Research between dental and health care markets revealed that nearly 40% of total dental health spending is out-of-pocket, with health care spending only comprising 11% according to Health Services Research. In the same research study, dental health professionals and dental practices have in recent years merged with Dental Management Service Organizations (DMSOs) to have an upper hand when bargaining with dental insurers. The rise of DMSOs has seen strong prevalence in recent years, with about 4% of all dental practices tied to a DMSO group.
DMSO groups have made it easier for dental professionals and practices to control and receive higher reimbursements from dental insurers. Although it can offer an array of positive financial outcomes, DMSOs remain centrally responsible for managing accounts, administrative services, operations, and any reimbursements. The International Journal of Health Economics and Management study revealed that locally and privately owned dental practices are decreasing year after year, with larger DMSO dental groups on the rise. DMSO groups enjoy a concentrated prevalence in the relationship between dental professionals and insurance companies, but this influence is now being felt by the patient.
Changes in dental insurance
In the not-so-distant past, dental health care professionals, practicing under their own names, or a local dental practice would have to bargain and negotiate pricing with insurance providers. The playing field now looks somewhat different since the induction of DMSO groups. Although these groups can provide positive outcomes for dental professionals in terms of financial security, DMSO groups focus on mitigating the need for reimbursements to smaller practices that are not listed on their preferred list of providers.
The outcomes are a lot different for the patient. It now means that a larger corporate body, a DMSO group, can negotiate prices and discount rates patients are allowed to receive at their local dental provider. This can make it even harder for patients and individuals to find affordable, accessible, convenient, and trustworthy dental providers. Simply put, DMSO dental groups do not necessarily own any of the local practices, they simply act as a corporate veil between the dental provider and insurance company, but still, control the bargaining.
Can DMSOs control what’s covered?
To some extent, it’s quite difficult to say whether a DMSO dental group can control what’s being covered in an orthodontic treatment plan. In some ways, we can see that a DMSO dental group of practices can perhaps only control the prices which a local practice can charge for orthodontic treatments, while still holding firm in their acquisition to bargain with dental insurance providers. This makes the scenario somewhat complex, as DMSO groups can bargain for the prices and reimbursements on a variety of treatments and offerings available on their preferred list.
What can dental insurance providers cover?
It’s not always a given that dental insurance providers will cover a host of procedures and treatments, depending on the type of policy you hold and its coverage limit. But even with the inception of DMSO groups, dental insurance still only covers specific orthodontic treatments that differ between policies.
For young individuals and adults looking to straighten their teeth, while not breaking the bank, some dental insurance policies can cover the cost of Invisalign and a select few invisible teeth aligners.
In some severe cases, braces are required. Braces are a long-term solution to improve your smile but can cost you anything between $3000 and $8000 if your dental insurance policy doesn’t include orthodontic benefits.
At-home or clear aligners
A relatively new concept on the market, at-home aligners have made it more convenient for patients to straighten their teeth without the need for braces. An orthodontic benefit that has seen multiple dental insurance providers change their policies to include. Smile Prep has given thought to the rapid rise in popularity regarding invisible aligners allowing customers to compare various brands based on consumer reviews.
A final thought
Dental insurance is just as crucial as health insurance but individuals are more likely to pay out-of-pocket for orthodontic treatments. While a corporate body may control reimbursements between insurance providers and dental professionals, it’s important to consider what your personal needs may be, and how much of it you’re willing to pay by yourself or with the assistance of an insurance company.