福利姬视频

[00:00:00] Wright: What a hot topic today. We are tackling something that is universally a pain point for most dental offices, and that's dental insurance. I'm Dr. ArNelle Wright.

[00:00:11] Ioannidou: And I'm Dr. Effie Ioannidou and you are absolutely right. It's, you know, the unknown sometimes can be stressful. So I think it's really important for us that we are digging into this, you know, some misunderstandings about how insurance reimbursement works, navigating the challenges and learning, what we can do to help dentists on this issue, right? So I think it's, I'm looking forward to this conversation. I'm excited, I'm excited!

[00:00:46] Announcer: From the 福利姬视频, this is Dental Sound Bites created for dentists by dentists.

Ready? Let's dive right into real talk on dentistry's daily winds and sticky situations. 

[00:01:03] Wright: Hey, hey everyone! I am so happy that you could join us for this episode because as Dr. Effie already shared so beautifully, this is a topic that really tends to get people worked up.

[00:01:15] Ioannidou: So true, I'm so wise.

[00:01:17] Wright: Mm-hmm. You are, that's why I need you right by my side.

[00:01:23] Ioannidou: No, but it's true. No, you are absolutely right. It's an important topic and I think we have so many, I mean, I have so many questions. Being in academic dentistry, and I'm sure your perspective, ArNelle, is very different in private practice, so we need to clear some things up for dental insurance. We need to clear misinformation, so that's why we invited the right person for this job, the person that can help us answer the most complicated questions for you.

And who is this ArNelle?

[00:01:56] Wright: Yes. We have our District 10 trustee of the ADA. We want to welcome back to Dental Sound Bites鈥攈i, Dr. Stuefen, thank you for being here.

[00:02:06] Ioannidou: Hi. Hi. Hi.

[00:02:07] Stuefen: Hello. Thanks for having me. This is so fun to be back.

[00:02:11] Ioannidou: I mean, what, you are one of the regulars now, right?

[00:02:14] Wright: Yeah. An expert.

[00:02:15] Ioannidou: You know, the regular, she's one of the regulars.

[00:02:18] Stuefen: Happy to be.

[00:02:19] Ioannidou: So you have been part of the first season that I was not part of, but then we met in the, during the third season and we did a very interesting episode. So for our listeners that have missed the previous episodes, tell us a little bit, Sara, speak a little bit about yourself and tell us how you became an expert on this topic and what kind of led you there.

[00:02:45] Stuefen: Yeah, thanks. So I am a general dentist practicing in Iowa. I'm in a solo practice, but how I got involved with insurance was one鈥攕ome of just my experiences, buying a practice, learning the hard way in some ways, but then I served on the ADA's Council on Dental Benefits and I really just dug in and love learning about policy and what our policy is at the 福利姬视频and advocating. Advocating for our patients and advocating for our practices. So over that time, I've served on the Council on Dental Benefits, and now like Dr. Wright said鈥擨'm a trustee for the ADA.

[00:03:25] Wright: Yeah. Woo hoo. I'm like so excited about that because not only are you a trustee, but tell us more, come on, brag on yourself a little bit. Aren't you like the youngest trustee that there's ever been?

[00:03:37] Stuefen: We think so, yeah.

[00:03:38] Wright: You think? Yes, that is so good! That's good news for us, right? You are blazing new trails, so thank you.

[00:03:46] Stuefen: Thank you.

[00:03:47] Wright: Yeah, you're welcome.

So well, let's go ahead and jump into our episode for today. One of the main things, Sara, that we really want to get across in this episode, and for all of our listeners who are tuning in, make sure you kind of sit up straight for this part and for the whole episode because we really want to help you and as Dr. Effie shared in the beginning鈥攖here are so many misconceptions. We have so many questions as practicing dentists, in academia, wherever we are in the dental world, and however we're trying to contribute to the advancement of dentistry. There are so many misconceptions that exist surrounding dental insurance, and so, we really want to bring some clarity to this topic to help our dentists that are both members and non-members really understand this topic.

So with that in mind, Dr. Stuefen, can you help us just, you know, take us back to the basics. How do insurance reimbursement rates work?

