Dr. Mary Jennings · Editorial · Weltschmerz
My friend Dr. Lucas tells me I have Weltschmerz. The sadness that comes from being weary of the injustices of the world. He is right, the dental insurance industry has let me down.
I thought the dental insurance industry existed to simply oversee the money an employer sets aside for dental benefits for his employee and to ensure payment to the provider. There should be a reasonable fee for providing that service. Mine, evidently, is a quite naive perspective.
The thing that bothers me the most is that I do not feel the insurance industry has my best interest at heart as a subscriber or a dentist. It is interested in its own machine. Even though I know that the industry is based upon gamblers gambling against loss, I expect better.
I know wounds run deep over the WDS fee reduction. The fee reductions combined with learning about the huge insurance executives’ salaries topped off by the callous “take it or leave it” attitude added unnecessary insult to injury that no dentist will forget.
Here in Washington state, it looks like House Bill 1002 will pass the Legislature this year. When it was introduced, it listed twelve insurance problems that clearly need fixing. Now, it’s been amended to include two. It’s a start. But we’ve got so much more to fix. Among other things, it requires stand-alone dental carriers submit loss ratio information to the public through the Office of the Insurance Commissioner. This will show how much of an individual’s premium goes to actual health care – compared to administrative costs like, oh you know, large executive salaries. That should prove enlightening.
It also covers peculiarities like insurance not covering emergency treatment the same day as the emergency diagnosis and radiographs. Who does this to a fellow human being? Must we really spend valuable legislative time to ensure humane treatment?
I feel more and more that insurance companies, including Medicaid, consider themselves the dental police. Code Nazis, so to speak. One step out of the line they drew, and no soup for you! Shameful…
Tell me why a family has to spend down a $6,000 deductible to access their dental policy? They have pseudo-insurance. Thank you Affordable Care Act for helping insurance companies create clever smoke and mirror policies that help no one. The WSDA and Representative Dr. Michelle Calder, et al tried to fix this by proposing HB1852. This would require preventive care be paid for before the deductible is met. The bill got stalled in the House and is dead for the year. Justice rides a slow horse. This is not over. We are all engaged and ready for the long game.
I would like to share a real life insurance problem from my community health world that I am not sure how to fix. Two or three times a month, I see children of working parents who require general anesthesia. Many of these parents are in the military. They can afford co-pays if they are done over time like regular dental appointments, but they cannot afford the giant co-pay that comes with GA. Even though dentists can give away pro bono care to our hearts delight, we cannot, by state law, waive or discount a co-pay even when we know in those same hearts that a family is struggling. Most of these parents try to ride things out until the child is more mature or they can save up. They are courting disaster. This is a glitch in the system that makes deaths like Deamonte Driver’s possible. This is not a classic access to care problem. It is a money problem linked to insurance. They have an insurance benefit they cannot access. I know the parents should have brushed better and saved for this rainy day, but how do we solve this catastrophic problem once made? Still, I do not see anyone holding an actuarial table showing any concern for these children even though they must know they are there. Shouldn’t there be some kind of contingency for this?
The Children’s Defense Fund says there are 7.2 million children still uninsured in the United States. I worry for them. The access to insurance problem is far from over for our children.
Senator Ted Cruz just declared that Obamacare, “puts a government bureaucrat between you and your doctor.” Well, it must be a mighty crowded room with your insurance company standing right in the middle. Cruz will not be the only politician working that platform. I have little hope that we will tear everything up and start over. But, something is bound to shift. This is an excellent time for organized dentistry to help guide the grumbling American public to change anti-trust laws, force transparency and effect simple honesty and compassion into a very ugly industry. It’s about damned time.