Earlier I wrote about Nobel Biocare’s report that outlined the six trends that will change implant dentistry (you can read the earlier post by clicking here). The second trend is Insurance Coverage.
Fourteen years in the dental field has given me some insight into insurance trends. A few things have changed – the age limit on sealants and fluoride is higher now, some ten-year prosthetic replacement clauses have decreased to five years, and periodontal maintenance is now paid on a different level (and more frequently) than prophylaxis. I’ve also seen that implant reimbursement by insurance plans is becoming more frequent. Not just by medical either – dental plans are now adding it to their major class.
Nobel’s report asserts that changes in coverage have prompted large dental groups to adopt implants as a treatment modality. This sounds a little like which came first…the chicken or the egg? I’m more inclined to side with the egg-camp…to clarify, the opposite of Nobel’s report. Let me explain…
Patients are usually prepared by us – specifically financial and treatment coordinators – to plan on covering the full cost of implant treatment. The standard rhetoric includes “we’ll do our best to obtain reimbursement for you” or “any payment for the procedure will be sent directly to you.” Not once in an ADIA meeting have I heard an office state that they collect the patient copayment and accept assignment for the bulk of the insurance portion. I think I’ll hear it eventually though. So … back to my point: implant insurance has changed because more implant services are being done. Not the other way around.
When have you heard of an insurance company reimbursing ahead of the curve? They add coverage and increase benefits in a response to purchaser (employer) demand and to stay current in the marketplace. Coverage for an expensive procedure isn’t just added unless it’s been requested enough to warrant it. And even then, the numbers are crunched to reach an acceptable UCR (usual & customary rate).
The practices that Nobel refers to in the report create added revenue stream by performing procedures that are generally not covered by insurance companies thus placing all financial responsibility for implant treatment on the patient. As more implant procedures are completed, more companies will add coverage to their plans. Slowly the playing field will change and the language in my seminars and the ADIA presentations will adapt to it. Until then we’ll keep advising the patient to plan to pay the full amount.
Click here to read the post detailing Nobel’s six trends
Click here to read Patient Trend #1: More Patient Friendly Procedures
[...] **The second trend, Insurance Coverage, is discussed in this post. Click to read [...]