Insurance in the time of corona

In a few short weeks, the spread of the novel coronavirus has dramatically impacted the United States, causing yet untold loss of life, incalculable harm to the economy, and a wholesale reorganization of our society, which seems to revolve entirely around Zoom meetings and webinars for the moment. Outside of our homes, the risk to individual and public health is of paramount concern. However, as we begin to think about returning to some semblance of normalcy, we must take stock of the ongoing impact COVID-19 may have on the dental profession.

The requisite intimacy of dental work, combined with the high transmissibility of this virus leaves our field in a unique and perilous position.¹ This reality engenders many concerns, not the least of which is safeguarding patient, staff, and personal health while delivering care. Other concerns include decreased demand, changes in scheduling and protocols (i.e., jumping from a crown prep to a hygiene check may be a thing of the past), and required mitigation efforts such as new personal protective equipment (PPE) and treatment regimes. Ultimately, all of these considerations translate directly into costs. 

At the national level, the American Dental Association (ADA) has been hard at work developing a PPE code that may defray some of these new upfront and ongoing costs. We are optimistic that insurers will appreciate the effort and attempt to serve as a bulwark for dental practices as costs per patient/procedure skyrocket.

Regarding the last point, it is worth noting that many insurers will continue to collect premiums after having their liabilities drop to zero for six weeks or more, and will have an ongoing decrease in liabilities writ large. And while we recognize that they likely have lost some subscribers given the tumult in the economy, and some employers may have been granted premium holidays, it remains likely that the most cynical of dental insurers may elect to retain this largesse.   

With these facts in mind, we should be hopeful that insurers might work with organized dentistry and state dental societies in an attempt to preserve businesses by moving monies that would have otherwise gone to them if not for a once-in-a-century pandemic. This seems especially urgent given the ADA’s Health Policy Institute survey results suggesting that if closures are required beyond July, up to 50 percent of practices would have to shutter by the end of the summer.² It would therefore seem a reasonable gesture for insurers to offer, at minimum, discount holidays going forward (where contracted discounts are removed), and for those weeks when offices were completely closed, some percentage of the average monthly payments over the last 12 months, less their own loss in business. Naturally, the mechanisms for such arrangements would have to be negotiated.

Anyone who has interacted with an insurer in recent years may worry that the ADA’s efforts could be in vain. While we remain optimistic, in the event that insurers cannot be called upon to be partners in this time of incredible uncertainty for dental practices of all stripes, dentists will have to make some purely economic calculations around how their businesses may survive until we can put COVID-19 behind us. 

Ultimately, there remain many unknowns and facts are changing by the day, but our costs and productivity will be profoundly impacted until there is a vaccine or a robust, community-based testing procedure in place. Absent such protocols, and in the event that insurers refuse to surge reimbursement to reflect these exigencies, practices across the country will have to decide if the discounts received through relationships with dental insurers reflect adequate reimbursement for their practices to survive.

Materially, such changes will mean that patients will share some of the new costs we are sure to bear. In the short term, concerns around issues such as access to care may be exacerbated, and advocacy on those fronts (e.g. increased reimbursement for RCTs and extractions through state Medicaid programs) should be undertaken. But when practices are faced with the question of survival, all considerations must be made.  

We hope that insurers choose to join us as partners in the midst of this global crisis that calls for acts of goodwill and good faith. However, in the absence of such partnership, dentists should be prepared to establish fees that reflect present realities and to reevaluate whether contracts from a pre-COVID-19 world are appropriate in these extraordinary times. 

References

1. Gamio L. The workers who face the greatest coronavirus risk. New York Times. Published March 15, 2020. https://www.nytimes.com/interactive/2020/03/15/business/economy/coronavirus-worker-risk.html
2. Second week of HPI polling shows dentists' response to COVID-19. American Dental Association. https://www.ada.org/en/publications/ada-news/2020-archive/april/second-week-of-hpi-polling-shows-dentists-response-to-covid-19