Fred L. Goldenberg: Grand Traverse dentists leaving a bad taste in patients' mouths

Nov. 6—Where is the only place you go that when you check out, you are asked to set up another appointment for some date six months in advance? Answer: the dentist office.

The American Dental Association has done a masterful job of convincing us that getting our teeth cleaned every six months helps maintain good oral health and prevents potential issues from developing. I, for one, dutifully follow that advice, and every six months allow someone with sharp objects to scrape and prod my mouth in the name of "good oral health."

One of the main reasons I go every six months is they've also convinced my health insurance provider to include these cleanings as part of the basic coverage and pay for them. You may not know this, but the reason they agreed to pay for them is that during a dental cleaning, dentists and hygienists can often detect early signs of various health issues associated with gum disease, such as oral cancer, diabetes, heart disease, kidney disease, osteoporosis, gastrointestinal disorders, nutritional deficiencies and autoimmune diseases — thereby saving thousands of dollars in future claims.

By now you're probably wondering why has Fred become the poster child for oral health? The answer is that I am not. As a matter of fact, I am a very angry consumer advocate. Every day my Medicare clients, who have heard from their dentist that they are no longer going to take their dental insurance, want to know why.

This question is being asked so often that it has left me wondering if somehow all the dentists in the Grand Traverse region got together and, as a group, decided to avoid using a specific provider, thereby forcing them to renegotiate their fee structure.

I have no proof that a meeting of this sort took place because if it had, competitors collectively agreeing to boycott a supplier or a provider may be considered illegal under the Sherman Antitrust Act if it unreasonably restrains trade.

Far be it from me to insinuate that our local dentists did such a thing, but when you read in the November 2024 issue of the Traverse City Business News an article titled "Out of Network: Why dentists are ditching Delta Dental, and dropping other carriers, too," one might draw the same conclusion that there might have been a touch of collusion going on. The gist of the article is that the dentists claim Delta (and others) have not raised reimbursement rates to keep up with rising costs and Delta (and others) claims they have. In either case, it is the patient who will bear the brunt of this fight.

If your dentist goes out of network, this will be the scenario when you go to pay. You will be required to pay for your treatment in full up front. The cost of your cleaning will be determined by your dentist, who may say it's worth $300 (actual amount, per my client). You pay the full amount and they magnanimously submit your bill to Delta for you. You receive a reimbursement check from Delta equal to the amount they'd reimburse the dentist.

What you quickly find out is what your dentist thinks his/her service is worth is far different than what Delta thinks its worth and you are left with paying significantly higher fees out of pocket.

I don't know who is right in this fight. I don't know if Delta's fee schedule is fair or not. All I know is what I'm hearing day after day from my clients. They are very angry at their dentists and feel they are being used as pawns in the battle with Delta Dental.

If the local dental establishments' strategy was to rile up their patients so they complain to Delta Dental and champion their cause, I don't think it's working because, as one of my clients said, "I love my dentist. But I don't have $300 in my checking account to pay and then get reimbursed from Delta for $90. I'm searching for a new dentist right now."

So, if it is their strategy, maybe it will work and maybe it won't, but in any case, it's leaving a very bad taste in a lot of people's mouths.

Fred L. Goldenberg is a Certified Senior Advisor (CSA) working with Michigan Planners, a financial services and certified health insurance organization in Traverse City. Contact 231-944-1400 or [email protected] with any questions or comments about this column or with interest in monthly Medicare classes.

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