Dentists Oppose Dental Insurance Fee Setting

Post comments on dental insurance fee capping to our blog.

98% of dentists oppose dental insurance fee cappingFully 98% of dentists think it’s inappropriate for
dental insurance companies to try to set fees for services they do not cover.

We asked dentists, "What do you think of dental insurance companies setting fees for non covered services?"

  • 2% say it’s a legitimate business move.
  • 98% say it’s totally inappropriate.

Read more about about how the difference between dental insurance plans and discount dental health plans
may be eroding: 28 States Considering Legislation on Dental Insurance Fee Capping

Here are a few comments from dentists on dental insurance companies setting fees.

This should not be legal

  • “Our State Legislature has wisely forbidden such practice.” (General dentist)
  • “Fee capping should be illegal, especially since the insurance company fees have not kept up with the standard of living cost increases.” (California dentist)
  • “It's probably illegal.” (California periodontist)
  • “I believe it is restraint of trade.” (Pennsylvania dental hygienist)
  • “Not only is it inappropriate, it should be illegal. If they are not going to cover it, they have no say.” (California dentist)

Why does insurance get to set fees in the first place?

  • “It’s inappropriate for insurance companies to set ANY fees. Their choices are who to insure, and what levels to reimburse at.” (Michigan dentist)
  • “They have no business telling us what to charge in the first place. Who are they to determine fees of services they don’t even cover!?! If they want that luxury, they should start covering more procedures!” (Illinois dentist)
  • “They shouldn’t dictate anything related to care or fees. They should just pay up to the maximum and get out of our way.” (Minnesota dentist)

Dentistry has gone downhill

  • “Dental Practice was FAR better prior to Dental Insurance. Patients budgeted for treatment, and proceeded with necessary Dentistry. Today,
    they believe the insurance processor instead of the treating doctor for their dental needs. If the insurance does not allow it, in their minds, it must not be needed!” (Illinois dentist)
  • “Free enterprise?!? Not if insurance has it their way. If I wasn’t ten years from retirement, I would change careers!” (Pennsylvania dentist)
  • “It should not be allowed at all. The insurance companies already have resulted in a decreased quality of patient care enough.” (New Jersey dentist)

It makes business sense for the insurance companies

  • “I don’t like it, but the contractually lower fees is something of value that the customers of the insurance company are paying for with their premiums.” (Oregon dentist)
  • “I hate it, but for their business, it likely is a good maneuver. We must remember that they don’t give a rip about the dentist or dental care. They want contracts and bodies.” (General dentist)

Delta Dental is all about it

  • “As a former Delta PA board member, they simply want to be more competitive selling their product but at the dentists expense. Since we the dentists are participating, they feel we should share the burden just for the privilege to be included on their panels. My feeling has always been if the 3rd party carrier is unwilling to pay, then we have the right to charge our normal fees. In fact there are fees they do cover, but pay so low that it's not
    financially possible to really do the procedure. But it looks good on paper to the companies they sell their business to. Lastly, our committee that argued against setting fees for non covered services, was threatened for legal action if we continued to cause this to be an issue, and regardless, national Delta was going to institute this policy.” (Pennsylvania oral surgeon)

It's not the insurance company's place

  • “If they are not covering the procedure, I don’t see why they should set up the fee." (Indiana dentist)
  • “If they are not going to cover the procedure, and they don't have a qualified and knowledgeable dental administrator involved, they should not be setting fees. Also, the road to having fee allowances raised should, at the very least, be tied to inflation, as it affects the cost of providing dental care. The pressure to raise fee allowances should not involve the process of losing providers to a certain level before allowing the increase.” (General dentist)
  • “If they want to have a say in the fees, then provide coverage for the service." (Connecticut prosthodontist)
  • “‘Not a covered procedure’ should mean ‘this procedure is not in the contract,’ and that should mean the dentist is not contractually obligated to alter his UCR fee.” (Illinois dentist)