[00:04:44] Stuefen: That鈥檚 big question, ArNelle, but let's get to it. So let's kind of lay a foundation a little bit. I want to make sure that we understand what a, what the dentist's full fee is. So that is what the dentist or the practice is setting as their full fee. That's not what's being set by the insurance company. It's what you and your practice, or maybe your college is setting as the full fee. And then there's the maximum plan benefit, and that's what the insurance company is saying is their allowable fee for a certain code. Sometimes you'll hear this called UCR or usual, customary, and reasonable. I think people throw that out a lot. I don't really like that term and at the 福利姬视频we don't really like that term because who's deciding what's reasonable here, right?

[00:05:35] Ioannidou: That's right.

[00:05:36] Stuefen: So I think it's kind of a misconception and kind of sends a mixed message to a patient, that someone's determined that, that fee was reasonable and it's not. So we like to use the term, maximum plan benefit.

[00:05:48] Wright: Oh, I love that. That's good. So language and terminology is important. Especially for people like me who just acquired a practice, but go on, go on.

[00:05:55] Stuefen: Absolutely. You are just, you are going through a lot right now and...

[00:06:01] Wright: Oh yeah.

[00:06:02] Stuefen: As someone who's been there too, I'm cheering you on and here for you anytime.

[00:06:07] Wright: Thank you, thank you

[00:06:08] Ioannidou: Sara, for me, this is like a magical unknown still remains, although you have given us, you know, tutoring on this repeatedly. Still, I have a little bit of, you know, lack of clarity. Who is responsible, who sets up the reimbursement rate?

[00:06:29] Stuefen: Very good question.

[00:06:30] Ioannidou: Is it an arbitrary assessment? How is this done and who is, who should we point fingers at?

[00:06:44] Stuefen: Everywhere. Everywhere, reimbursement rates are set by the insurance company, so they're determining that.

Now, 福利姬视频policy says, we want to know what your methodology is: how are you, where are you coming up with this? Right? You say that this is customary and reasonable, but how? Why? And they don't give us their exact methods for determining that, but we have some ideas. So some of that is going to be based off of geographic region. Some of it's going to be based off of your specialty and then the other thing is taking a look at your insurance claim data. So when we talked about that full fee, that's so important when you're sending an insurance claim that you put your full fee on there, and that's no matter what. No matter if you're in network or not, it's so important that you put that full fee because the insurance companies are taking that data now.

They want to make sure that their network is semi-reasonable, right? So if they don't have any dentists, then obviously the market is not allowing for those fees. So they're trying to make sure that they have a competitive network so that they can attract enough dentists when they're out there talking to employers. They want to show, 鈥渉ey, look, we've got dentists that are going to be able to take care of your employees when they need care.

[00:08:11] Wright: There's so much to this. My brain is just like spinning with questions, but you know, this isn't my consultation and my personal session, so I won't do that to everybody that's listening. But one question that I hear and I see a lot, that's tossed around online is, why isn't the 福利姬视频doing anything about the reimbursement rates? And can you just tell us a little bit about that and then what the 福利姬视频can do about the rates?

[00:08:44] Stuefen: Sure, yeah. This is a question I think if anyone that's involved in organized dentistry and leadership is getting this question, right? And, and we hear like we're not doing enough and on the other side of it, I will say we're fighting hard.

One of the things that we really have to understand is that the 福利姬视频or any sort of association can't specifically ask for better reimbursement rates. We can't go to an insurance company and say, 鈥渉ey, pay us more.鈥� We just can't do that and that's because of antitrust regulations. 

[00:09:19] Wright: I was just about to say, wait, why? Can you please like you, we got to go double click on that a little bit, please.

[00:09:26] Stuefen: Yeah. So, there are federal guidelines that limit what the 福利姬视频can do in this space and so that does tie your hands a little bit. But we can do, we can still do a lot here and so I think it's important to understand that I still walk into a conversation with an insurance company or leadership, walks into a conversation and explains our experiences and our practices because I can't say, 鈥渉ey, you need to increase your rates鈥�. But I can explain what's being seen across the country鈥攚e're seeing workforce shortages, practices can't find hygienists and assistants. And when they can, the wages are much higher than they were three years ago, five years ago and we're seeing increased supply costs too, right? So all of these things are pushing on the cost of care and reimbursement rates aren't keeping up with that.

