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Insurance Issues in Dentistry

Dental License DefenseDentists and hygienists endure many industry-specific challenges with their respective professional licensure. Potentially the biggest area of concern and hardship is insurance, both that the patient has/does not have insurance, and if insurance is involved, struggling to work with the insurance companies to get patients’ procedures effectively covered. In the same vein, on the professional/business side, dental offices also must contend with insurance companies to get paid for their own work that they do. These struggles are industry-wide, and do not have a blanket solution.

In the United States, which has a for-profit health care system and citizens are not required to have health insurance, including the many individuals that simply do not have the ability acquire it. In addition to the struggle to obtain health insurance, dental (and vision) insurance are completely separate insurances that are often not included with basic healthcare plans. This results in individuals having to do one of three things: 1) do not get dental insurance, 2) pay extra/additional to get dental insurance through their main health insurance plan, or 3) pay for a separate dental insurance plan that is separate and different from their health insurance (and usually costs more than if it is attached to their main health insurance).

The above-referenced conditions for the patient directly affect the services that the dental office is able to provide. If the patient does not have insurance, many struggle to afford the services that are needed for their dental health. This could result in less visits to the dentist, having to go on a payment plan, or even being delinquent in payment on the care provided to them, which particularly affects the licensed professional who needs to acquire income in exchange for their services. If the patient does have dental insurance, whether it be dedicated/separate or alongside their health insurance, both the patient and the dental office may have to fight to get the services covered. Some services are not covered but are common procedures; some insurances cover certain common procedures, whereas others do not; some insurances claim to cover specific services, but then will not do so; the list of scenarios goes on.

These hiccups, or sometimes even long term insurance battles, can create a stressful environment and experience for all parties involved. Because of the particularities of dental insurance in the United States, licensed dental professionals are in a unique position where their services are not guaranteed to be covered, or ultimately paid, and some individuals may enter the industry without knowing about these conditions. This is not expected to change any time soon, unless there is an overhaul of the US health care system, so current and prospective licensed dental professionals should be aware of the above outlined struggles before they commit to the path of dentistry.

Williams & Nickl has represented thousands of licensed professionals and their licensed business entities who face issues with IDFPR. If you find yourself in such a situation, Williams & Nickl can provide the help you need.

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