For Immediate Release
Date: Apr 15th, 2013
Contact: Dr. William J. Moorhead
United We Stand, Divided We Fall
It is indeed an honor to take the helm of our state dental association. I emphasize the word “our” because it belongs to all of us. We are all fortunate to follow in the footsteps of dentists who have given back to our profession for its betterment. I am especially thankful for the guidance of three mentors: Dr. John Thompson, Dr. John Creech and Dr. Terry Norris. They have taught me valuable leadership skills and have raised the bar of performance for the KDA. For any leader, whether voluntary as for an organization or club, or for an elected office, there are two things that ultimately define success. A successful leader must have a vision and be able to portray that vision so as to energize its members and better the organization. In addition, a successful leader must be able to properly react to situations that arise during their term in a manner that places the organization and its members first.
During our annual meeting in March, one of our speakers was the highly motivating Kirk Behrendt. Kirk has a positive energy about him that can’t help but to lift spirits and make his listeners want to take hold of their lives and focus on how they can better themselves, their families and their co-workers. Kirk takes a lot of his lessons from Jon Gordon’s book The Energy Bus: 10 Rules to Fuel Your Life, Work and Team with Positive Energy. Gordon’s 10 rules encourage us to know and understand our vision and purpose and live our lives with positive energy. With a clever metaphor, Gordon describes “Energy Vampires” as negative people who can take away our positive energy, and he give us useful tools on how to deal properly with the energy vampires.
So, where is this going, you may ask. (And as I’m writing this, a big smile comes over my face!) Two weeks before our annual meeting, I was called to testify in Frankfort before the Senate Insurance and Banking Committee. In 2012, the KDA was successful in getting Frankfort legislators and the governor to enact legislation that prohibits insurance companies from forcing providers to honor fees they set for services that are not covered under the company’s insurance plan. Our “non-covered service” bill, however, did not offer a definition for a “covered service.” In common sense, the concept of whether a service is covered or not covered by an insurance plan should, one would think, be easy enough to understand. Politicians and attorneys, who too often think in terms of exceptions and loopholes, wanted a definition.
The lobbyist in Frankfort for the largest non-profit dental insurance company in our state informed us in early March that said insurance company planned to offer a bill in Frankfort which would introduce a definition for “covered services” that would largely negate almost the entire intent of our 2012 non-covered services bill. The insurance lobby’s language would have made exceptions for waiting periods, annual maximums and frequency limits, which would require providers to honor their established fees for a service, even if the policy holder had a waiting period or had exceeded their annual maximum. It also would add language for “alternate benefits and other such limitations.” The KDA reacted by introducing our own bill which would define “covered services” in a common sense fashion.
Before our Senate committee hearing, we provided committee members with a letter stating our talking points. I felt it was important to be fair and factual. With the high overhead we face daily in running our dental offices, this issue can ultimately affect whether our profession can retain dentists within our state who can practice independently, and it can affect whether rural areas have access to dental care. During the Senate hearing, the lobbyist for the largest non-profit dental insurance company in our state made statements that I viewed as non-factual and truth bending. One female state Senator from Louisville stated that if SB70 passed, it would “just be money that would go from consumers straight into the provider’s pockets.”
Senate bill 70 ultimately passed the Senate with just one minor amendment, an exception for frequency limitations, but House leaders would not call the bill because the insurance lobby was able to contact state government workers and teamster unions to oppose the bill. Now, the definition of covered and non-covered services will be determined by legislators through regulation instead of statute, probably this summer.
After the Senate committee hearing, I researched what our contracts say. A majority of dentists in Kentucky are “Preferred Provider” members of the largest non-profit insurance company. Before about 2008, our contracts with this company simply defined a covered service as “a service or supply specified in the Group Contract for which benefits will be provided when rendered by a Dentist.” During 2012 and 2013, this same company gradually required re-credentialing that defined a covered service as “Dental services specified in the Contract for which benefits will be provided when rendered by a Dentist. A service is a Covered Service even if the full Allowable Amount is not paid in the following circumstances: (1) the Covered Person has exceeded the annual or lifetime benefit amount; (2) the Covered Service exceeds the benefit frequency limitation; or (3) the Covered Person is excluded because of waiting period limitations.” An Addendum also defines a non-covered service as “Any Dental Service that is not a Covered Service.”
Dr. Terry Norris, our immediate Past-President, and Dr. Abney, the President of the Kentucky Optometric Association said in a letter to the Senators in March:
“Our members are small business people. What other business situation exists in this state where one business entity attempts to dictate to another business what they can charge the public for services and materials of which the first entity pays no part? We cannot think of another single instance where this is done. Only the insurance companies would attempt to do so. These plans are attempting to frighten consumers into pressuring you to oppose this bill. Remember, this bill only defines the term of covered service so that the Department of Insurance can enforce a law already in statute. Thank you for your consideration of this issue and we would be happy to discuss the merits of SB 70 with you further.”
Earlier I referred to Jon Gordon’s book The Energy Bus. At first reaction, I had pictured the insurance lobbyists and some of our legislators as “Energy Suckers.” Whether that is correct or fair I haven’t yet been able to determine. I understand that we all have a different perception of reality and that they are trying to protect their own turf. For me, though, it isn’t a turf issue, it’s not an ethical issue, it’s what is needed to be able to keep dental health available to the public. What I see with clarity, though, is that at the present time, we lack the clout to make it happen. Few of us, including myself, have wanted to be involved in the political process. I’ve heard comments that donating to a political action committee is “just buying votes.” In reality, becoming active in the political process is the only way we can get our message heard. Dentistry is truly at a crossroads now, with forces that include the economy, increased consumerism in health care and the Affordable Care Act (“Obamacare”), just to name a few. Now more than ever, we must step up and get involved, in order to protect what we believe in.
In the coming months, I’m going to be challenging our association to become involved and to become advocates for oral health, where we can be seen by the public and by our legislators doing what should come natural to us – acting to decrease dental disease and in the process improving the quality of life for the citizens of Kentucky. I look forward to the coming year and its challenges, and need your assistance, because – well – I think you’ve heard this one before: “United We Stand, Divided We Fall.” Have a great month!