So I think it's important that we tell the insurance companies, 鈥渉ey, we've noticed your rates aren't keeping up with CPI and we're experiencing all of these other increases, and we want you to know what that is and what a burden that is on our practices鈥�.

[00:10:38] Ioannidou: I mean, this is a very pragmatic approach, right?

This is really important to catch up with the, I guess the cost of living expenses and the inflation that affects businesses. So it's very realistic what you're saying now. Out of my own curiosity, the reimbursement rates vary among insurances, right? So, if someone needs to go into this negotiation, I guess it has to be done individually with the different insurers, correct?

[00:11:14] Stuefen: Right.

[00:11:16] Ioannidou: Which makes the process and the energy required for the process even more complicated and even more exhausting. Right?

[00:11:24] Stuefen: Right. It's daunting the first time I, the first time I decided I'm going to negotiate for myself鈥攐ne, confidence level coming into like a business discussion at the time was not my height of confidence, and so I'm just nervous and saying like, 鈥渉ey, I want you to look at my reimbursement rates, they haven't changed.鈥� But you can do it and so we can kind of talk about some simple steps and strategies to help.

[00:11:51] Ioannidou: Which brings me to my question that is, how can individual dentists, we speak about organized dentistry, but how can an individual dentist say, Dr. ArNelle Wright, that starts a private practice...

[00:12:03] Wright: I'm going to need it.

[00:12:03] Ioannidou: How can they, what can they do to play a role to improve reimbursement rates?

[00:12:11] Wright: Mm. So good

[00:12:13] Stuefen: Talking with your provider relations manager. Normally there's some sort of term with provider relations, so likely going to be a provider relations specialist or provider relations manager talking with them.

So first of all, Dr. Wright, I don't know if you sign contracts or not, but you want to make sure if before you sign a contract. That you know, what those fees are and understand what that fee schedule is.

[00:12:40] Wright: Yeah. I'm going through that literally right now. So I haven't signed contracts yet, I'm going through and getting all of the fee schedules. That's exactly where I am.

[00:12:49] Stuefen: Good. So you're, you have listened to some of these podcasts cause we've talked about getting that information ahead of time. So you're definitely doing that and that's a great first step. Another thing you want to be doing is taking a look at your main codes that you're going to be billing.

So you can look at the reimbursement for some procedure that you may never do or you might do once in the next 10 years, it might be great, but that's not the important thing. So you want to look at kind of that top 20, top 25 codes. Make sure that those are going to work for your practice. And that's whether or not you're starting with a new contract or trying to increase your reimbursement rates and you're already in network.

[00:13:36] Wright: That's so good. Can I jump into something as we talk about, like, my transition from associate to a practice owner now and for any of our new or early career dentists that may be listening to this, that may be going into associateships. Do you have any recommendations on the way they can talk about this with either, like if they're in a large group practice or a DSO setting, or if they're in an associateship within private practice. How can they have these conversations so that they too can advocate for themselves?

Because as we all know here, we don't really learn dental codes. You may have a few codes like your O150 or whatever, like when you're doing your exam in dental school, and I shouldn't use air quotes, but we don't focus on the code. We focus on performing the actual comprehensive exam. And so, if they don't know those codes or what the top procedures are that they're going to provide, how can they advocate for the reimbursement rates when they're entering into a situation? Because I've never had to even deal with this as an associate and it's just a, it's a whole new walk of life for me.

[00:14:42] Ioannidou: In addition to this, let me add one more thing. You're absolutely right, it's very hard because we don't really make this part of dental education. In other words, to teach students how to code for the procedure. The student鈥檚 education is so much procedure focused, right? Collect your credits, make sure you fulfill a competency test this, that...

So in addition to what you just said, I was thinking, not only the correct coding, but also the limitation that coding comes with, right? So how frequently you can code like this, what is the restriction that you might have, you know, based on the plan that certain patients are, but also the requirements that are oral health standards of care, right? Standards of care, but, you know, oral care, systemic care, compromised patients, it's so complicated, you know? Usually people criticize from outside the US, that the way that health is delivered in this country is insurance prescribed. So how to find this balance between what exactly the care requires versus insurance reimbursement and coverage. It's, I know it's a loaded question, Sara, but I think it...

