Conversations about Real Insurance in OAT can be DIFFERENT


Successful dental and medical treatment depends on several variables working together harmoniously:

  • Agreement on the Desired Outcome
  • Accurate Diagnosis
  • Selecting the Appropriate Treatment For The Diagnosis [Medical Decision Making]
  • Treatment Recommendation and Case Acceptance by the Patient
  • Patient Compliance (Adherence to Therapy)
  • Payment from Third Parties And Patients

Although these steps are true for both, there is a BIG difference in how they are closed and financed. In dentistry, there is NO real insurance. Real Insurance is defined as when a third party takes a risk for a catastrophic loss.  There is nothing catastrophic about $1200-$2000. It is more than I carry with me, but far from a catastrophe. House swept away by a tsunami or total your car? That would be catastrophic! Similarly, “insurance” coverage in dentistry covers the same as it did upon its inception in 1955; we forgot to index it for inflation. Dental “plan” or “benefits” are better names than “insurance”. As a dentist, I also often work through the deductibles, co-payments and pre-authorization discussion hoping to get patients to say YES!

Sometimes, how we look at the problem is the problem!

Consider a different paradigm. On a trip to Las Vegas in December my wife and I had a little scare. Denice had experienced intermittent tingling in her left arm, perhaps her lower leg and maybe a portion of her neck. She had a ‘feeling’ that her grip was weak but it really wasn’t. Some say that knowing a little medicine is a dangerous thing, but we felt it was important to get to the hospital fearing a TIA, Stroke, MS or something along those lines. The emergency room staff agreed with our concern and said that far too many ignore early signs and symptoms that lead to a sorry ending. All the tests were negative (urinalysis, blood work, CAT Scan, MRI, MRA, carotid ultrasound and more) and she is fine. We still do not know what caused these transient symptoms but we know, with her stats, she is certain to outlive all of us!  Further analysis and good news, it looks like it was just a pinched nerve under her scapula.

During the day and a half we were in the hospital, no one spoke with us about our insurance coverage, what was covered or not, how much our deductible was or what our out of pocket cost would be. They took our insurance information at the registration in emergency, but no one asked us if we wanted to proceed with diagnostics, testing, analysis or eventual treatment. In medicine, unlike dentistry, there is Real Insurance by a third party for a catastrophic loss. That is what insurance is. Oh, there may be deductibles and co-payments for a while, but when the proverbial yoghurt really hits the fan you have coverage. Dental benefits run out at $1200 or so for most plans. That is not insurance; a preventive benefit or maintenance plan, yes, but NOT Insurance!

What Should We Say or Do Differently?

We should NOT cheapen obstructive sleep apnea treatment and the subsequent oral appliance therapies by talking about them like we would dental benefits. Patients deserve a medical diagnosis, treatment, and  good outcomes. OAT is a medically necessary treatment that the patient will not live well without. We all can recite the co-morbidities and decreased life expectancy statistics in our sleep (pun intended). This is the time to step up, think beyond the paradigm that shackles us about insurance and simply tell the patient what is needed and expect them to schedule. If the patient asks, of course we should answer as best we can.  But almost 100% of the dentists I have observed and spoken with, LEAD with the fee and what will be covered by insurance. This somehow makes it seem optional. Or at least lets the patient feel it is optional. It ‘feels’ to patients like we are having yet another dental treatment discussion like we do about bite splints, implants, crowns and other discretionary purchases. That is how so many of those in our care view dentistry…as an option, not a necessity.

When we become involved in patients with OSA we have an opportunity to have a paradigm shift. We can change how we discuss the need for the treatment., the role of insurance and how we will exact payment. It is life threatening, not optional. Patients have real insurance for this. They may have deductibles and co-pays to be sure, but we should act more like physicians in this arena. We will do more and help more. Will there be collection problems down the road when they experience co-pays, deductibles and fee exceptions? Of course, there will be. The Dentists who have made the leap successfully often use third party billing partners and they are excellent at supporting this model.  I am fortunate to work for a company completely dedicated to helping dentists treat more patients with efficiency and effectiveness. At ProSomnus Sleep Technologies, we assume all your patients deserve the best sleep appliance. We want to help you succeed. This discussion may help you have a few more good conversations with patients about OSA.

Mark T. Murphy, DDS, FAGD, is the Lead Faculty for Clinical Education at ProSomnus Sleep Technologies, Principal of FunktionalTracker.com, serves on the Guest Faculty at the University of Detroit Mercy School of Dentistry and is a regular presenter on Business Development, Practice Management and Leadership at the Pankey Institute. He has served on the Boards of Directors of the Pankey Institute, National Association of Dental Laboratories, the Identalloy Council, the Foundation for Dental Laboratory Technology, St. Vincent DePaul’s Dental Center and the Dental Advisor. He lectures internationally on Leadership, Practice Management, Communication, Case Acceptance, Planning, Occlusion, Sleep and TMD.

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