United Dentists of Kansas is now among other emerging grassroots dentist and patient advocacy organizations including the Concerned Dentists of Washington State, the Concerned Dentists of Texas, and the Massachusetts Dentists Alliance for Quality Care.
These associations target specific matters relevant to dentists and patients within their individual states. Such firebrands often are the spark that ignites larger groups such as their state dental associations under the ADA into action.
Also, many members of these organizations say they are proud to be a part of a team apart from the general apathy found elsewhere in too much of the dental profession.
“It’s our complacency that got patients and dentists alike in this situation to begin with. Two years ago, in that apathetic environment, the movement to pass a law to allow dental therapists to practice in the state of Kansas almost succeeded,” said Mark Troilo, DDS, a director with the United Dentists of Kansas.
“Because of the efforts of a few of us doctors, to make a long story short, we began to rally the troops via phone calls, emails, and personal contacts. Then we started pursuing legislators hard the same way and eventually found a strategically placed representative that liked our cause and helped us through the problem,” said Troilo.
“Because we didn’t quit when it looked like we couldn’t win, our passion turned the tide. The real lesson learned was it took many dentists from all over the state to get involved before we could start to use our powers of persuasion. One or two can’t do it. You absolutely must motivate the masses. That’s where the power is,” said Troilo.
“Now, we had a well-established network that we all wanted to keep together to accomplish other projects. After the therapists issue was settled, a small think tank of docs began to meet in Kansas City every few weeks and months to begin to work on dental issues and how we could legitimately effect change in different areas,” said Troilo.
“We started to see a direction we could go and used the think tank’s contacts, the large list we had put together for the political push, and any and all contacts we could get our hands on from there. We encouraged our group to reach out to others as well, and before you knew it, the group swelled to over 350 doctors,” Troilo said.
“We hired an attorney to keep us on the straight and narrow, and before you knew it, we had delved into Delta Dental of Kansas’ bylaws, which the dentists in Kansas control, and began to make changes that could help patients and doctors overcome the obstacles that Delta had put in the way to allow patients to get their benefits they paid for,” Troilo said.
“To ensure that we did things the right way, we hired an attorney to comb through the bylaws and identify anything in them that gives Delta an unfair advantage over dentists or patients. We found a lot,” said Chris Leiszler, DDS, another director with the United Dentists of Kansas.
“Also, we decided to try and take steps to challenge some of the ‘Mickey Mouse’ rules that Delta and other insurance companies have put into place that interfere with our ability to provide the best care for our patients. Of course, we put out a plea for financial help to all the doctors, and many contributed to the cause, which has helped defray our legal costs,” Troilo said.
“Once again, because we are trying to change something we control, the bylaws, we can meet and discuss all we want. We do not want to encourage people to drop Delta or discuss fees, because that’s not what this is about. We want to be Delta’s partner, and right now, we are their slaves,” he said.
“A positive partnership with Delta and the dentists and patients would benefit everyone involved. We’ve also created an environment that enables us to have special meetings, so we don’t have to wait for the annual meeting provided for in the bylaws,” said Troilo.
“It took us almost two years to develop from scratch. Now, we feel empowered and hope to accomplish more and face tougher issues going forward. If we can start to share ideas with other states that are doing similar things, we can begin to reverse the tide of second-rate care that seems to be infecting our country more and more as the years go by,” Troilo said.
“We submitted some amendment proposals to Delta, and although we’re still working on them, we certainly got their attention, and we’ve opened the lines of communication with their CEO. He has actually been quite responsive, and we are now working together to find ways for Delta to become a better partner to dentists in caring for our patients,” said Leiszler.
“For decades now, dentists have been forced into a subservient role with Delta, and we are changing that back to a strategic partnership as it was originally intended,” said Leiszler.
The role that dentists play as patient advocates and in providing access to care is critically important to Leiszler and the United Dentists of Kansas.
