Dentistry’s Co-dependent Relationship with Insurance

Build your relationships first….then your dentistry. ~ Bob Barkley

Dentistry’s Co-dependent Relationship with Insurance

Posted on

Some great questions were recently posed by Kevin Daugherty DDS in relation to my “The Tail that Wags the Dog” commentary here on Codiscovery.com:

Q: Is it my imagination or does organized dentistry promote the dental insurance industry? Why is that? What happens to dental insurance if all dentists stop accepting assignment of benefits? Do they not lose control over dentists profit margins?

A: Dentistry as a whole has been in a co-dependent relationship with the dental insurance industry almost since day one. And the same can now be said for some dental schools and educational programs as well.

What at first appeared to be a win-win-win has -in my view- turned into a win-lose-lose, with the final “lose” disguised as a “win” due to the use of intentionally deceitful language, clever marketing, and shady review practices.

The primary carrier in the country- run by dentists- was supposed to be a non-profit collaboration created solely for the benefit of patients. Now, it has clearly evolved into a government-like organization that has self-preservation and self-reward as its primary purpose, although it is still shrouded in patient-centered language which deceives most of the public.

This has all created a largely false economy in dentistry, where the primary source of income is streaming from third parties. So the game evolved into: How do we get more out of the third parties? And of course, the third parties responded with counter-tactics.

So yes, we are locked into a relationship like a sober wife married to an alcoholic husband who buys them booze to keep them happy and off our back while rationalizing it all as being normal because everyone around us is doing it as well.

We dentists hold the key to our own freedom. But it requires learning how to function in the marketplace without crutches – without addictions…learning how to connect with our patients more deeply and significantly, so that their insurance plan coverage largely becomes irrelevant…and learning how to professionally promote ourselves so that people who are in alignment with our Purpose know about us and move toward us – in spite of all the dysfunction in the marketplace.

That is what I am trying to point out here. The path to freedom is never easily fought, but freedom is the only pathway to having a truly patient-centered practice and for many, a deeply fulfilling career.

Paul Henny DDS

Your Future with Dental Insurance

Posted on

Dental insurance has clearly been the “tail that wags the dog” in most practices, and that of course, is nothing new. Dentists since the 1970’s have long tolerated the dysfunctional relationships with insurance carriers rs, relationships which more closely resemble divorce court negiations than healthy collaborations for the benefit of patients (and by that I mean the prove-your-innocent-of-over-treatment process dentists must go through to seek rapidly diminishing third party payments).

But we may be reaching an even lower tipping point soon; we may soon see the proverbial tail wagging the relationship between dentists and insurance companies in an even worse direction.

To wit, some of you noticed that CVS recently shared its intention to PURCHASE Aetna. This represents a new type of vertical integration in the health care industry- a move likely to involve the-infolding of medical practices into the CVS corporation as well.

Not to be outdone, UnitedHealth Group, America’s largest health insurer announced yesterday that it plans to buy DaVita Medical Group and its nearly 300 doctor’s clinics across the country for $4.9 billion dollars.

More close to home, in late 2016, Delta Dental of Massachusetts sent dental providers new contracts and notified them that Delta would be transitioning all business to a for-profit corporation DSM Massachusetts Insurance Company, Inc.. This followed its intention to convert most of its policies over to PPO plans because the company’s growth was too stagnant to support its overhead even as a non-profit (one needs only to look at executive compensation levels to see where much of the overhead problems lie).

It does not take much of an imagination to see the direction toward which dentistry is turning. It is mostly shaping up to be a war between massive corporations for profits, with patients and providers as the vehicles through which those profits will be realized.

Consequently, it is indeed time to re-assess relationships with insurance carriers, as they neither have our long-term best interest in mind nor do they they guide our practices in a direction which is healthy for those associated with them.

