Preferred provider : prefer not!

Dr Michael Sernik, January 2003 - Dentists around the country are receiving letters from some dental insurance companies telling them that they are to be removed from the list of 'preferred provider'. This is because these dentists are costing the insurance company too much money. Some of these dentists have 80% of their patients insured with that insurance company.

Bad news travels fast and now the remaining dentists are becoming increasingly reluctant to offer optimum dentistry. They are forced to under-chart, under¬ diagnose and under-treat their patients or face excommunication. The 'ideal dentist' for some dental insurance companies, is the dentist who practices minimalist patchwork dentistry. And the ideal insurance company patient either has perfect teeth, no teeth or never goes to the dentist. If they continue to follow this line, dentists, patients and suppliers will be the big losers as these flow-on effects travel through the food chain.

As Dental Practice Management consultants, we have been asked by a number of dentists for advice. Our suggestion was to talk to every single patient that comes into your surgery about this issue.

Here are some ideas and sound bites you could use:

• These funds are not part of a government organisation like Medicare. They are private companies and they have a simple agenda: to make profit.
• Their ideal customer is one who pays their premiums regularly and claims as little as possible.
• Insurance is great for avoiding catastrophes such as life insurance and fire insurance. But insurance for dentistry doesn’t work well for the insurer if there are regular claims. There is no way the insurance company can routinely pay out more than it receives. Its simple. The patient has to lose. The insurance company has to limit its payouts and restrict its dentists from providing high-end dentistry to its clients. Just like a casino has to win because it sets the rules.
• Patients need to be forewarned that they may receive a letter telling them to go to a different Dentist. This only happens if the insurance company wants the claims to be reduced. This is the same as having insurance clerk telling you what dental treatment is best for your health. (It’s a lot easier to pre-empt this problem than try and explain it to patients after the fact).
• Patients should be told to consider the concept of self-insurance. That is, seeing the dentist regularly for Preventive maintenance.

Initial response from patients has been very favourable to our suggested approach.

Be very careful not to slander or liable any company. I’m sure some of them have only the patient’s interest at heart. Dentists should remember that their relationship with their patients has to be made strong so that the patients will continue to frequent the dentist even if the relationship between the dentist and the insurance company breaks.

An entire industry has arisen in the US based on teaching dentists how to wean their patients away from private dental insurance. It keeps the practice managers there very busy, but we in Australia should all avoid that route at all costs.

Why the most successful dentists need practice management consultants and the struggling Dentists don’t need any help.

It’s an interesting thought and it seems to apply to all industries. I think anyone in the world of corporate training will agree that the biggest most successful companies use a hugely disproportionate number of outside trainers and consultants. It seems that the more you know, the more you want and need to know. This notion mirrors the observation you hear from experts in any particular field that the deeper you get into any topic, the more fascinating it gets…. a larger world opening up.

At Prime, we do a large number of talks around Australasia and at the end of each talk the same scenario repeats itself. The Dentists with the most stress always have the lowest earnings, their patients will not accept anything other than patchwork palliative dentistry and they are far too busy to think about making any changes. They also tend to be the most adamant in defending their philosophies.
Conversely, we have a number of clients who have magnificent practices, do showcase dentistry, seem to be far less stressed and yet are always open and eager to improve.
The greatest motivators are the testimonials of others. If a dentist can hear from another unbiased dentist what practice management has achieved for them, it can be a compelling reason to look further. If you are contemplating joining a programme, make sure you first talk to others who have done that course.

[Published Australasian Dental Practice, Yearbook 2003]