“To speak in general terms, dental benefits belong to the patient, so we are first advocating for our patients and their ability to fully utilize the benefits they’re paying for. Dentists can benefit when that happens, but facilitating more access to care was the original intent of dental benefits,” said Leiszler.
“We are also looking for ways to give dentists clarity when helping patients with their benefit claims and transparency in Delta, since they are a nonprofit social welfare organization, at least by IRS Code 501c4. The ADA has some excellent policies on patient benefits, and we’d like to see those be followed by every company that provides benefits,” said Leiszler.
“We are helping the patient get a better product. What significant improvements have been made in dental insurance in the past half century? There haven’t been any. Even the Delta Dental of Kansas CEO agreed with me on that,” said Leiszler.
“In fact, I could argue that the product our patients have been receiving has actually gotten worse over time. Each year, dental insurance companies seem to make up more rules and more obfuscations to prevent patients from fully utilizing their benefits. They seek to make dental insurance less user-friendly every year, yet premiums continue to go up,” said Leiszler.
“Can you imagine what would happen if Apple intentionally made the iPhone less user-friendly each year, yet continued to raise prices? It would never work. But it’s been working for the dental insurance industry because they play by different rules—rules that they make up. We’re trying to change those rules in order to hold them accountable to provide better dental benefits. Better dental benefits can result in better health, and that is the goal,” said Leiszler.
“Holding patients’ benefits and claims service hostage doesn’t give them freedom of choice. We intend to address the fact that patients receive less benefits and service if they choose to receive care from an out-of-network provider,” said Leiszler.
“Since patients, generally through their employers, are paying Delta for these benefits, we would like all of Delta’s policyholders to receive uniform benefits within a plan, without being penalized for going to the dentist that they feel is in their best interest,” said Leiszler.
“Once the premium has been paid, Delta should allow the patient to fully utilize the benefits and receive their service from Delta without additional penalties or restrictions. It is the patients’ benefit,” said Leiszler.
“This is ADA policy, and there are several other states where regulations are in place that are fair to both the patient and the insurance provider. We would like the people of Kansas to be treated fairly, too,” Leiszler said.
“It’s one thing for a patient to go to an out-of-network provider and knowingly have to pay more than the allowable amount. Many patients are fine with that and are happy to pay the difference,” said Leiszler.
“But what many patients don’t know is that Delta might cover 100% of their allowable fee for a prophy if the patient sees an in-network provider, but then they change the rules and cover only 80% of their allowable fee at a non-contracted provider. So, Delta saves money in this scenario, and the patient doesn’t get all the benefit they’ve paid for,” said Leiszler.
“We are working on ways to utilize the bylaws in order to get more transparency from Delta. We are also working toward eliminating many of the made-up rules that Delta uses to get out of paying providers fairly or limiting the treatment that patients can use their benefits for,” said Leiszler.
“I’m talking about tricks they use like bundling radiographs, downcoding procedures, providing alternate (lesser) benefits, ‘disallowing’ procedures, and considering separate procedures to be considered ‘content of service,’” said Leiszler.
“As dentists, we are legally and ethically obligated to code accurately for the procedures that we provide. But for some reason, dental insurers are held to a lower ethical standard where they aren’t required to reimburse for what is billed,” said Leiszler.
“We are not powerless to make significant changes. It was our own complacency that has allowed dental insurance companies to take advantage of patients and dentists, and the time has come to stop being complacent,” said Leiszler.
“If you are a contracted provider with Delta Dental, it is your right to make changes to the bylaws under which the company operates. We just need to shine a brighter light on the failings of the current insurance environment and start working to improve them,” Leiszler said.
Dr. Davis practices general dentistry in Santa Fe, NM. He assists as an expert witness in dental fraud and malpractice legal cases. He currently chairs the Santa Fe District Dental Society Peer-Review Committee and serves as a state dental association member to its house of delegates. He extensively writes and lectures on related matters. He may be reached at mwdavisdds@comcast.net or smilesofsantafe.com.
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