There's A Storm On The Horizon For Patients, Thanks To Insurance Carriers

A few months ago, the largest dental insurance provider in Washington, Washington Dental Service, sent me a foreboding letter. The company announced that it would soon be reducing reimbursements to participating dentists, like me, who care for patients that carry Washington Dental Service (WDS) insurance plans.

People who are aware of this upcoming WDS change may think that change is a benefit to patients everywhere. Some may believe insurance companies like WDS with buying power and large numbers of insured may be capable of controlling rising costs in the dental care market, and that must mean patient spending might be reduced. And some may feel that access to dental care could be easier to come by for would-be patients in need. I wish that were the case. On the contrary, it is detrimental to everyone in the dental care system: patients, dentists, and insurance carriers.

As a dentist who started a practice from scratch, I have grown my business of health care over the past 12 years. I have fostered some amazing relationships with many patients, and love this career because I can help people become healthier and improve their quality of life. Every year, my costs to support patients go up. And every year, my patients count on me to maximize their insurance contributions for their care.

I've been happy to do what I can in recognizing the importance of their insurance assistance. I have felt a connection with their insurance carriers has been an important facet of the doctor-patient relationship. I signed a contract to become a partner with WDS promising to offer dentistry at a specific cost to patients who have that insurance plan. This is a very popular insurance plan in the state, and it has been estimated WDS supports over 4 million insured in Washington.

Over the past several years, I have changed my business strategy so I could offer the best possible quality dental care and the best customer service in my area, even in the face of increasing limitations and restrictions insurers have made. WDS reimbursements for the dental care I provide have continually decreased relative to the cost of doing business. My expenses are not decreasing at the same rate, so my ability to provide the same excellent care is becoming harder to provide to the WDS patients and their families I love to treat.

In January, I received the aforementioned letter, which contained a shocking plan to significantly reduce reimbursements to member dentists, in some cases up to 15% for some dental treatments. In addition, WDS decided that there would be no increase in reimbursements in the foreseeable future. I have talked with dozens of dentists, and read comments from countless others, and the discussions are all the same; WDS has done something that has made Washington dentists unhappy about the future of patient care. And that includes me.

So it is obviously going to hit me hard as a dental practice owner. I care most about how it will affect the level of care I provide to my patients. But it's not just about the consequences my business and my career will suffer. This change is going to affect patients and dental insurers, notably WDS. I can't possibly cover the entire scope of the fallout this WDS decision is creating now and in the future, so I will pass on articles, stories, and broadcasts that relate to this situation as they become available. Here is are two news stories that broke recently.

http://www.seattlepi.com/local/article/WA-s-largest-dental-insurer-to-cut-reimbursements-1351909.php

http://www.king5.com/home/States-largest-dental-insurance-provider-cutting-reimbursements-120656054.html

At this point, I have to decide whether or not to pass the WDS limitations and restrictions on to my patients in certain ways. In the past, I didn't have to bill my patients for certain things associated with dental care. For example, I didn't consider charging patients for local anesthesia to have a crown or a filling done. I didn't consider charging to adjust a restoration after it was placed in or on a tooth. I didn't consider charging additional costs for medications I routinely use to treat periodontal disease. These things were included in the basic cost of the treatments. Now that WDS has significantly reduced the reimbursements for everyday fillings, crowns, and gum infection procedures, I can't make up enough of the costs in other ways within my business. What were once "bundled" services could be "unbundled"services at additional fees. These services are not typically covered by WDS or other insurers. This results in greater out-of-pocket expenses for patients.

These options are not being considered to increase profits; rather, they are measures to preserve our ability to deliver the same great care to patients. I want to let you know that I am not the only dentist who is considering these options. There are hundreds of Washington dentists who are being affected by this. And that translates into thousands of patients who may suffer this fallout.

WDS has continued to spin these changes to its member dentists as "competitively priced" insurance options for Washington companies searching for reduced-cost insurance plans for their employee benefit packages. But these changes are almost certainly going to be passed on to the patients, and patient spending will increase. Patient access to care will be restricted more and more. Because the cost of providing dental care isn't going down for any dentist who wants to do right by patients with WDS dental insurance.

WDS and other insurers are looking to cut THEIR costs, not patient costs. I believe patients will start to complain to their HR reps and employers, and search for different insurance options.

If dentists decide to break their contracts with WDS, and patients have insurance plans that require treatment by WDS contracted dentists in order to receive reimbursement for dentistry, patient access to care will be restricted further. Fewer available dentists will result in more patients waiting for solutions to their infections, pain, and inability to function. Without a certain level of participation by dentists and employers, carriers like WDS will succumb to losses and not be capable of offering insurance products.

Patients will have fewer options for support and reimbursement. And that possibility, created by insurance companies like WDS, makes me sad and embarrassed as a dentist, as a patient, and as a business owner.

I want you all to remember that you have a voice in this matter. Talk with your employers and HR representatives. Call Washington Dental Service. Let any and all know that these changes are not creating excellence in dental care.

I am committed to giving you my very best as a dentist. I'll keep you posted about our efforts on this issue. Please send questions or comments to chris@cascadiadentistry.com.