[00:16:01] Wright: Yeah. We just Loaded you up there.

One bite at a time.

[00:16:06] Ioannidou: Yeah, that's right. That's right.

[00:16:08] Stuefen: Where, where do we start?

Well, I'll take just questions about coding in general. I think I got into dentistry to help patients and get them healthier, right? I did not get into dentistry to sit behind my computer all day and code, so it's not the exciting part, but it's a part of our careers. And so, to your question, ArNelle, talking about coming in as a new dentist or a new graduate and trying to look at an associateship and how you evaluate that. I think, one, just asking what networks is this practice involved with. As a new dentist, as a new grad, it's going to be kind of difficult to understand what that means, but I think it's a good question to ask and it's good for those employers to know that you're aware and you're taking a look at it.

I would, if you have any sort of possibility, talk with the office manager. What plans are you seeing a lot of? What plans are good to work with? What aren't? You鈥檙e probably going to have some time in your day when you're practicing that's free. A patient cancels, something like that.

Those office managers who are sending claims day in, day out and following up, they can tell you so much and they're going to be such a wealth of information as you're kind of starting to get your feet on the ground and get going. And then to your question, Effie, this is a hard part, right? We have these limitations that insurance companies put on us, and we know, we know that that fluoride varnish is needed for that high caries risk patient. Even if it's not covered by the plan, but we still recommend it.

So one of the big things we always talk about is coding for what you do. No matter what. No matter what you do, even if the insurance company isn't going to cover it, you have to code it. This is your legal record. It comes into a whole other discussion of understanding what codes are going to be covered and what aren't. Some of that is just experience and you kind of, you maybe get burned once or twice and you kind of learn, right? How to have that conversation with a patient and you kind of flag that in your mind鈥攏ext time I need to make sure that the patient is aware, but that's a difficult conversation. I don't have a perfect solution for you except for that I think the more that we code for what we do and not hide what we did and just throw it in a note, the more that the insurance companies are going to be seeing that this is actually a utilized code and hopefully that can drive change in the future.

[00:18:52] Wright: Yeah. That was so good. Yeah.

[00:18:54] Ioannidou: That's a very good point.

You're absolutely right. So in other words, you know, be honest to what you're doing and keep your standards, the care delivery standards high and you know, don't focus on the coding, but focus on the care delivery.

[00:19:13] Stuefen: Right, cause at the end of the day, it's my dental license, it's not the insurance company鈥檚.

[00:19:19] Ioannidou: Right. Absolutely not.

[00:19:21] Wright: And the coding part that you just explained, that's also informing the patient too, that there is a code attached to that part of the procedure, whether it's reimbursed or not. Do I understand that correctly?

[00:19:35] Stuefen: Yeah.

[00:19:35] Wright: Yeah, because it communicates, I just feel like it keeps it transparent for everyone that's involved.

Um, so I really like that coding for what you do, because that's typically what I try to follow. I always try to look and see if there's a code for something. Whether it's covered by the plan or not, and I want to make sure that the patient understands that there is some sort of designation attached to that part of the procedure. I really like that. So thank you for clarifying.

[00:20:02] Ioannidou: We will be right back.

[00:20:05] Announcer Ad: Are you ready to start, grow, or buy into a practice or group? Panacea Financial can help. Panacea Financial is endorsed by 福利姬视频Member Advantage and offers thousands in savings to 福利姬视频members looking for practice financing. Doctor founded an expert driven, Panacea Financial offers concierge level service and finance options designed exclusively for dentists with competitive pricing and experienced advice. Go to panacea financial.com/ada today to get started on your practice ownership goals. Panacea Financial is a division of Primis Member FDIC.

Upgrade your dental team's wardrobe with logo apparel from Lands' End. 福利姬视频members save 10% on comfortable and high-quality clothing. To promote your practice's brand in the office and out in your community. Visit ada.landsend.com.

[00:21:06] Ioannidou: Welcome back to Dental Sound Bites. Today we are talking about dental insurance with Dr. Sara Stuefen.

