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For Your Wellbeing and Benefit

May 21, 2012

Why we don’t participate in Network Insurance plans Many employers and insurance plans are directing, and even driving, those with traditional insurance into they consider their more ‘cost effective’ network plans.

On paper and first appearances, these plans and offerings may even look more cost effective to you the consumer and end user. What a paper contract can’t show you is the quality of service you receive or actually don’t receive for your insurance premium dollars. Dentistry and all health care is a service, not a product that can be massed produced or manufactured under a variety of circumstances. Dentistry in particular is a service that requires a high level of skill, knowledge, and experience in addition to varied pieces of equipment and technology. Along with all these items, the most important requirement is a genuine care for the patient’s well being and pride in their work.

When an insurance company, whose sole purpose to exist is for monetary profit, devises a better way to do business, it simply means they have found a better way for the insurance company to profit. Regardless of what is said or implied about “cost containment, service utilization, etc…” the bottom line remains their interest in their profits. To do this they have to charge you more premium dollars, which they readily do almost yearly, and pay the providers (hospitals and doctors) less.

The Network dental plans have been the latest venture in ‘cost containment’ for the insurance carriers in which dentists and more frequently franchise clinics are contracted to provide a service(cleaning, filling, extraction, etc.) for a specified fee. The fee is always reduced from what the dentist would normally need to charge. In exchange for this consideration of a reduced fee, the dentist or doctor is placed on a ‘network list’ of which employers will encourage to send their employees. The intention is to transfer a ‘production model’ where mass production drives down the per unit cost and apply this to healthcare and dentistry! The insurance companies focused on profit think this model works but patients and doctors have found the hard way that patients needs and well being don’t have much in common with widgets.

The reality has become unsettling at best, if not even detrimental. Corporate owned Dental clinics with production oriented staff and inexperienced doctors have become the norm, but the patient satisfaction and quality of care has suffered. Young doctors aren’t being given the chance to develop a doctor-patient relationship, but are placed in an environment that is monetary based and production driven despite the patient’s best interest or needs. Not only does the patient’s care and ultimately health suffer, but the profession is becoming indifferent to being truly able to deliver quality healthcare and pushed always closer to a clock punching mentality.

Whether we like to admit it or not, Doctors are susceptible to human error as are patients. When the pride and value in our workmanship and knowledge becomes minimized and the inability to establish a caring relationship with our patients is overrun by contractual obligations to produce ‘x’ goods in ‘y’ amount of time, the susceptibility to err will certainly rise.

To be sure, doctors, nurse, and hospitals must profit to maintain and ensure their future. What network and many traditional insurance plans don’t allow for is the check and balance, and reward system, of an unencumbered doctor/patient relationship. Healthcare has become so subconsciously, but intentionally, driven by insurance benefits, that if insurance plans deny or exclude a procedure it is perceived, and even communicated by some unscrupulous carriers, that it isn’t really needed by those whom insurance is suppose to be providing benefits in the first place. The profitable alternative, for an insurance company, will always be to deny and discourage rather than to actually provide a benefit. Think about it. Is a clerk, or medical evaluator, on the other end of a phone line, possibly a thousand miles away, have the patients best interest at heart, let alone the ability to truly assess their needs, or have they been straddled with a ‘bottom line’ by the same widget driven industry?

Dr. Reese on Insurance Plans

Dr. Reese on Insurance Plans

My intention and our allegiance rests with our patients. We understand that insurance benefits are a tangible work related compensation that must be utilized when available. The network plans that we have been approached with, do not have you the patients, best interest at heart, nor do they allow us to provide the quality of care and service to our patients that we desire. Dentistry more than any other healthcare doesn’t lend itself to ‘healing, and restoration’ amidst an environment of hurry and shortcuts. Dentistry, and restorations done poorly and hurriedly do often hurt, and won’t last as long as they could, or even jeopardize sound teeth.

For your better wellbeing and benefit,

Ted M. Reese, DDS