Dental Benefits and Practice Management

A Guide for Successful Practices

Michael M. Okuji

• Publisher: Wiley-Blackwell
• Year: 2015
• Print ISBN: 9781118980347
• eBook ISBN: 9781118980361
• Edition: 1
• Topic: Medicine
• Subtopic: Dentistry

Dental Benefits and Practice Management: A Guide for Successful Practices is a practical tool that helps you manage your office in tune with the realities of modern dental practice.

• Written by both dentists and insurance industry professionals
• Practical explanations to effectively and legally process claims
• Describes the changes in dental practice management to make your practice patient centered
• Competitive strategies for dentists and organizations

PART I
History of Dental Insurance

CHAPTER 1
Why dental benefits?

Michael M. Okuji

Delta Dental of Colorado, Denver, USA

Introduction

This chapter delves into the history of dental benefits and lays the groundwork for the subsequent chapters. The story is one of the social transformations of health care in the USA and the expansion of access to care to wider segments of our society. Prepaid dental benefits available to a worker and their family did not exist, in the way we understand dental benefits, until the last half of the 20th century. From that point in the 1950s to the new millennium, dental benefits broadened in scope and depth as coverage grew to include new eligible members. Dental benefits that became available to a wide swath of consumers profoundly changed the dental profession and dental care delivery.

Dentists enjoy a great deal of professional autonomy and independence in their practice. These features attracted generations of students into the profession and shaped their dental personality to the point the dentistry is rated the number one best job in the USA. From the mid-20th century, the emergence of dental benefits fueled the demand for dental services that fostered dental practice growth and lifted the dentist into the club of well-paid professionals. This is the world into which all dentists who practiced at the turn of the 21st century were born.

But the health-care world continues to evolve into a new order from care delivered by guilds to fraternal group purchases, to industry and union-provided health care, to capitated care, to the emergence of dental benefit companies to the Affordable Care Act. Now, dentists must once again adapt to a profound change in the order of dental care delivery to continue to deliver quality care to a wider segment of the population.

This chapter sets the stage for the coming chapters. Perspective is important to understand that change in the way dental care is delivered and financed has changed over the past 150 years and will continue to change. The status quo isn’t destiny.

The coming of health insurance

We all practice and thrive in a world where dental benefits are a common benefit of employment. We have always practiced where patients we targeted for care had access to dental benefits. While we sometimes struggle with the administrative requirements to bill for our services and chafe at the paper work and the rules of the road, we understand that dental benefit coverage drives patients to our offices. Without dental benefits, many people would not seek dental care on a regular basis and dentists would struggle to fill chairs. For those dentists that started dental practice in the 1960s around new housing developments in the former fruit orchards of the Santa Clara Valley (CA) that became Silicon Valley, the convergence of employer-purchased dental benefits with families moving to new homes proved to be a true golden age to start from scratch a solo private practice and grow a patient base at a lightning-fast pace. So for many dentists, dental benefits proved to be godsend for their practice and their patients.

But dental benefits are a relatively new phenomenon and health insurance didn’t always exist. Can you imagine a world where all of your medical, hospital, and prescription bills are paid out of pocket? Can you imagine a world where the middle class pays a large proportion of their income for a medical bill? Can you imagine a world where the working poor are consigned to welfare infirmaries?

The manner in which health care is paid evolved slowly in the USA over the past 150 years. Historically, medical care was available to and paid by principally the upper class with the hospital portion of care taking place in their home. Only the poor went to a hospital. The middle class and the working poor were left to seek episodic care at rates that comprised a significant portion of their income. The very poor sought care at charity infirmaries.

In the 19th century, on the East Coast, fraternal organizations and benevolent societies sprang up among the immigrant tenements to help pay for health care through the voluntary, mutual pooling of money. The fraternal organizations contracted with individual medical providers to deliver care on a prepaid per-capita basis. This medical financing arrangement was more prevalent on the East Coast than out West because of the high density of immigrant populations on the East Coast. Young physicians struggling to establish a private practice contracted on the prepaid basis with these groups for their services but hurriedly left the arrangement as fast as they could once their private practice grew. Organized medicine, in the form of the local medical society, frowned on prepaid contract medical care and ostracized these young and struggling physicians that participated in such arrangements and often refused their membership into the medical society. Out on the West Coast, a large French immigrant community in San Francisco established a French hospital, La Societe Francaise de Bienfaisance Mutuelle, during the gold to aid their French compatriots.

Early in the 20th century, industries like the railroad and mining established health centers for their employees. Industry medical care was limited to work-related injuries to get the workers back to the job. The railroads hired physicians along their rail lines to care for their workers. In the mining industry, unions hired physicians to care for those with injuries from mining accidents. Throughout this period, tension existed among industries, unions, organized medicine, and the government on the proper role of health insurance in the American society and on the people who would control payments to hospitals and physicians. For physicians, it was about the autonomy of the medical profession from any outside influence over who and what controls the cost of care and where it is controlled. For industries, unions, and the government, it was also about the cost of care and gaining access to care for a wider swath of the population.

With the coming of the Depression, workers’ wages plummeted or disappeared all together. Hospital and medical visits decreased and physician bills were left unpaid so that families could pay for their food and rent. During the Depression, medical care became recognized as an essential welfare need, and welfare agencies began to pay physicians for their medical services. While the government-sponsored medical relief fund was a benefit to the lower-paid physicians, organized medicine urged all of its members to hold the ...

Table of contents

• Cover
• Title Page
• Table of Contents
• About the author
• List of contributors
• Preface
• Acknowledgments
• PART I: History of Dental Insurance
• PART II: Dental Claim System
• PART III: Competitive Strategies
• Index
• End User License Agreement