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09/17/2013

What new dentists need to know about dental benefit plans


As a new crop of licensed dentists take the next steps in their dental careers this fall, there will be host of new experiences ahead, including dealing firsthand with dental benefit plans. 

In order to gain a better understanding of what new dentists need to know about dental benefit plan issues, CDA reached out to three dentists who have a less than five years of experience. Each dentist operates in different models of practice and offered what they’ve learned about dental benefits and what they feel their colleagues should know as they begin their professional careers.

Tina Beck, DDS, MS, a periodontist, associated with two other dental practices prior to starting her own practice in early 2012. In her associate dentist role with a dental practice that was contracted with many plans, she learned the hard reality of dental provider agreements when she saw the negotiated reimbursement for some of the lengthy and complex procedures she performed. 

“I quickly learned that I would need to increase production in order to maintain a viable practice,” Beck said.

As a result of her associate experience, when she went into private practice, she opted to only contract with those plans that honor her practice’s usual and customary fees.

Jon Pascarella, DDS, a general dentist, also associated before buying his first practice in 2009. Based on the limited exposure to dental benefit plans during dental school, he assumed all dental plans were similar in terms of what was paid for patient treatment. 

“My assumption was wrong and there were great differences in patient dental benefits and how plans administer benefits,” Pascarella said.

Vaheed Shahnam, DMD, also a general dentist, works in a corporate-owned dental practice. Despite the fact that he doesn’t have to manage the billing and receivables in the office, he has had to learn more of the nuances of the various dental plan types of the patients he treats. As an employee, he noted that it is difficult to evaluate the profitability of the various plans since he has so little control over the business side of the practice.

“I’ve learned that some plans can take months to pay on a claim and what I can do in terms of narratives and documentation to expedite the claims payment process,” Shahnam said.

All three dentists agree that contracting with a large number of dental plans will not guarantee a new dentist an instant referral source for driving patients into the practice. Beck notes that dentists should, “look at what you need to get paid for procedures in order to build or sustain your practice. Then take your 20 most commonly performed procedures and compare them against the proposed plan fee schedule to see how close the numbers are and if you can make your numbers.”

All three dentists concur that educating patients regarding their dental benefits is another critical element to thriving practices despite inconsistent payments from dental plans.

“Most patients do not understand what is or isn’t covered under their own plan,” Shahnam said. “Many patients equate their dental benefits to medical insurance and they are surprised to learn that dental coverage is very different and their out-of-pocket expense may be higher.”

Pascarella notes that training staff to handle patient calls and questions about their dental benefits is also essential. 

“Preparing patients for the fact that their plan may not pay for various types of treatment is crucial since it impacts the patients’ expectations,” Pascarella said. “Many times, dental offices will underestimate the amount the plan will cover so that the patient is pleased in those instances when the plan does pay more for treatment.” 

Both Beck and Pascarella also said that it is important for dentists to look at their demographics of their practice area and find which dental plans employers are offering their employees and then research the reimbursement rates before contracting with the plan.

Trial and error is one way these dentists have learned to navigate the bumpy road of dental benefits.

Verifying benefits for patients isn’t enough to ensure payment, there are always plan processing guidelines that dentists need to ask about (e.g. treatment provided on adjacent teeth on the same day).

“Keeping notes on the more obscure plan payment limitations, and developing an internal system of checks and balances to improve our accuracy when providing treatment estimates, has been helpful in our office,” Beck said.

The final element that is critical for all new dentists is confidence, both in their skills and their ability to provide services valued by their patients. Beck noted that many new dentists are compelled to accept positions that may be less than ideal in order to begin earning a living, but she says that shouldn’t prohibit one from learning what they can about the business of dentistry and how to work with dental plans before moving on if so desired.

Beck offers one final piece of advice to new dentists: “Don’t sell yourself short with your patients or the dental plans.”

For more Dental Benefits resources, visit cda.org/dentalbenefits.