[00:21:14] Wright: As we continue to have this conversation, can you share, um, any other big misconceptions that are out there that we haven't talked about yet concerning, uh, dental insurance?

[00:21:25] Stuefen: Well, I think, I think one of the things that I see is people knowing what their state insurance regulations are and, but then thinking that every single plan has to follow it.

[00:21:36] Wright: Ooh, tell us about that.

[00:21:38] Stuefen: Yeah. Right. So. I'm in the state of Iowa, and I feel like if State of Iowa says this insurance regulation that we've created to protect consumers of insurance, uh, is important, but not every single plan follows it.

[00:21:56] Wright: Why doesn't every single plan have to follow it?

[00:21:58] Stuefen: There is a law, a federal law called ERISA.

And that's kind of a hot topic, I think in the past couple years. So that's the Employee Retirement Income Security Act, and that was really created to regulate self-funded plans. It's a federal law and so insurance carriers will say that federal law supersedes state. And so this is regulating us, and we don't need to be looking at what the state insurance regulations are saying.

Now, the ADA, we think, uh, hang on a second, right? So ERISA is meant to regulate administrators, but its intention was not to regulate everything. And so our state laws that are talking about non-covered services or assignment of benefits, that's not changing the administration of the plan.

[00:22:53] Wright: There's too much gray area for me.

I can't do it. I can't. Hmm, but I digress.

[00:23:01] Ioannidou: Too much, too much.

[00:23:04] Stuefen: It's frustrating, it's complex. And you know, ERISA plans are over half of plans, so it's gonna be a lot of your patient population. I think the big, big one that I see is non-covered services, If I do a non-covered service, the most common one I do is adult fluoride varnish.

Very typically not covered by a plan. Um, do I bill my full fee or do am I gonna be billing the, is the patient gonna owe the network fee. Wow. It's hard to know until you know whether or not that plan is, is obligated to the ERISA laws.

[00:23:42] Wright: And do you just figure that out by trial and error? So like you, you have to send in the claim and then you find out and then you look like the bad guy. Right?

[00:23:48] Stuefen: Right.

[00:23:49] Wright: Yeah.

[00:23:49] Stuefen: Yep. Yeah, yeah. Um, generally now there are definitely some people who can track that. So once, you know, you can kind of keep track of that in your payment software within your practice management. So there are ways to do it, it's just how much time and how well staffed you are.

[00:24:09] Wright: Love this. Yeah.

[00:24:10] Ioannidou: Wow. And how patient you're, right?

[00:24:13] Stuefen: Yes.

[00:24:14] Wright: Detail oriented, all the things.

[00:24:17] Ioannidou: So we touched upon this earlier, but in the frustration that many of us have, many dentists have in terms of the, as we discussed, the fact that the reimbursement rates don't really follow the, the inflation rates, right?

So even one would say the 福利姬视频Health Policy, actually not one, the 福利姬视频Health Policy has documented that the reimbursement rates sometime, in some reimbursement rates decrease while the cost of business increases. So there is this perceived increase in denials, processing fees, x-ray cost. So what's going on? What's causing all this and what can we do and is there anything we can do?

We, the organized dentistry. Yeah. People like this way is very, very, yeah. Yeah.

[00:25:16] Stuefen: It's a collective, right? Like it,

[00:25:17] Ioannidou: it's very, very fluid. It's a fluid way. Yeah.

[00:25:20] Stuefen: Yes, it needs to be organized dentistry, but it also needs to be every single dentist that's experiencing this in talking about it. Talking about it with the insurance companies. Yes, we can do things, we can talk about policies that insurance companies have say they start requiring a certain type of X-ray for a procedure. We can talk about how that's maybe not standard of care or that's an increased burden. And we do that. We have those conversations.

I was on a conversation one time about, a claim not being paid because the patient elected not to be anesthetized for scaling root planning and the plan actually required anesthetic or they weren't gonna pay for it. So it's those kind of frustrations that we hear over and over, and I, you betcha I was in on a conversation saying, what's the standard of care there if the patient elects no anesthetic? The treatment result is still the same, right?