Relationship-based / Health-centered dentistry which functions outside the negative influence of dental insurance is an alternative direction for your future. If it is your true desire to remain a professional -keeping the best interests of your patients ahead of profits -then the dog should be wagging the tail, and not the other way around.

Paul A Henny, DDS

Thought Experiments LLC, ©2017

Read more at www.codiscovery.com

Insurance & Co-dependency

Posted on

One of the biggest concerns relative to dental “insurance”, has less to do with reimbursement levels than it does with the negative influence it can have on the nature of the Doctor-Patient relationships.

We can counter low insurance reimbursement levels via innovative cost-cutting and increased efficiencies, but we can not easily counter the demand for less interpersonal time with patients that these greater “efficiencies” naturally create as a side-affect.

Greater efficiency is thus easily traded for less interpersonal effectiveness in the name of “progress”. And less interpersonal effectiveness leads to more dependent and co-dependent relationships, where interpersonal boundaries are both poorly defined and poorly developed.

Dependent and Co-dependent relationships cause us to non-verbally agree to maintain a relationship where one person assumes a role of taking care of the other, while “the other” agrees to let themselves be taken care of.

The design of this type of relationship is fixed, and it’s rigidly defined roles impair growth. Consequently, it perpetuates the status quo rather than facilitating the moving-on to a higher level of health and functioning. And worse, co-dependent relationships are full of unspoken assumptions about responsibility and accountability which -when violated- erupt into conflict.

Co-discovery is the pathway to transitioning patients from co-dependency to inter-dependency, as it moves decision-making and goal-setting from being individually executed / imposed toward becoming a shared responsibility.

Hence, Co-discovery is all about collaboration. Collaboration begets synergy, and synergy creates a level of positive change and growth unachievable by functioning alone.

And as Three Dog Night sang, “One is the loneliest number”.

Paul A. Henny, DDS

Dental Insurance – An Intentional Deception

Posted on

Dentists who are contractually involved with insurance today are fully aware of the shift toward PPO style plans, which restrict patient access to dentists of choice, as well as restrict dentists under contract from referring to specialists of choice.

In and of themselves, these restrictions would be manageable if it were not for the substantial reductions in fee code compensation, where in some cases, that compensation drops from payments in the range of 82% of “reasonable and customary” rates down to 58%.

One does not need an MBA or a degree in accounting to see that a broadly experienced additional compensation drop of 24% devastates profitability, which then forces upon the practice changes in business structure and climate to survive.

This external force – the shift from indemnity plans to PPO plans- is affecting the dental profession more than any other trend, as it demands a ramped-up economy-of-scale approach to dental practice. In other words, it is forcing the dental profession to become industrialized, where patients become “units” and workers become day laborers.

With all of the focus on maximizing productivity and reducing costs, while maximizing profitability, the discussion of health is easily lost, and the dentist and teams are reduced to being repair workers laboring under a remedial philosophy, and with patients who are often dissatisfied with both the outcome and their experience.

This trend line was noticed early by Bob Barkley in 1972 when he said, “Dental service corporations play a very critical role nationwide since they can stymie progress in prevention…Somehow service corporations acquire a marked distrust for the honesty of dentists and use this as a reason for holding back on their preventive teaching programs. One prominent dentist-executive of a large corporation declared that to pay for such teaching would be an open invitation to fraud.”

So there we have it- the core of the problem, the fact that dental insurance has everything to do with money and is only peripherally associated with health. And that the contractual relationship between the dentist and service corporation is founded on distrust. Consequently, a more dysfunctional relationship could not be designed or advanced.

Paul A Henny, DDS

Thought Experiments LLC, ©2017

Read more at www.codiscovery.com

What is “Insurance”?

Posted on

What is “insurance”? Insurance is a product structured in such a way that the provider of the product benefits financially from offering that product to the public. “Fine”, you say, “but isn’t the public benefiting from the product? Isn’t this a “win-win” arrangement?”

Sometimes yes.

Sometimes no.

