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Depending on the state where you practice and the overall economic well-being of your municipality, establishing and maintaining a policy for treating the uninsured and under-insured is one of the most difficult decisions you'll have to face.
Depending on the state where you practice and the overall economic well-being of your municipality, establishing and maintaining a policy for treating the uninsured and under-insured is one of the most difficult decisions you’ll have to face. The Affordable Care Act (ACA), while expanding coverage for the uninsured in many ways, requires health plans to cover dental services for children, but not adults. Medicare generally does not cover dental care, and Medicaid coverage for adults varies by state and may only cover a limited list of dental services.
Data from the American Dental Association (ADA) show that emergency department visits for dental care doubled from 1.1 million in 2000 to 2.2 million in 2012. Many others who lack insurance forego dental visits altogether, which can lead to higher costs and lower health in the long run. Striking a balance between providing needed services and maintaining your practice is complex and challenging. As you are probably intimately aware, most reimbursement through state Medicaid programs is significantly below what private insurers pay.
Yet, the desire to help others and give back to their community compels many dentists to dedicate certain days and hours to providing the uninsured with check-ups, and others operate on a sliding payment scale or find other means of providing care. Many volunteer at community health centers, and still others allow bartering arrangements or discounting of services whenever possible.
One Common Denominator
No strategy for treating the uninsured will be appropriate for every dentist or every practice. But no matter how you choose to deal with the issue, one thing that is consistent across every practice is that once you have begun an appointment with a patient, their ability to pay must have no bearing on the level of service you provide. The standard of practice cannot vary based on the identity of the patient, the type of dental coverage, or the patient’s ability to pay.
Any failure to recommend appropriate treatment, any improper treatment, or any other form of malpractice will be subject to potential lawsuits, removal of licensure, or censure or suspension by dental coverage plans (such as Delta Dental and others). Participation agreements with those plans have very clear language about this and strict terms on providing patient care.
No matter how your practice deals with the issue of the uninsured, you can become personally involved in serving the uninsured and under-insured by volunteering at a community health center or low-cost health clinic. As I noted in my article on volunteering, volunteering offers rewards for not only the recipients of your care, but it offers tremendous non-pecuniary benefits for yourself as well.