So we're definitely having those conversations. Now we need to take a step back a little bit. I think one of the things we all need to remember is that over 70% of dentists are part of some sort of network. And if you look at the National Association of Dental Plans, which is kind of the association for the dental insurers, they say that the average, yeah, that's NADP.

The average dentist is a member of over 26 networks. Wow. Right. So now when we're having this conversations, that kind of puts us up against the wall a little bit.

[00:27:03] Wright: Mm-hmm. Yeah. Mm-hmm.

[00:27:04] Stuefen: The good news is we're still successful even with that. So we are advocating, I think since 2018 over 160 dental insurance reform laws have been successful in states across the country, over 160.

So we are fighting things like virtual credit card payments, and issues with pre-authorizations, and retroactive denials. Those are all very frustrating. And so, insurance reform at the state level is a significant way that we can gain some ground.

[00:27:38] Wright: I have a quick question for you about an individual or like a doctor who wants to get involved.

Yeah. Um, because you have, you have like depths of knowledge through being on CDBP. So, council on Dental Benefit, is it plans or programs?

[00:27:53] Stuefen: Programs.

[00:27:53] Wright: Programs. Okay, perfect. Thank you. So with all of that knowledge, someone, we may not have all of the insights because there's like a group of you all that are, you know, like insurance experts and you kind of put all of that knowledge together, um, to help us as members.

[00:28:10] Ioannidou: The insurance nerds. Yeah. Know the insurance nerds.

[00:28:12] Wright: But you know what, yeah,

[00:28:13] Stuefen: I was thinking nerds too. I definitely fall in that category.

[00:28:17] Wright: Yes.

But you know what, from a business practice perspective, like in addition to clinical, um, like understanding like from a clinical perspective how it impacts your patients, but then how you run your business. This is very important because as you said in your question, Effie, If the reimbursement rates are declining as the cost of business is increasing, that's an inversely proportional relationship. Like that is not good for the business. Right.

But anyway, I digress on that part. How can someone at the state level. Get involved or where can you begin, um, like helping to make this impact?

I know we talked about what can be done and how as an individual we can get involved or we can have these conversations with our provider relations manager or directors. But from an advocacy perspective on the state level, where would you recommend for someone to begin? Or what was your start?

[00:29:11] Stuefen: I started at the local level, just showing up at a dental society meeting and, and kind of getting the bug for advocacy and wanting to get involved. Most state associations are gonna have someone who, uh, some staff who is involved with the legislative side of things and just, just make a phone call, say, Hey, I'm interested.

Organized dentistry. Like we are so excited to have volunteers, right?

[00:29:39] Wright: Yeah, yeah, yeah.

[00:29:39] Stuefen: Um, we want you, we want you to get involved and it's great to have Yeah, just a, a diversity of ideas and perspectives and experiences. So get out there, make that phone call. If you know someone who's already involved, that's great too. Most of us want to lift you up and, and bring you in.

[00:29:59] Wright: Yeah. And you know what? Side note, I, you just spoke about virtual credit cards. I had no idea that this was a thing, and I can imagine that most new dentists have no idea that this is a thing. Especially if you are an associate or if you're not really involved in that part of the day-to-day.

So like the operations side, the billing, um, and I learned about virtual credit cards by going to Dentist Day on the hill here in my state and I was like, what? Once I was educated by it, I was like blown away, and so now I'm just like, that better not be a virtual credit card.

[00:30:30] Stuefen: Right. I know. Yeah. They're not allowed in my office.

[00:30:33] Wright: Exactly. I was like, no way.

[00:30:35] Ioannidou: What do you mean? What do you mean by virtual credit card?

[00:30:38] Wright: Yeah, talk about it.

[00:30:40] Stuefen: Yeah, so sometimes when you get a claim payment from an insurance company, they actually send either email or send a piece of paper that looks like a paper credit card, and it has a credit card number that you can just enter into your, like your POS.

Right? Merchant. Yeah. Right, exactly. And so you just type that in and so now you're paying the credit card processing fee for that claim.

[00:31:05] Ioannidou: What?

[00:31:06] Wright: Yeah. That's the response that I had. I was like, excuse me.

Yeah. So now you're losing what, 3, 4, 5% off of that payment just because they paid you by credit card rather than sending you a check or an EFT.

