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Jacob O. Layer DMD, PC December 2021 Newsletter
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2021 Christmas Message

As a team, we have been more intentional this year at counting our blessings. We see the good that God has provided all around us. Good people, strong relationships, friends, family, positive growth, great energy, opportunities for healthy living, choice & accountability, faith, and assurance of great things to come. Everywhere. All around us. Please take several minutes to count your blessings. Take a gratitude walk, share it with someone, or just think of all the good around you wherever you are, right now. Reject fear and uncertainty. Remember why we celebrate Christmas. Choose faith. Choose love and respect for others. Try to see others as God sees them: as possessing infinite worth and divine heritage.

Thank you for the opportunity to serve you and your family this year. Really.

-Merry Christmas from all of us at Layerdental

Dental Insurance Realities - Part 4

We’ve all heard the term “preferred provider network”. Let’s dig into that a little here. Benefit plans often will have a "preferred provider" network. When you buy into that plan you can't just choose any provider, you choose one from a specific list. The providers on that list have signed a contract with that benefit plan. You can't always tell if a plan is a "preferred provider" plan just by the name of the insurance company. And benefit plans will often withhold their fee schedule from out-of-network providers thus making it impossible to accurately estimate how much a benefit plan will contribute to a given procedure (much less a whole treatment plan). It's like they fold their arms, purse their lips, and stubbornly refuse to share if you're not on their 'nice' list.

Now, remember the November article: if the benefit plan gets to set the procedure fees, even for procedures that are not a 'covered' benefit, then what influence does that exert on the provider? Could that pressure cause some providers to consider using lower-quality materials? Or maybe to have crowns made by an inexpensive foreign dental laboratory? Certainly, not every provider does this but pause to consider what influence this might have. But what about 'standard of care'? Wouldn't the provider be violating the standard of care? When you hear the term 'standard of care' understand that it is a legal term that means 'minimum competence'. So, no: using a cheap foreign lab or low-quality materials, or spending less time refining an occlusal orthotic appliance doesn't violate the standard of care. Because the results can meet a low 'minimum competence' standard. That's easy. But sooner or later you’ll have to decide for yourself if the result is lower quality than what you might get in the absence of said behind-the-scenes pressure.

Did you know that dental benefit plans market themselves to dentists? They do but that shouldn't be surprising in our marketing-saturated world. This is how they do it: "Do you need new patients? Do you have room in your schedule & want to make more money? We have x number of patients in our ABC Dental Benefit Plan (in your town!) who are looking for a great dentist just like you! Just sign up with us and we will fill your chair." It's the fill your chair that's pretty attractive for the dentist. See more patients, right?! And it works. The schedule will become more full. Other sectors of the economy call that ‘make it up on volume.’ Could that partly explain why we can sometimes feel like a "number" when interacting with doctors? Feels like there's less individuality.

Let's get real for a moment. There have been a few times where I know that I cannot deliver a quality result under the reimbursement rates offered by a particular plan and I have had to tell the patient, "I can't help you." It doesn't mean that she has no access to care. It just means she has to go somewhere else to get it. And occasionally, a patient to whom I have to say 'no' will ask, "what if I pay you the difference outside of the benefit plan?" It’s a fair question. But that's viewed as insurance fraud. So everyone's hands (except those of the benefit plan!) are tied. Is that an 'access to care' problem?

A provider who is contracted with a benefit plan to be an in-network provider can't pick and choose what procedures he will do in-network and which he will do out-of-network. That's also insurance fraud. If you're an in-network provider you're all-in. You have to play by the contract rules for every patient in that network, all the time. Providers who can't afford to deliver quality care under low reimbursement rates have to say no, deliver care at a loss, or cut corners. What would you do?

Providers should never cut corners or deliver lower-quality care because of third-party influence. If the patient chooses a solution that is less than ideal it should because all solutions have been personally and thoroughly discussed with the dentist and the patient has made the choice on his (or her) own. That's essential to proper, ethical informed consent.

So, after you boil it down, are "preferred provider" networks the in-crowd we think they are? You decide.

Dreaming of a White Christmas?

Teeth whitening is pretty rad! What once was unpredictable is now effective & convenient. If you have always wanted whiter teeth, now is a great time. There are options. Whitening toothpastes can be effective at maintaining your current white. If your teeth are darker and need more oomph to get that glow, consider whitening strips or custom trays. Whitening strips can be a great screening tool: if you have no cold sensitivity with them, you'll likely be OK with professional-strength whitener in custom trays. Always consider a professional cleaning to jump-start the process. Sensitivity to cold is still the most common complication associated with tooth whitening. If you experience this common but annoying side-effect, try bleaching for a shorter period of time, or simply do it every other day. Tweak it & find your formula.

Fun fact: teeth that are traumatized or that have had root canal therapy will often darken. Those teeth can be whitened from the inside out, restoring their former glimmer.

Want a whiter smile? Got questions? Pick up the phone and give us a call!

Dr. Jake and his Team would love to hear from you! Got a question? We can help!

Jacob O. Layer DMD, PC | layerdental.com | 541-734-0970
1485 East McAndrews Rd., Medford, OR 97504



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