And which situation insurance falls under has mostly to do with whether or not the insurance company’s values align with our needs and values at the moment we need to use their product.

And is it possible to know if this “alignment” exists on the front end of a contractual relationship with an insurance company?

Yes, but most of us are too lazy to make that determination. Instead, we function on assumptions until our assumptions are proven wrong.

In a recent article in the Washington Times,
a Nevada physician stated that insurance companies in states where assisted suicide is legal, are starting to refuse to cover expensive, life-saving treatments for his patients but have offered to help them end their lives instead.

You heard that right. Some “Health Insurance” companies now represent pro-death values:

“Brian Callister, associate professor of internal medicine at the University of Nevada, said he tried to transfer two patients to California and Oregon for procedures not performed at his hospital. Representatives from two different insurance companies denied those transfer requests by phone, he said. And in both cases, the insurance medical director said to me, ‘Brian, we’re not going to cover that procedure or the transfer, but would you consider assisted suicide?’ Dr. Callister told The Washington Times.

The phone calls took place last year within the span of a month, Dr. Callister said, adding that he did nothing to prompt the assisted suicide suggestion in either case.

‘You would think the second time, I would have been ready for it,’ the doctor said.  ‘But I was so stunned, I muttered the same stupid line: That’s not legal in Nevada yet. That’s all I could come up with.’

The allegation comes as more than a dozen states are considering legislation to legalize physician-assisted suicide, including Nevada, where Dr. Callister testified against a proposed bill on Monday.”

Is there reason to believe that dental “insurance” has parallel values conflicts?

You bet.

Caveat emptor.

Paul A Henny DDS

Thought Experiments LLC, ©2017

Read more at www.codiscovery.com

The Toxicity of PPO’s on Health-centered Dentistry

Posted on

Dentists who are contractually involved with insurance today are fully aware of the shift toward PPO style plans, which restrict patient access to dentists of choice, as well as restrict dentists under contract from referring to specialists of choice.

In and of themselves, these restrictions would be manageable if it were not for the substantial reductions in fee code compensation, where in some cases, that compensation drops from payments in the range of 82% of “reasonable and customary” rates down to 58%.

One does not need an MBA or a degree in accounting to see that a broadly experienced compensation drop of 24% devastates profitability, which then forces upon the practice changes in business structure and climate to survive.

This external force – the shift from indemnity plans to PPO plans- is affecting the dental profession more than any other trend, as it demands a ramped-up economy-of-scale approach to dental practice. In other words, it is forcing the dental profession to become industrialized, where patients become “units” and workers become day laborers.

With all of the focus on maximizing productivity and reducing costs, while maximizing profitability, the discussion of health is easily lost, with the dentist and team are reduced to being repair workers laboring under a remedial philosophy, and with patients who are often dissatisfied with both the outcome and their experience.

This trend line was noticed early by Bob Barkley in 1972 when he said, “Dental service corporations play a very critical role nationwide since they can stymie progress in prevention…Somehow service corporations acquire a marked distrust for the honesty of dentists and use this as a reason for holding back on their preventive teaching programs. One prominent dentist-executive of a large corporation declared that to pay for such teaching would be an open invitation to fraud.”

So there we have it- the core of the problem, the fact that dental insurance has everything to do with money and is only peripherally associated with health. And that the contractual relationship between the dentist and service corporation is founded on distrust. Consequently, a more dysfunctional relationship could not be designed or advanced.

Paul A Henny, DDS

Thought Experiments LLC, ©2017

Home Testimonial

“Thanks so much for your continuing efforts to promote and advance the concept of the relationship based practice.” – Jim Otten

Great Forum

What a great forum for sharing the wisdom we have been privileged to gain from those who came before us. Hearing that wisdom expressed in the language of today is so important. ~ Mary Osborne

Get Involved with the
Bob Barkley Study Club Now!

1213 Corporate Circle SW, Roanoke, VA 24018
(540) 774-1577 |

Contact Us