[00:31:23] Ioannidou: It blows my mind.

I know.

[00:31:28] Stuefen: Now you should know. You do not have to accept that virtual credit card payment.

[00:31:33] Wright: Say it again?

[00:31:34] Stuefen: You do not have to accept the virtual credit card payment. Sometimes it takes a few frustrating phone calls, but you, they should pay you by check or by EFT.

[00:31:45] Ioannidou: Interesting. Yes. What's the bottom line from today's conversation?

If we want to give one biggest, most important advice that could be for a seasoned or a new dentist, an aha moment. What is that we should tell them related to the insurance reimbursement rates and the negotiations?

[00:32:10] Stuefen: You have to read your contract. It's not fun. Like we talked about earlier, I didn't get into dentistry to read contracts or sit behind my, you know, in my email and read emails all day. But you have to read your contract.

The 福利姬视频does have a contract analysis service, so if you're really not excited to read it, you can send that into the 福利姬视频and they can help you evaluate it. They can't make the decision for you, but they can explain what some of the clauses are there.

You want to ask for processing policies, and sometimes it's called uniform regulations, but normally in that contract that you're gonna sign, It's going to refer to those processing policies or uniform regulations. So you wanna ask for that too, because a lot of times that isn't just given to you, but it should be before you sign that contract.

[00:33:00] Ioannidou: That's very good.

[00:33:01] Wright: That was so good. The language alone. Yeah.

[00:33:04] Ioannidou: Yeah. That's the bottom line.

[00:33:05] Wright: Terminology that we just don't use on an everyday basis, but I guess as you have these conversations more often you get to understand like how these impacts you on a regular.

[00:33:17] Ioannidou: And I think it's really important for people, you know, especially junior, newly practicing dentists not to be afraid to ask questions. Yeah. They frequently, people feel intimidated. They think that, uh, um, you know, that everybody knows everything. You know, people the rest of the community understands the contract. Most of the people do not understand the contract.

So the advice that Sara gave is very important. Read it carefully if you don't understand it, which probably you won't, lean to the ADA. That's why the membership has a value. We ask questions, get your supporting group, figure it out. But you need to understand this unknown lingo for us. I mean, we are not insurance lawyers. How would you know? Right, right. So any question is the right question. Yeah.

[00:34:10] Stuefen: absolutely. Absolutely.

[00:34:12] Ioannidou: Sara, you should write the book Insurance Contracts for Dummies.

Yeah, we'll pick it up. Definitely right. Have we missed something, Sara? Is it something else that we need to bring up that we didn't cover?

[00:34:25] Wright: Oh yes.

[00:34:26] Stuefen: If you want one more little tidbit.

[00:34:28] Wright: Please.

[00:34:28] Stuefen: You've got time. So one of the other misconceptions, and one of the things I hear a lot about is, annual maximums.

So, um, I talked to dentists who have been practicing before I was, and they say, you know, 20, 30 years ago, annual maximums were the same as they are now. They haven't changed. You all hear that too?

[00:34:53] Wright: I have. Yep. Yeah.

And, and that's just such a shame. Like, like, uh, continue. Sorry, but this is your moment.

[00:35:01] Stuefen: It's right. So, maximums have not kept up with CPI just like. A lot of the things we've just talked about that haven't kept, kept up with CPI.

[00:35:11] Wright: Can you tell us what CPI is for all of our listeners?

[00:35:13] Stuefen: Oh, sure. Consumer Price Index, so that's basically inflation. Yeah, yeah, absolutely. So maximums haven't kept up with it.

But when you take a look at data over the past 10 years, maximums are creeping upwards. So most or the majority of plans were maybe at that thousand dollars maximum 10 years ago. Yeah, baby, baby steps creeping. And now we see more of the 1500 to plus maximums. So it is increasing, that is not keeping up with our expenses or patient expenses by any means. But one of the things I, I wanted to relate to you was that I think sometimes in conversation.

With dentists, they think that having a no maximum or the maximum is what's holding patients back from dental care. Right?

[00:36:05] Wright: Oh, let's talk about that.

