate in that plan.Is freedom of choice important?
Participating in managed care dental plans is like being told where to shop and, to some degree,what you can buy. When you enroll in a managed care dental program, your employer provides you with a booklet containing names of several dentists participating in the plan. Certainly, you can select a dentist from this list, but how many of those dentists do you know? Most likely, the majority of dentists located in your geographical region do not participate in your company's plan. Managed care is a concept in which patients have very little say. Insurance providers contract with specific dentists whom they have selected to treat patients in their specific plan. Patients are then either assigned to one dentist or told to choose from the provider's list of dentists. They are also given a corresponding list of covered services. Patients have nothing more to say about selecting their own dentist. If the dentist you currently visit is not on "the list" for the insurance plan, the plan will typically not pay for services you receive, or will pay a greatly reduced amount. In some plans, you may be stuck with that particular dentist whether or not you feel comfortable.
Why so few on the lists?Have you ever noticed that only a small number of dentists are able to participate in a typical managed care plan? These dentists have chosen to participate because they are willing to reduce fees, making dental care more cost effective for the insurance company, while further limiting your choices. The bottom line is that managed care plans employ dentists based on dollars without regard to the quality of care they provide."Keep the line moving"Although most dentists want to provide you with the best possible care, those who participate in managed care plans are often unable to do that. Because managed care encourages dentists to drastically increase the number of patients they treat, dentists must spend less time with their patients. That means that patients must be ushered in and out of the office quickly so those dentists can sustain a large volume of patients. The managed care companies call this efficiency."I have to wait how long for an appointment?!"Many patients find that the dentists participating in managed care plans do not have openings available in their schedules. Many times they can't get an appointment because there are already too many patients waiting to see the dentist. Or maybe there are no openings in the schedule because the practice limits the number of hours available for managed care patients so that the dentist can accomodate his or her fee-for-service patients. In addition, managed care dental plans direct you to preselected offices. If you want to change offices you may be tremendously inconvenienced by the distance from your home to the office.
"Will I really get the same care?"In a managed care system, the overall concern is for the bottom line. The insurance company's contract with certain dentists closely controls the costs, procedures and treatments conducted. A dentist might not recommend the ideal treatment you need because the plan may not reimburse them for the services rendered. In some plans the dentist is actually required by contract to only offer the cheapest treatment options and is forbidden to mention any options that the plan does not cover! Some of these plans also have penalties for dentists who refer patients to specialists or who perform too many procedures. Conversely, some plans give bonuses to doctors for requesting fewer x-rays, diagnostic tests, etc. In this "cost containment" environment, it is obvious that the patient's needs are not a priority."Calling patient number......."In managed care plans you become a number, not a patient. Some managed care dental plans, known as capitation plans, reward doctors financially when patients do not seek treatment in the office. Dental offices that, in the past, made it a point to call you when you were overdue for appointments, have more incentive in a managed care program to hope that you never come into the practice.Our bottom lineFor these reasons our office decided long ago not to be involved in managed care contracts. We know you appreciate and value the individualized care and attention you and your family receive from us. You can be assured that your health and comfort will remain the "bottom line" in our practice no matter what changes occur in the insurance industry.
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