Managed care bites benefit! Dental benefits may not be extracting the same amount of dollars as core benefits, but it's still important to keep them brushed and flossed

Business & Health, May, 1991 by Martha Glaser

At Hewlett Packard, enrollment in the prepaid plan varies between 19 and 40 percent of employees. "At some point, enrollment will reach a leveling-off point, but we're not quite sure where that will be," says Mariconi.

In many cases, employers don't force a capitated dental plan on employees, but offer it as a choice, says Patrick P. Gribben, Jr., president of Delta Dental Plan of Michigan. That is, the employee can either stay with his own dentist under fee-for-service, or opt for a capitated plan that gives a richer benefit package.

Under the CIGNA Dental Option Plan, for example, employers can offer employees a choice at open enrollment time, with the employee able to change his or her mind at one other time during the year.

Discounted dental care is also a big part of the managed care picture, according to Kenneth O'Connor, president, Independent Dental Consultants, Princeton, N.J. But many dentists do not like discount plans because they're paid less. And, if a dentist agrees to a lower fee from the PPO, "and the indemnity system finds out about it, it immediately tries to make the lower charge your fee; the discount drives down the usual and customary fee. So, in a sense, the dentist might be penalized for joining a PPO. Most PPOs will try to get the fee down 25 percent," he adds.

Capping services

Still, dentists are being recruited without too much trouble because they're in oversupply in many areas of the country. In this environment many have to accept lower fees in order to build their practices and fill their chairs. Elaine Fields, director of marketing at United Dental Systems, New York City, brings together unions and corporate employers with panels of dentists who agree to take less. For instance, "where the customary fee for a full orthodontic procedure might be $3,500, our dentists have agreed to cap the service at $2,000."

Despite the evident turn toward managed care, for some the jury is still out on whether it actually saves money. One problem, says Robert Eicher, principal, Foster Higgins, New York City, is that most companies, in order to induce employees to sign up for managed care, enrich the benefits. And with a PPO, the cost may actually go up because the dentist may recommend "more cleaning or more exams, or whatever, than the patient would normally have been expected to go for." It's much easier to stimulate over-utilization in dental care than in medical care, he says, "because you're not killing anybody by over-utilizing" in dental.

Another problem, according to O'Connor, is quality of care. He charges that with some dental PPOs, "you have to start looking out for the quality." Unfortunately, no one is looking, although the PPOs' "should be the ones that are policing the dental offices to see that quality is kept up.... They just try to get dentists to sign on so they can show an employer how many they have in the network. It's let the buyer beware--caveat emptor."

This charge is sharply disputed by many others in the field. Davis at U.S. HMO Consultants, for example, says the real problem is indemnity service where "there have been no checks on quality except for the conscientiousness of the individual dentist, essentially."