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A look at the drivers for curbing rising dental costs

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Dave Patriarche:

Great Article. I think that dental fraud is MUCH more prevalent than people think. Waiving the dental plans co-payment is fraud, but is VERY commonplace and seldom reported. The Canadian Dental Association even includes this on their site… https://www.cda-adc.ca/en/oral_health/talk/copayment.asp

Tuesday, November 06 at 12:29 pm | Reply

Joe Nunes:

—-Mike Guest, president of benefits consulting firm Guest Consulting, says instead of these guides being determined by the dental associations, insurers should step in and work together to set the guides. “Don’t ask dentists what to pay for services. Tell them,” he says. “Insurance carriers could be setting the reimbursement fees for the services.”

This is some good thinking. I don’t begrudge dentists making a good living but the simple reality is that if the dentists set the fee guides it is very close to collusion and we don’t have an active market for dental services. Accountants, lawyers and actuaries all earn less (relatively) than earlier generations because of the fee pressure of the ‘open market.’ Dentists shouldn’t be insulated from this competition.

Friday, November 09 at 9:16 am | Reply

Gordon Simle:

The fee guide process has set full recovery for the dentists and everyone thinks as long as they charge the fee guide it is good. But the cost of doing a filling on the side of a tooth being broken down into 1, 2, 3 or 4 surface fillings is a very simple procedure that is costing plans an exorbitant fee. It is not just high cost procedures causing cost increases or utilization it is the fantastic increase in costs for straight forward procedures that make the bulk of the costs – roughly 80-85% from these areas. Joe is right – there is no competitive pressure to be put on these costs, we just go along with the fee guide. He is right that virtually every other professional has seen significant pressure to reduce costs – but the fee guides just keep going up to full recovery and then insurers add to that with inflation and utilization again – supposedly what went into setting the fee guide too. The guide is supposed to be the maximum cost and there was to be competition below that but now it is the standard cost and all the shopping in the world won’t bring down your costs much. Dental capitation or preferred networks have been tried before and most people will not change dentists which also makes consumerism difficult too. The idea of the dentists and the insurance industry working together to at least not duplicate cost increase drivers and a look just what the cost of a filling, x-ray, and most basic services should be is the only way to effectively bring control to the dental costs. Setting a floor and a maximum that the client can see would be the best way to bring in consumerism as well. I would have loved to work in the environment where I set a fee for my work and nobody questioned it as I rose it each year to cover everything I wished for in it. Being a dentist is the only place that happens with no payor looking for the most part.

Tuesday, February 19 at 2:49 pm | Reply

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