The Health-Insurance-Finance ENIGMA

Health is the greatest gift, contentment the greatest wealth, faithfulness the best relationship.” -Buddha

As Health is indeed “The Greatest Gift,” regaining or maintaining it should be a matter of serious focus and attention.

Using “taking my insurance” or finances as the sole criteria of choosing a dentist, physician or other health professional comes with risks and responsibilities. The attitude of “If my plan covers it, it’s OK and I’ll do it” also comes with significant risks.

While I hate to generalize and I know some dentists who selectively participate in insurance plans, and first-class dentistry, I’ve seen and even experienced some real ethical and professional issues that, in some cases, can be directly traced to the Practice’s focus on insurance reimbursement and financial considerations rather than proper, individually-focused, customized, long-term care and solutions.

This came home personally when, several years ago, my grandson was taken to a dentist who took insurance rather than the pediatric dentist I had recommended who was less convenient. That dentist, who I would love to meet in a dark alley, did things that could only be explained by a policy to make the most out of insurance rather than do what the child really needed. For instance, in my opinion, there was no reason to give a child below the age of 5, with little risk of decay a fluoride treatment. The result was that my then 3-year-old grandson swallowed some and threw up. To make matters worse, when they did the same thing during his next visit, he threw up again! Too bad he didn’t do it all over the dentist!

My grandson has now been traumatized by this dentist and will always connect it with his bad experience from a dental practice that used insurance guidelines instead of common sense. I can’t tell you how many people I see that have endured a childhood trauma at a dental office and now suffer from anxiety every time they come to see me. Such childhood experiences are very difficult to overcome.

I’ve seen dental practices that take x-rays every 6 months as a matter of “POLICY.” I can’t see any justification for that except in very extreme cases, other than financial.

And, I believe that such financially driven practices are more common in areas with higher office overheads that eat into profits or those that participate in Insurance Plans. Call me cynical, but I do believe money is at the root of the problem. Insurance controls doctor’s revenue with little to no consideration given to overhead expenses. So, some doctors find ways around the situation.

The challenge is, that if you don’t want to fall victim to such “Insurance-focused” or “financially-focused” practices and POLICIES, you have educated and advocate for yourself. YOU have to ask questions such as WHY?

WHY x-rays and is there an alternative?
WHY antibiotics and is there an alternative?
WHY fluoride and is there an alternative?
WHY 3-month hygiene visits vs. 6-month visits?
WHY a crown instead of a filling?
WHY an implant instead of an alternative?

At Manhattan Dental Health, you should be presented with justification for any proposed treatment prior to its initiation. You should feel secure that the proposed treatment is appropriate for YOUR SPECIFIC NEEDS. You shouldn’t have to question us, we should volunteer the information. But, if we somehow forget to provide the explanation, please do question us. And, we should back up our claim with some evidence such as pictures, Carivu-non-x-ray images or results of tests such as bacteria profiles will act as evidence of the need for the action prescribed. And, if we somehow forget, you should NEVER feel reluctant to ask us WHY?

Yet, that doesn’t happen in most offices; insurance or non-insurance-driven. Doctors often feel that their degree confers upon them some magical power that allows them to automatically get patients to accept their recommendations. In fact, I’ve seen some doctors become angry and incredulous when questioned as if putting on a white coat turns them from Clark Kent into SuperDoctor. How pathological is that?

Sorry, but the days of the Doctor SuperHero like Dr. Kildaire, Marcus Welby, MD and Hawkeye Pierce are gone. It’s a new healthcare world out there and its getting harder to navigate through it. Finding the right people to trust is becoming MORE challenging rather than LESS.

Asking WHY something is being recommended should evoke a response of justification. “Mrs. Smith, you have this problem and I believe this is the best course of treatment because_______.” That justification should be backed by some degree of proof. And, if WHY isn’t answered, justification not given or proof not forthcoming, JUST SAY NO. Better yet, just walk out. You’re in the wrong place.

Healthcare by “POLICY” is a sure sign of non-customized ‘by the numbers” and not individualized care.

And please, while I know we all use the internet, Dr. Google is NOT a superhero either. I’ve written about the foibles of using Google to search for medical/dental information. It, too, requires a lot of education and time taken with a healthy dose of skepticism. Google too wants to make money.

“Be careful about reading health books. You may die of a misprint.” -Mark Twain

The responsibility of getting the best care, in most practices other than Manhattan Dental Health, falls upon YOU the patient. So, you have to be willing to do your homework, spend some time and ask the questions. Better yet, find someone who you trust and who gives you the justification and the alternatives.

Maybe I’m crazy but I believe that most dentists and physicians can and want to do what’s best for their patients. Most are taught the right things. Today, with a focus on money and with little TIME to spend with patients, doctors are being pushed against a wall. Some, saddled with student debt (I know of one Doc who had $800,000 of student loans) or other economic stressors such as divorce, have a “financial gun” to their heads. It’s up to you to make sure that such pressures don’t get in the way of you getting the best possible care.

Financial concerns are real. Sometimes there are hard choices to be made. Having all the facts, being your own advocate, knowing all your options and having someone you TRUST can help resolve the ENIGMA.

To Everyone’s Excellent Health and Wellness,

P.S. While these emails do get posted on my website’s blog and Facebook page, my mission is to educate as many people as possible. I ask that if YOU know of someone who would benefit from the information I send, either pass it along or give us their email address and we’ll place it on our list. Thank you for your help.