[00:36:06] Stuefen: Yeah. So it is, but there's a whole another part of that, and that's the out of pocket. That's what the patient is paying. So HPI did all this analysis for us a year or two ago, and took a look and basically the closer a patient gets to that maximum, the more that patient is having to disproportionately pay out of pocket versus the insurance company.

So then burden is increasing for the patient, the more care that they're receiving. Mm.

And that really slows down care. So even when you take a look at, we do have plans now with no maximum. They're out there. And that's increased over the past 10 years too. That's not the whole part of the story. No, maximum is great, but we also have to be thinking about copays, limitations, those kind of things that really are that barrier to care for the patient.

[00:37:02] Ioannidou: It's not an easy story, right? There are consequences to the practicing dentist. There are consequences to the public. So it's really very complicated thing.

[00:37:16] Stuefen: Yes, it is.

[00:37:18] Wright: There's like, it's very layered. And so one thing that with everything that you just shared with the last tidbit, which was great by the way, so I'm glad you put that in there.

How does maybe your conversations on CDBP, like what do you all do to like address that? Or is that more from a. Um, an advocacy perspective, like when we have like our 福利姬视频Lobby Day, is that when those conversations are happening as it relates to maximums?

[00:37:48] Stuefen: All of the above, ArNelle. Okay. All of the above.

So, I think we need to be having those conversations with the insurers. We need to be having those conversations with our patients and other dentists.

And I think, so one of the things that recently came out was a open letter to insurers from the 福利姬视频that said; Insurers, there are barriers to patients choosing preventive care that we know there is evidence for, like fluoride treatments, silver diamine, fluoride, those kind of things. And by not covering those procedures or creating copays and things like that, it's preventing the patient from getting needed care.

So we're, we're advocating on all levels and that's what we have to do. We can't just, we can't just go at this from one, one place. We have to go from everywhere.

[00:38:48] Wright: Yeah. It sounds like it worsens it in the long run too, for the patient.

[00:38:53] Stuefen: Right, right. So prevention, we're all about prevention. Right. So, um, and, and that's, we wanna, we, we're here to keep our patients healthy. And we wanna make sure they have the best access to health they can.

[00:39:10] Wright: This was so good.

[00:39:12] Ioannidou: That's a great sentence to end. Yeah, for sure.

[00:39:15] Wright: Oh, I feel like we could talk about this forever. Yeah.

[00:39:20] Announcer: On the next Dental Sound Bites.

[00:39:23] Wright: We are talking about why leadership skills are a must for today's evolving dental landscape. We're talking about how to cultivate strong leadership and why it's essential for helping shape the future of the profession.

I am so glad we did this.

[00:39:42] Stuefen: Yeah, me too.

[00:39:42] Wright: I'm so glad we did this. It almost reminds me of like our HPI episodes and then our sticky situations and like all of our episodes. I just get so excited.

[00:39:51] Ioannidou: No, this is great. This is really great. It was really wonderful having you here. Sara, thank you so, so much.

[00:39:58] Stuefen: Always a pleasure. And I always love listening in too. Yeah.

[00:40:03] Ioannidou: Where is our community going to find you if they want to ask a question or connect with you or learn a little bit more?

[00:40:10] Stuefen: So if you want to learn more information about what we've talked about today and get even more tips and information on evaluating contracts, check out ada.org/dentalinsurance. You'll get a whole lot more information there.

If you wanna reach to me personally, you can find me on Instagram. My handle is sarastuefendds.

[00:40:31] Wright: Nice. And to all of our listeners, we are going to link all of the resources and information that were mentioned in this episode. They will be linked in our show notes at ada.org/podcast

[00:40:44] Ioannidou: And if you liked and found this episode interesting, which I'm sure you did. Yes. Please share it with a friend. Then be sure to subscribe wherever you're listening so you can get all of the latest episodes.

[00:40:57] Wright: You guys. And don't forget to rate it, write a review, and follow us on social media. This was so good, I hate to say goodbye, but now it's time to say goodbye. Bye everyone.

[00:41:09] Ioannidou: Goodbye.

[00:41:10] Stuefen: Bye.

[00:41:12] Announcer: Thank you for joining us. Dental Sound Bites is an 福利姬视频 podcast. You can also find this show resources and more on the 福利姬视频Member App and online at ada.org/podcast.