The Dangers of Insurance-Driven Care

Again, this week I saw a patient who succumbed to inadequate dental care through no fault of her own.   She went to the Dentist.   She complained of her problems and she followed advice.   Yet, her problems became worse and frustrated, she just stopped going to the Dentist.   After all, it just wasn’t getting better.

Why did her problems go untreated?

Our healthcare system is directed by people who don’t care about your health.   Is that crazy?  You bet it is.  It’s the ‘fox guarding the hen house’.

Insurance company and Government bureaucracies direct much of our healthcare much to the frustration of the Doctors who care for you.   Just ask your Doctor.  Is insurance a help or a hindrance?  I know what they’ll say.   They love the access and they hate the control.

So, many of my physician colleagues are opting out of accepting insurance and Medicare.   Why?  Because they feel it’s compromising the quality of their care.  They’re right.

This isn’t political; it’s the honest, hard truth.   If you have a Doctor who truly cares, he or she wants what’s best for you.   They went into the profession to be ‘of service’.   Watching people not get the care they deserve is abhorrent to them.  No one wants to see their efforts fail and yet we’re failing to keep people healthy.  According to the World Health Organization, we’re #37, just behind Costa Rica!

Yet, people still come here from all over the World for Dental and Medical care because we still have the best schools and our experienced Doctors are the best.

The problem is actually worse than it appears.  Some may say, well, we’ll just go to these experienced, good Doctors and pay out-of-pocket.  That might work for a few more years.

What’s happening now is that our Nation’s young doctors are being trained in Hospitals, Medical and Dental Schools all over the Country in this insurance-driven health care.   Faculties are being decreased because of decreases in reimbursement just as tuition to schools have gone through the roof and class sizes increase, diluting resources even further.

Graduating healthcare students are facing such incredible debt that they have no choice other than to accept jobs with large, insurance-driven clinics that also practice the ‘insurance-driven’ style of care.

In Dentistry, it means that even if a Dentist wants to practice the “ideal” care he or she was trained to do (if they were), they can’t.   When care is guided by the meager yearly maximums that insurance companies pay, the only option is to do “patch-up” care.   That works for some but for my patient this week, it was severely damaging.

What happened to Jane (not her real name)?  She started noticing when she was pregnant that “my teeth seemed to be loosening”.  What Jane was experiencing was gum disease that often is exacerbated by the hormonal changes of pregnancy.  But the problem went undiagnosed.

After the pregnancy, the acute part of the disease subsided.   The underlying effect, the loss of bone and support of the teeth continued.   That loss of support, together with nighttime clenching then caused her teeth to shift.

Jane came to see me because her smile had changed.   She now had spaces between her teeth, spaces that only recently appeared.   Also, the gaps between her back teeth were getting more annoying.   Everything she ate got caught.   She has to floss after every meal just to be comfortable.

Worse, while all this was happening, she had 2 caps done.   Guess what?   They have gaps between them now too.

Did she go to a “bad” dentist?   I wouldn’t go that far.    What I do know is that no one ever took the time to really get down to the causes of her problems.   WHY NOT?  Because insurance companies pay a premium for treatment and not diagnostics.   Yet, you need a proper diagnosis before you have any treatment!

Insurance companies have it backwards.  They should pay maximum fees for preventive and diagnostic care.   Doctors should be rewarded for keeping people healthy and not by doing procedures when they get sick.   That’s part of what’s wrong with the system.

Back to poor Jane, who is now undergoing gum treatment.   She’ll need Invisalign to move her teeth back to where they should be and close some of the gaps.   Some, that can’t be closed, will require restorations and caps to be redone.   Moreover, she’ll need porcelain veneers to fix her smile and compensate for the loss of gum and bone from the gum disease that started the whole mess and resolve the ‘black triangles’ that make her smile look aged.

Will insurance cover this?   It will cover up to the yearly maximum and Jane has a superior plan that covers $2,000 a year.   It will not cover anything they deem as ‘cosmetic’.  So over the 2 years it will take to treat Jane, she’ll probably get $4,000 of benefit.   Her out-of-pocket expense?  Nearly $20,000!!

Wow, $24,000 to treat problems that could have been prevented with relative ease while she was pregnant.

To your health..and Jane’s


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