Dentists need to make a living

  • “If you are not going to pay, then cough it up and let us dentists eat once in a while!" (Florida dentist)
  • “It’s crippling dentists.” (Texas dentist)
  • “It’s bad enough they are behind the learning curve with the ‘state of the art’ in dentistry.” (California dentist)
  • “If insurance wants to set a fee schedule, fine, but only for what they want to cover – not non-covered procedures. They also shouldn’t be allowed to have policies that dentist can’t balance bill the patient. Things are tough enough out here as they are.” (Texas dentist)

Insurance companies benefit only themselves

  • “The best definition I have heard for an insurance company is a bank that does not give you your money back.” (General dentist)
  • “They are only feathering their own nests by being able to offer a lower fee for non-covered services for which they do not collect a premium thereby making the insurance plan more attractive to purchasers. A participating DDS is then obligated to charge a lower fee thereby enhancing the insurer's chance of selling their plan. If that is the case then a DDS should get a portion of the premium collected for unwittingly helping the insurance company." (Orthodontist)
  • “Insurance companies are in the business to make money, not to provide healthcare. They only do this by limiting their payout and restricting
    legitimate services. Direct reimbursement would offer the patient a better option as well as let them decide where/ how to spend their healthcare dollars." (Washington dentist)
  • “It’s basically cost-shifting, and patients without dental insurance end up carrying the burden.” (Massachusetts dentist)

Stay away from insurance companies

  • “I am so glad I stuck to my guns and never became part of PPO’s or other insurance plans.” (New York dentist)
  • “Buzzards.” (General dentist)
  • “It has always seemed to me to outside of their purview as I am not participating in their provider network. I don’t tell them that the insurance companies CEO’s make too much (that is their stockholders decision), that their premiums are inappropriate or that their view of what should be covered is consistent with accepted dental practices (why do some insurance plans cover ortho or implant treatment, while other policies they issue do not.) I think that it is inexcusable that we are the ones that have to justify our fees to patients when it is the insurance companies that fail to update coverage levels and they never explain their choice of fees (percentile of an arbitrary baseline fees) or of percentages (some endo and perio is major while for most it is part of basic coverage.)” (New York prosthodontist))

Dentists must unite

  • “It can only happen if we don’t stand together against this. Unfortunately, there are too many among us that elect short-sided greed for long-term prosperity and freedom.” (Oregon orthodontist)
  • “It is a power grab by insurance companies. Participating dentists have caved in to pressure by the companies."

Insurance companies are (too) powerful

  • “It looks like they have a bigger lobby than us to get their way!” (Arizona dentist)/li>
  • “They need to butt out of our business. They have way too much power." (Texas dentist)

Double standard as to "price fixing"

  • “We aren’t supposed to compare our fees to other dentists, which they call price fixing. If insurance companies cover the services and we are providers for that insurance, then it is appropriate for them to ask what the fees are. If they do not cover the services then they do not have a right to know the fees we charge for the non-covered items.” (Arizona dentist)

Connections to national health care reform?

  • “This, along with the reform of health care is one more step down the road to socialized medicine.” (General dentist)
  • “If they don’t pay anyway, what business is it of theirs? They are trying to control all the fees at a level that they approve. Just like the govt. when they control health care.” (Oregon dentist)

Why does the insurance industry get special treatment?

  • “Its completely inappropriate. How would the insurance companies respond to a ‘patient watchdog group’ contacting their clients to inform the patients that the premiums that the insurance companies charged were out of line and inferring that the insurance companies were just being greedy and ripping them off. The insurance industry would not stand for that for a minute, they would react strongly and use every means possible to eliminate the group responsible for presenting them in a bad light. For a long time, the insurance industry has had special ‘rights’ that would be considered illegal for anyone else, including the right of price fixing. If a dentist were to call a colleague to ask how much he charged for a particular procedure, the insurance companies would be first in line to have the dentist brought up on charges of price fixing. Insurance companies consult with each other every day to price fix! Their lobby group has made sure that our legislators have exempted them from the restrictions they so zealously keep tabs on for everyone else. It is a
    frustrating situation.” (Illinois dentist)


Note: Survey sample included 128 respondents. Posted 7/7/2010

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