The Saga of Erik the Red, written in the 13th century, depicts a story of Old Norse Vikings exploring the land we now call North America. History tells us that Vikings were one of the fiercest cultures to exist with their presence creating a lasting impact between the 8th and 11th centuries.1 With celebrated stories of Odin, Freda, Thor, and many other characters that entertain us through Marvel and Disney productions, Vikings have a place in recent history that the world both loves and respects.
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When Viking explorers made their way to the Americas around 1000 AD, they were soon met by a community of local inhabitants, the Native Americans. The Viking conquerors, dressed for battle with their iron armor, shields, steel spears and axes, were driven out of the entire hemisphere by Native Americans wielding weaponry made of wood, stone, and animal parts. Vikings originally referred to Native Americans as “Skraeling” or “weakling,” not knowing the resilient and rich battle and tribal culture of the American Indians. As documented in The Saga of Erik the Red, the Vikings “realized that even though this was good land, their lives here would always be dominated by battle and fear.”1 That, my friends, I believe to be the highest compliment Vikings can pay you.
While we mostly share the same national history and culture with our foes in the insurance industry, the truth is, they are winning the battle when it comes to the financial component of dentistry. We’ve collectively given insurance companies more power than we realize. One of those powers is the ability to control what dentists get paid and what insurance benefits are available to subscribers. I firmly believe that dentists were swindled by the insurance industry, being told that in-network participation is a “partnership.” Yet, such partnership has proven to be a unilateral type of contract where dentists and patients have little to no say when it comes to fees and benefits. At least that’s what history and current interactions with insurance companies tell us.
If there’s anything I know about dentists, they are not stupid. They are certainly not weaklings, despite what insurance executives might believe. Dentists are not narrow-minded or without direction. No, they are strong, driven, passionate, and willing to fight an enemy that is trying to eliminate their ability to deliver quality care. Despite all the issues that dentists face when dealing with insurance companies on patients’ behalf, dentists are proving that insurance is a bully they can defeat. Here are ways dentists are fighting insurance in today’s climate of insurance administration:
Terminating insurance
It is no secret; doctors are dropping dental insurance in large numbers and in large part due to the lack of fee increases. As a response to this mass exodus, insurance companies are begging dentists to retain their in-network agreements and have even implemented fee increases with dentists who have retained in-network status. For many years, I’ve maintained the belief that insurance carriers need dentists more than dentists need insurance carriers. The positive changes that many insurance plans have implanted to retain participating doctors is evidence of this. I would argue that those changes are still not enough to address the postpandemic financial concerns and struggles that many dentists are still experiencing.
Arguably, the response by the insurance industry has been weak, unimpressive, and certainly an insult to dentistry considering that most insurance plans have not increased their reimbursements to keep up with inflation. As a result, the reaction of thousands of dentists is to drop their insurance contracts in protest of the lack of positive change by the insurance industry. This type of protest is not exclusive to just one dental plan, as the current trend in dentistry is showing that all insurance carriers are suffering a loss of in-network providers. As this trend continues, you will see more changes in both benefits and reimbursements in favor of those who have insurance, and those who provide clinical benefits to the insured.
Negotiating fees
Over the last 15 years, the number of doctors who have engaged in some form of fee negotiations with insurance companies has risen to record levels. From the date I’ve been able to verify, nearly 32% of all in-network dentists negotiate their fees with insurance every 2 to 5 years. Among those dentists, 95% have engaged in dropping an insurance plan that refuses to negotiate. Interestingly, during the process of terminating an in-network contract, 90% of the time insurance companies attempt to negotiate fees in an effort to retain doctors under an in-network contract. The average fee increase proposed by insurance is between 5%–16% where such increases are still 30%–40% below usual fees for those doctors.2 The result is that many doctors continue with contract termination unless insurance plans provide more sustainable fee increases.
According to Rick Wilford, CPA, the average patient retention among dentists who go out of network with a major insurance carrier is 81%.3 Such figures have emboldened dentists to negotiate with insurance with out-of-network terms in mind. Meaning, if insurance doesn’t accommodate with acceptable fee increases, out-of-network is where those doctors end up. In short, dentists are fed up with letting insurance companies dictate final terms of negotiations to the point that insurance plans are increasingly fearful of dentists going out-of-network. Current trends indicate that due to the fear of losing more providers, insurance plans are relaxing their traditional standards by negotiating fees at levels the industry has never seen (20%–70% above traditional rates).2
Appealing denied claims
Tessina Bullock, president of Verus Dental, is known for her ability to get her local insurance commissioner to fight denied claims on behalf of insured patients.4 Through her teachings and practices, we’ve learned that insurance companies tend to think twice when the government gets involved in fighting back against unethical and illegal claims-processing practices. The rate of denied claims and payment delay tactics declines when the government warns insurance companies not to mess with dentists and their patients.
While many insurance companies will continue to find ways to avoid payment, pay less than your dentistry is worth, or even block or reduce available benefits, there will always be strategies to appeal and fight insurance that will benefit you and your patients. As we learn from The Saga of Erik the Red, no opponent is too fierce to be defeated by an underdog. Stay tuned for more reporting on proven insurance administrative strategies that will allow you to fight insurance and win!
Editor’s note: This article appeared in the December 2023 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.
References
1. The Saga of Erik the Red. https://sagadb.org/eiriks_saga_rauda.en
2. Unpublished research performed by Veritas Dental Resources among 4,000 dental offices.
3. The Business of Dentistry: Using Your Dental Practice Data to Increase Revenue. Eide Bailly. October 11, 2022. https://www.youtube.com/watch?v=JhlJ6iXfHHk
4. Tuinei B. Policing illegal or unethical insurance practices. Dental Economics. February 8, 2017. https://www.dentaleconomics.com/16389678
Ben Tuinei, president of Veritas Dental Resources, works to help dentists improve insurance reimbursements. He has been recognized by several state dental associations and continuing education institutions as “the authority” on PPO strategies and fee negotiating. He has worked with 6,000-plus dentists and influenced more than $3 billion in negotiated revenue for his clients. To learn more, visit veritasdentalresources.com.
