Dentists or patients: Who should get the insurance check?

Jan 29, 2009

Insurance companies and dentists in Indiana are clashing over legislation that could change the way dental procedures there are reimbursed.

The legislation, which is up for a vote on February 4, gives patients the option of either receiving insurance money themselves or having it sent directly to their provider.

Two bills are up for consideration: House Bill 1299 and Senate Bill 0075. The measures proposed in these bills are already in place in 22 states.

The Indiana debate started last June when Delta Dental, the largest dental insurance carrier in the state, stopped sending direct payment to out-of-network dentists. Other insurance companies have also taken similar measures.

Traditionally, the insurance check goes to the dentist, who then bills the patient for any remaining amount.

The Indiana Dental Association (IDA) feels this new policy is a way to strong-arm dentists into joining the networks. More insurers are refusing to cut checks directly to dentists who aren't members of the insurance company's preferred provider organization (PPO) -- even if that is what the patients want, according to Doug Bush, the executive director of the IDA. Instead, the checks are sent to the patients, who must then issue the payment to providers.

"They will send payment directly to the patient knowing that it will be difficult for dentists to collect it," Bush said. "It is leverage to get the dentists to join the networks."

Eventually, the move will impact both dentists and patients, he added. If dentists don't receive the payment from insurance companies, they will require patients to pay upfront. This could cause some cash-strapped patients to delay or even forgo dental treatment.

"Benefits belong to patients, and if they say it is more convenient for them that the check goes straight to their dentists, the insurance companies should honor that," Bush said.

He accused the insurance companies of unnecessarily dragging patients into the discussion.

"If a dentist does not want to sign a company's contract because it is not suited to him, the company should not use patients as leverage," Bush said. "Insurance companies and dentists can sit down and negotiate all they want, but patients should not be dragged into the process."

The new legislation is also being supported by the state medical association and other healthcare provider groups, he added.

The insurance companies feel that discontinuing direct reimbursement to out-of-network dentists can grow their networks and make dental care more affordable.

"When a dentist agrees to join the network, they agree to specific costs on procedures," said Ari Adler, the communications administrator at Delta Dental of Indiana. "That makes healthcare more affordable and ensures that patients are not overbilled."

Direct reimbursement to out-of-network dentists is a problem because it allows them to enjoy the benefits provided by the network without following cost guidelines and quality control measures of the network, he added.

"We put our dentists thorough a credentialing process and provide quality assurance," Adler said. "That means if a dentist does a filling that should last a certain amount of time and it doesn't, they have to fix it without charging the network or the patients."

The new legislation will raise healthcare costs in Indiana, Adler warned.

"Since last June our network has grown," he concluded. "We don't want to turn the clock back."