Dental Service Organizations: The Guide to the Dental Insurance Maze

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By Justin Jory, Founder & CEO of Lightwave Dental

Dealing with dental insurance was never a simple process, but it certainly wasn’t always this difficult. In the past, a dentist could open a practice, hire a devoted team at reasonable hourly rates, build a patient base almost entirely through word of mouth, and file insurance claims for fair reimbursement with little to no pushback.

Unfortunately, the dynamics of running a dental practice have changed significantly.

Today, a dentist must be a business leader, a marketing guru, a recruiter, a financial wizard, and an expert insurance negotiator, just to be paid for the services they provide to their patients. Additionally, dentists today need to be a Human Resources director, to manage hiring and retaining a staff while creating a competitive salary and benefits package, as well as a procuring new technology and state-of-the-art equipment. They need to do all this while also providing the latest and greatest dental care for their patients. This is a daunting challenge, a challenge that very few dentists would ever be capable of handling alone.

Perhaps the most mind-bending of all the roles dentists are forced to play is the negotiator of insurance contracts. Insurance is an extremely complicated business. Dentists go to dental school to hone their clinical skills, not to learn how to negotiate contracts with insurance providers. It’s an intricate maze and it distracts from the real work that needs to be done but insurance isn’t going anywhere anytime soon. So, what is a dental practice to do?

This is where a Dental Service Organization (DSO) can help. DSOs were once seen as the option of last resort: a last-ditch effort practices made to help prevent themselves from going out of business. That is far from the case today. The right DSO, one that values the clinical autonomy of the dentist and cares about the people and culture of a dental team, can make for an incredible partner for dentists who are struggling to fill all the roles a top quality dental practice truly requires. Chief among those business issues is insurance negotiation.

DSOs offer relief from the hassles of working with insurance companies. They negotiate directly with insurance payors to ensure that the doctors are reimbursed at a higher level. They work with dental teams and insurance carriers to process claims properly, which otherwise might have been denied or written off. Additionally, they identify billing and collection challenges while providing sustainable solutions so that dentists and their teams can get paid correctly, in a timely fashion, all while training the practice team in claims processing and reimbursement best practices.

Partnering with a DSO to navigate the insurance “maze” means practices won’t need to have a dedicated set of team members who specifically work to negotiate and navigate insurance contracts. This frees up the team to focus on all other aspects of practice management, from researching and acquiring the latest in dental technology to participating in professional development courses to bolster their knowledge and clinical skills.

Perhaps most distressing is the simple reality that patients often do not understand their own insurance situation or how it works. So often, a patient will refuse necessary treatments that are not covered by their insurance provider. It is even likely that a dentist might not recommend a procedure if they know it is not covered by insurance and the out-of-pocket expense will be too high to pay for. It’s unfortunate but it highlights why a practice’s insurance situation needs to be as streamlined as possible to uncomplicate the process and get the patients the procedures they truly need.

Insurance is the “homework” of the dental industry. No one wants to deal with it, and it often feels like a chore that no one has the time to figure out. DSOs can take away the mental stress of insurance from dentists and their practices by providing a higher negotiated fee schedule, streamlining the revenue cycle process and training their team. With the right DSO at their side, dentists can focus on what they do best: providing top notch dental care for their patients.