Share this article

print logo

Dental insurance isn't what it used to be, say East Amherst dentistry partners

Technology has changed since Drs. Mark S. Wendling and David Rice joined forces in 2000 at East Amherst Dental Center.

Dental insurance? Not so much, the dentists told me this week during an interview for today’s In the Field feature in WNY Refresh.

“Over the course of time, insurance companies have not kept up with cost of living or changes in the industry,” Wendling said, “so generally speaking when you deal with them, you’re still dealing with the same numbers that you may have seen in the ‘70s and the ‘80s, and it’s just not that way anymore.”

The Refresh feature story focuses on the technological changes, but the two University at Buffalo Dental School alums also sounded off on insurance.

Wendling, 42, and his wife, Katherine, have two children, Riley, 12 and Alexandra, 5. They have a good sense about how family health insurance works.

Rice, 46, understands the insurance world from a personal standpoint as a single person.

The partners provide free dental services for the families of their four dental assistants, four dental hygienists and four office specialists in their office. They also provide health insurance. They consider their employees their “team,” not their “staff.”

The team will help assemble the paperwork needed to file insurance claims, but patients are required to file the claims themselves. There are too many insurance companies, with too wide a range of reimbursement plans, for a small business to address, Rice and Wendling said. The partners said they have chosen to focus on “patient-based care,” instead of operate an “insurance-based” office.

“Dave and I simply look in your mouth, determine what is your best option and present it without prescribing to an insurance code,” Wendling said.

Here are insurance- and business-related excerpts from our interview:

What do you mean by the difference between insurance-centered and patient-centered dentistry?

Rice: Insurance companies are really good at trying to command what types of diagnostics and procedures patients get. This is an interesting subject when you look at diagnosing and treating (periodontal) bacteria, in that many insurance companies, if you participate with them, won’t cover that.

Wendling: Things get better every year. They advance every year. But that also comes with a cost, and the insurance companies generally speaking don’t want to incur that cost. So the same $50 filling I had when I was 12 years old is still available but I wouldn’t put it in my mouth today.

Do you accept insurance?

Rice: We work with every insurance under the sun. We simply don’t contract with them.

Wendling: That means the reimbursement is going to be different.

Wendling: Our team will facilitate everything for you as a patient, work on your behalf, but our relationship is with the patient.

How has dental insurance changed since you got into practice almost 15 years ago?

Wendling: The problem is it hasn’t ... and the dental industry has changed dramatically. It’s a multimillion-dollar business when it comes to products and supplies. A lot of things can’t fall under an umbrella where you can’t go over $1,000 in spending. That’s not how dentistry works. Heaven forbid one of your daughters loses a front tooth. You have to do something about it and there’s not too many insurance companies who are likely to do the right thing for a family.

Many employers used to offer dental insurance that covered everything, aside from braces. Over the years, it seems to have been chipped away. Now many family policies may cost employees $3,000 or $4,000 and pick up maybe half or 60 percent of the cost of some procedures.

Wendling: There was a day when contacts and glasses were covered, too. Now, my family is allowed one exam and we have co-pays.

Rice: Insurance has come full-circle. When it originated, it was for catastrophes, major life events. It’s coming full circle because it’s so costly for a company to provide it to employees. The only way to do it is going to be to say, ‘If you need to go to a hospital, we’re going to cover you, but if you need to go to the doctor or dentist or optometrist, you’re going to have to pay.’

Wendling: But there’s a range. If you have Delta Dental or Guardian, there’s about 10 plans, where years ago, it wasn’t like that. You may have a plan that allows you to get two cleanings a year and that’s it. We do see more of that. Your employer might be able to say, ‘We offer dental,’ and everybody feels good about it, but they’re not really paying much into that plan. Some plans do cover braces. But what’s allowed in a plan is what the employer is willing to pay into the plan.

In terms of percentages of patients who were covered by insurance plans that paid the majority of dental costs when you first started, what are you seeing now?

Wendling: It’s at least 20 or 30 percent less.

Rice: At least, and you have patients who still carry insurance but their benefit is a lot less. We have people who come into the office and tell us they’ve done the math and there’s no point for them to carry insurance. Those that do have insurance have recognized over the years that if, no matter what, something has to be done, they’re going to have out-of-pocket expenses. If you have a family of six or eight, maybe you have the benefit of an expensive plan, but with smaller families, a lot of times it just doesn’t add up.

You participate in community service. What can you tell me about Smiles for Life?

Wendling: It’s a national organization that gives us the opportunity to work with a local not-for-profit. Years ago, we decided to work with Camp Good Days, so it gives us the ability to help the kids and their families. … It’s part of a broader program where, over four months a year, we whiten patients’ teeth and split the money between Camp Good Days and Garth Brooks’ Teammates for Kids. We raise between $20,000 to $25,000 a year and we’re 13, 14 years into it. It runs March 1 to July 1. Patients make a check out or credit card payment right to Smiles for Life and get the tax benefits. We donate our time and materials. ($250 to whiten at home and $450 to “Zoom” whiten in the office.)

Rice: Weather aside, I’d say it’s the best four months of the year here.

Walk through the dental process you use.

Wendling: A lot of the way we do dentistry today and the way we used to do it is that the first visit is a lot of conversation, asking people what it is that they want versus us telling them what they need. In those conversations, you find out some interesting things. You talk about changing someone’s life. I can’t tell you how many people I’ve had tell me they don’t smile in pictures anymore because of the way their teeth are, or they’ve literally trained their lips to smile one-sided.

Rice: The first thing you notice about someone when you see them goes something like smile, eyes, hair. So when you start talking with someone and they tell you they don’t smile anymore or allow themselves to be photographed – that they hate the way they look – they may have just come in because they’re looking for a dental office and need their teeth cleaned, before they leave, you can learn some things about someone that can be changed easily in dentistry.

Wendling: You can give somebody more confidence to go to a job interview or their daughter’s wedding. Things that they would have dreaded before, they’re excited to do. It’s amazing.

We get a lot of kids with sports injuries or congenitally missing teeth. There’s a lot of reasons people need anterior work.

Is it an investment to come in and have that work, especially if you don’t have insurance?

Rice: Big investment. We’ve come up with different payment options. When people are interested in something, they will generally find a way to make it work.

Wendling: When you get into those $10,000, $20,000 treatment plans, it is an investment, but it’s often a better investment than what some people choose to put their money into.

Rice: The bacterial testing and treatment (about $300) is less expensive in the long run. It’s is a huge opportunity. We used to wait on things until people had a problem that we didn’t know how to fix.

Wendling: And this goes back to insurance – today, there is no reason a person should lose a tooth from periodontal disease. It’s treatable. It’s manageable.


Twitter: @BNrefresh


There are no comments - be the first to comment