WDS is making some Kool-Aid

Dental insurance is a great resource for my patients. I believe is is an excellent supplement when patients are seeking the right dental care. But it is important to remember a few things about the limits of insurance and how it works for dental care.

First, insurance benefits are negotiated by employers for their employees. Employers decide what level of supplements they are willing to pay for. There are countless levels of spending, and as a result, employers give employees what they can.

Second, dental insurance is different than other insurances, like car insurance or life insurance. It has never intended to reimburse the full cost of dentistry. It is a supplement for basic dental care, such as hygiene visits; a couple of examinations per year, with some basic x-rays; and a filling or two per year, maybe a crown. In my experience, about half of the patients I have seen over the past decade have needs that go beyond their insurance reimbursement.

The challenge with using dental insurance, is that current reimbursement levels are similar to what they were decades ago. They haven't kept pace with the cost of living increases or inflation. Dentists, however, have to make annual changes to keep pace with economic changes. Dentists' costs don't have to go up astronomically each year, they just have to increase modestly with the market around them. But insurance companies have chosen to only offer limited amounts of reimbursement. So the value of an insurance dollar has decreased.

Washington Dental Service, the largest dental carrier in the state, has created a sticky situation recently. They have decided that not only are they going to freeze the levels of reimbursements to participating dentists, they also are decreasing the allowable fees that dentists can charge to the patients. You would think this is a great solution for patients. But it's creating the opposite effect.

I wanted to share a letter with you from Washington Dental Service (WDS) that is being issued to employees who receive dental policies from their employers. WDS says it's aligning costs in Washington to get closer to the national average for dental fees, and that is supposed to aid patients in getting care for less.

WDS Letter to Brokers And Employers

Let's be clear. Washington state's cost of living is greater in virtually all aspects compared to the rest of the country. The big question is whether Washington residents, business owners, and dentists can find out-of-state solutions to any of their business activities. That doesn't appear to be realistic, because small businesses like dentistry rely on local economies to support much of what they do.

I'll summarize what this fee reduction means to you as a patient:
1) Dentists have continually rising costs to do your dentistry. Periodically, dentists typically assess what business strategies they can change to keep their costs from increasing dramatically. Hiring fewer employees, using cheaper materials, working more hours, etc. Whatever the case, they have to balance how they do business with the quality of work they want to do for patients, and what they want to charge patients to do it. WDS has decided that they need to determine what the price of dentistry should be for dentists.
2) WDS-participating dentists are going to suffer an average of 15% reduction in what dentists can charge for helping you. This is simply going to put some dentists in Washington out of work. 15% reduction in revenues means a 150% increase in business has to occur to break even. That is literally impossible.
3) Your amount of benefits do not change. In fact, they may not change for a long time. Your insurance dollar is already behind the curve by many, many years of economic growth and change. You will get less dentistry for WDS dollars as time goes on.
4)You will see costs rise for dental visits as dentists decide to drop a WDS relationship. Some patients won't be able to afford the changes. And that will hurt patients who really need help.

I hope WDS realizes this is a catastrophic mistake. But until then, it appears that the company wants to spin these changes as positive, and send policyholders letters that make it seem as if the kool-aid is worth drinking.

Send your comments and questions to me via chris@cascadiadentistry.com