Third Party Reimbursement Manipulation Among Dental Professionals in California

Objectives: Dental insurance policies are set by companies that are often separate from the everyday workings of dental practices. This results in a difference in the amount of dental insurance coverage patients have and the dental care they need. This cross-sectional study surveyed CDA affiliated dentists to examine this difference.
Methods: 4,254 CDA affiliated dentists were randomly selected to participate. Our instrument was developed in Qualtrics and contained multiple choice and case-based scenarios. In each hypothetical situation, participants indicated their willingness to make intentional billing errors to help patients afford care. Answers were reported on a five-point scale. Chi-squared tests were performed to identify relationships between scenario responses and demographic information.
Results: 414 responses were collected yielding a 9.7% response rate. 74.4% of respondents felt very, or always, limited by insurance policies. This varied most by dental specialty (χ² = 48.07, p = 0.03). 4.8% of participants were willing to change billing dates on insurance paperwork. This value was closely associated with the gender, (χ² = 29.14, p = 0.02) and dental specialty (χ² = 68.02, p = 0.00). We note that 1 in 4 participants would bill for different procedures than they performed if it benefited their patient’s well-being.
Conclusions: We hypothesize that feelings towards insurance policies varied due to the quantity of elective procedures different specialists perform. Private practice owners were more weary of billing for different procedures than they performed. We suspect this feeling of insecurity arises from immediate liability that comes with owning one’s own business. Although the population sampled is in favor of upholding the standards set in the ADA Code of Ethics, we cannot discount the portion of people who feel the need to bend the rules to benefit their patient’s well-being. Modifications to the current dental insurance model are warranted to better support dentists in providing optimal care to their patients.