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Reality Bites
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Business New Haven
10/19/1998
By: Fiona Phelan
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For businesses, managed-care dental plans might be something new, but to dentists it's a concept that has been around for a long time.
“Dental 'insurance' is a misnomer,” said West Haven dentist Sheldon Natkin, D.D.S. “Dental 'assistance' program might be a better term. Dental insurance already has many aspects of managed care with co-payments, maximum benefit levels and prescribed levels of payment to the dentist.”
What the insurance industry needs according to Natkin, a member of the board of directors for the Connecticut State Dental Association and past chairman of the Dental Care Council, is to become more innovative, increase the maximum level for benefits and be more responsive to the needs of patients.
Insurance companies are trying to meet the needs of patients by offering a variety of dental care programs. The relatively low premiums for these programs make it easy for a patient to buy into a program when they
need it.
“Unlike medical care, dental care is something that can usually be put off until you really need it,” explains John Gumkowski, marketing manager for Delta Dental of New Jersey and Connecticut. “So if you're not in a plan one year, but know you need a root canal, you can join the plan the following year and use the benefits.
“The decision to participate in a dental care program can only be made after you go through the economics,” he adds. “That's true for both the corporation looking to offer a dental program to employees and for employees thinking about paying the monthly premium.”
An insurance company takes all this flip-flopping into account when it designs and offers plans to employers. Delta Dental is in the enviable position of being able to spread risk over a substantial number of people and, therefore, keep premiums low.
As the country's largest provider of dental insurance, Delta offers coverage to more than 28 million Americans and has more than 110,000 dentists as plan participants. In Connecticut, more than 80 percent of dentists participate in one of Delta's plans. Companies like Pitney Bowes, Northeast Utilities, Fleet Financial Group and soon the Hartford counted among Delta's customers.
“The ability to sign up for dental care when you need it is the reason that dental insurance can not be bought on an individual basis. The cost to the insurer and the individual would be too high. The insurer knows that participation means claims,” says Delta's Gumkowski. “The more people buying in to the program, the more you can spread out the risk from high claims.”
When circumstances call for a patient to maximize her dental benefits, Natkin supports the notion of patients being able to “bank” their benefits. Unused benefits from past years should be available to a patient at a time when they most need them, he asserts. With most insurers paying a maximum annual benefit of $1,000, it doesn't take too many root canals, dentures, or crowns before the maximum is exceeded.
“The level of payment or maximum benefit has not changed in years,” says Natkin. “Insurance carriers are not interested in whether people have good dental care or not. They want to sign up as many companies as possible at the least cost.”
Despite his misgivings about dental insurance, Natkin has participated in Blue Cross & Blue Shield dental plans since he opened his practice in 1972. Since then, Blue Cross has become Anthem Blue Cross & Blue Shield of Connecticut and offers several different dental plans, including a new managed-care option.
Earlier this year, Anthem began offering employers a preferred provider option (PPO) similar to those in health care. So far, the Anthem PPO has more than 600 members enrolled with a network of more than 310 dentists in Connecticut.
“The PPO is attractive to the small-business owner,” says Anthem spokesman Albert May. “There's about a 15-percent savings over a traditional dental insurance program. For the small-business owner and the self-employed businessperson, this is a way to have dental insurance.
“There's definitely an issue of affordability with dental insurance,” adds May. “The overall cost of dental insurance, like health insurance, will continue to go up. The PPO offers employers an alternative way to provide dental coverage to their employees at low cost.”
Like managed health care, Gumkowski believes that some dentists are resistant to the idea of managed dental care.
“I think many are resistant to the idea of a dental PPO because they perceive the insurance company as telling them what to charge,” Gumkowski says. “I think you can judge from the number of dentists participating in the PPO that they've accepted Delta's plan as being acceptable.”
In order to participate, a dentist must provide Delta with a list of services and the amount that will be charged for those services. If those charges are within Delta's guidelines, the dentist signs an agreement to become a participating provider.
“Being part of the biggest dental network means that dentists don't have to reduce their fees drastically,” Gumkowski says. “If dentists can maintain the same fees and retain or increase the number of patients, then they'll be happy with the program. I think we see that with Delta.” BNH
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