Managed Care vs. Freedom of Choice.

CHOOSE YOUR OWN DENTIST

MANAGED CARE vs. FREEDOM OF CHOICE

ARE YOU LOSING THE RIGHT TO CHOOSE?

Unfortunately, today many patients are losing the right to choose their own dentist. The reason is that their employers have opted for inexpensive dental plans that force patients to see certain dentists. For many people, the traditional relationship between dentist and patient has disappeared. Patients are forced to see dentists they do not know simply because they participate in a particular plan. This new system is known as "managed care."

Managed care essentially forces patients to see dentist who have agreed to accept lower fees in exchange for their services. It is changing the relationship between dentists and insurance companies. Instead of subsidizing the care of patients, dental insurance providers are now dictating who patients will see and what type of care they will receive. It is not unusual for insurance company employees [non-dentists] to dictate the type of care that is acceptable for patients they don't even know.

It is true that managed care plans help reduce the cost of health insurance to employers. However, once in a plan, patients find that these managed care insurance plans severely limit their choice of dentists.

In a traditional dentist-patient relationship, a patient selects a dentist based on reputation and need. The patient is then treated by the dentist and makes a decision whether or not to stay with the practice. Typically, the practice handles the responsibility of submitting insurance forms to the insurance company and patients are responsible for the amount not covered by the insurer

THE TRUTH ABOUT MANAGED CARE

Managed care is a new concept in which patients have very little say. Insurance providers contract with specific dentist whom they have selected to treat patients in their specific plans. Patients are then either assigned to one dentist or told to choose from the provider's list of dentists. They are also given a corresponding list of covered services. Patients have nothing more to say about selecting their own dentist. If the doctor you currently visit is not on "the list" for that insurance plan, the plan will typically not pay for the services that you receive, or will pay only a greatly reduced amount. In some plans, you may be stuck with that particular dentist whether or not you feel comfortable.

Some managed care providers [dentists] may limit the appointment times available for managed care patients in their practice. This means that it may be difficult to find a treatment time that is suitable for you personal schedule. You may also encounter delays in seeing your dentist, as well as special restrictions on your treatment. These factors will detract from your overall dental experience and make you reluctant to accept the prescribed treatment.

HOW MANAGED CARE WORKS

In a managed care system, the overall concern is for the bottom line. The insurance company contracts with certain dentists and closely controls the costs of the work these dentists perform. [Some managed care plans actually have penalties for dentists who refer patients to specialists or who perform too many procedures!]

The concept behind managed care is "cost containment." Certainly, by encouraging doctors to not perform costly procedures or to not refer patients to specialists, overall costs are reduced. However, the focus has shifted from the patient's well-being to the bottom line, and patients lose the freedom to choose their dental care.

If you join a managed care plan, the dentist you are assigned or select from the plan's list will be your primary dentist. No matter what your dental problem may be at any given time, you will always have to see your primary care dentist before you visit a specialist. It is the responsibility of this primary dentist to determine if you require the services of a specialist, and even then, your insurance company may only allow you to see a specialist who is part of the plan. Once again, this limits your freedom of choice and prevents you from seeking out the most qualified specialist for your situation.

HOW MANAGED CARE REDUCES COSTS

Managed care organizations save themselves a great deal of money by keeping their pool of dentists and dental specialists to a minimum. The key to success for managed care dentists is to increase their volume of patients.

But…this means that you might not receive the attention and level of service to which you have become accustomed with your current dentist. Managed care dentists who do not see an increased volume of patients often find that the reduced fees have dramatic impact on their practices. Managed care plans strongly encourage their dentists to see as large a quantity of patients as possible.

In the past, it was the patient who evaluated a dentist's performance and rewarded him/her for excellent treatment by returning to the practice. In the world of managed care, a dentist is judged by a willingness to reduce fees and by the volume of patients who can be treated. Factors such as the number of procedures the dentist performs may be included as part of this cost containment method.

MAINTAIN YOUR RIGHT TO CHOOSE

If you are faced with the decision as to whether or not to enroll in a managed care program:

Think about whether or not you want to give up your freedom to choose your own dentist.

Carefully review the list of participating dentists and check to see if your dentist is on the list.
Carefully review all of the plan materials and benefit limitations.

If you are already enrolled:

Make it clear to your employer that you would prefer to have the freedom to choose your own dentist rather than be forced to see a particular dentist who does not know you or your particular needs.
Share the information found here with co-workers and friends so that they also understand the freedoms they give up when they join managed care plans.

With all the changes taking place today, health care can be confusing. We believe the dentist-patient relationship is one of the strongest factors in preventive dental care an in maintaining optimum dental health. We remain committed to excellence in the quality of care that we provide to our patients.