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11/25/2013

Wrapping up a bumpy year for dental benefits for 2013

By Ann Milar, CDA Dental Benefits Analyst

The holidays are quickly approaching and I’m hopeful that as we take a look back at 2013 and forecast what may be ahead for 2014 in the dental benefits world, you will appreciate the gift of knowledge and information. The good news is that this is one gift that isn’t returnable.

I would characterize 2013 as a bit of a roller coaster ride for dentistry. There have been many ups and downs, turns and twists relative to Delta Dental of California, Denti-Cal, the Affordable Care Act, reimbursement issues, network challenges, etc.

I wish I could say that we could jump off this bumpy ride and glide gracefully into 2014, but that will be unlikely.

The fact is that dentistry is in a state of flux, the profession is being challenged at many levels and the world of dental benefits is changing as well. Many dentists who have practiced this profession for a while can attest to the evolution that has made the practice of dentistry increasingly challenging.

The good news is that people will always need dentists in order to maintain their overall health, and that won’t change. In fact, a recent ADA report indicates that the aging baby boomer population is less likely to have dental benefit coverage as seniors. They are more likely to pay out-of-pocket for dental care and generally have the highest dental expenditures of any age group.

Another piece of good news is that there are an estimated 14 million adults and children who will gain comprehensive dental benefits by 2018 through the Affordable Care Act, either through the state or federally run exchanges or Medicaid. We know that those with dental coverage are more likely to seek dental treatment. While we are anticipating an upswing in adults covered, industry experts state that they aren’t expecting a huge increase in adult utilization over the next few years. Hopefully this multi-million growth of covered adults and children will escalate the percentage of the American population with dental coverage over its current high of 60 percent, good news for the profession as a whole.

While the profession will see an increase in the number of consumers who have dental benefits, the benefit plan types will continue to evolve. The trend toward purchasing dental Preferred Provider Organization (PPO) products continues in California and nationally, in addition to the shift of benefit costs from the employer to the employee.

The state of California, a long-time purchaser of Delta Dental of California’s Premier product, is changing the names of the plans it offers state employees from Delta Dental Premier Basic plan to Delta Dental PPO Plus Premier plan, potentially shifting more benefit cost to its employees and providing access to Delta’s Premier and PPO networks. Washington Dental Service (Delta Dental of Washington) recently sent out an announcement to providers of T-Mobile employees announcing its move to a Delta PPO product stating that no dental benefits will be payable if the patient/employee seeks treatment from a non-PPO provider, essentially creating an Exclusive Provider Organization (EPO).

These are just a few examples of what’s happening in the dental benefits marketplace.

The issue of stagnant or declining reimbursement levels to providers remains a high concern amongst CDA members, in fact this was the number one dental benefits issue conveyed to the Practice Support Center in 2013. Most CDA members report they have only been able to increase their contracted fees with dental plans by 1 to 2 percent, while PPO contracted dentists are starting to receive notices from plans stating that fees will remain unchanged, or decrease for 2014. While I don’t want to be characterized as a Scrooge, these are the unfortunate realities of the dental benefits world.

Peace of mind is a gift in and of itself, and one way to achieve it is to take advantage of the extensive opportunities to educate yourself, your staff and your patients about the benefits of dentistry and how they can best utilize their dental benefit plans to enhance their health. Take advantage of the dental benefit educational opportunities offered by your component and CDA. Dedicate some of your practice “downtime” during the holiday season to prepare for 2014 by revisiting the dental benefit resources available on the CDA website so that you’re prepared to weather what may be rocky times ahead.

One of the free CDA member resources available is the Dental Benefit Plan Handbook. It offers the basics on dealing with dental benefit plans, the implications of various plan designs and scripting to aid with dental benefit patient education. Role-play some of the frequent discussions you and your staff have with patients regarding dental benefits to increase the comfort level with having these conversations.

Dental benefits incentivize patients to seek dental care and maintain their health, eventually impacting the bottom line of your practice. Investing your time and energy to expand your understanding will be time well spent and could relieve some dental plan headaches down the road.