One thing a surprising number of my patients share is the inability to understand their dental care. It’s amazing how many people don’t know if they’re covered at all or what that coverage entails. Part of my goal in building Afora, a network of high-quality providers who offer the same services at a flat-fee structure, was to meet patients’ oral care needs in a more efficient and transparent way than is allowed by the traditional insurance models.
Roughly one in five adults has no plan to visit a dentist in the next 12 months, and their top reasons include cost and having no need for immediate care. I want to get people thinking about the care they have, what they’re actually paying for, and if there’s a better solution (hint: it’s called Afora). These are five ways our model improves upon the status quo.
1. Simpler, better payment structure.
Dental insurance is a broken model. Here’s the truth: for most consumers it’s typically not worth having. You’re better off as part of a streamlined network like Afora or simply paying for work as needed. Insurance companies often have higher premiums and low maximums meaning, you’ll pay out of pocket all along the way and might not be covered when you really need it. Which for most people, just doesn’t make fiscal sense.
Compare medical and dental insurance cost-sharing models. Medical will cover all of a member’s care costs after they hit their deductible; dental insurance stops coverage once members hit maximums. This creates a situation where dental premiums equal almost exactly what you get back from your insurance. It’s not worth the money or paperwork. With Afora, you pay into huge discounts on basic services that you need to have done—cleanings, x-rays, exams—and we offer fair pricing within a tightly curated network of trusted providers if you need more work, like a filling or a crown.
2. Treatment options based on best practices, not insurance obligations.
Dentists can be forced to put off treatment or present less-than-ideal options to patients so that their work falls within the parameters of what insurance will cover or what benefits that person has left on their plan. A patient may need specific work done, but their dentist has to work around an inefficient payment structure.
Take onlays, a procedure somewhere between a filling and a full-on crown, as an example. Often onlays are the best option for patients because it’s a less invasive treatment that’s also smoother aesthetically, but dentists can be forced to deal with outside fee restrictions and they might end up delivering a procedure that’s wasteful or inappropriate given the specific needs at hand.
3. More reliable claims reimbursement.
Dentists often have a hard time getting paid by their insurers for important or costly procedures. Companies will find reason to deny work that needs to be done and your practice or the patient gets left with the bill. Insurance tends to require extensive documentation of what was done, and make you jump through hoops to get claims paid. It’s an unnecessary headache of paperwork at a large lab and material cost to the dentist. With Afora’s model, dentists deal directly with their patients so everything is simpler.
4. Better cash flow, less paperwork.
Dentist-patient financial transactions are simpler under our plan. By taking insurance out of the situation, we eliminate time-consuming administration and anxiety about third parties dragging their feet on payments. We allow our dentists to spend time on what matters — treating patients — as opposed to keeping tabs on insurers and presenting proofs of procedure.
5. No waiting periods.
Many big dental care providers will have members pay tremendous amounts of money and simultaneously stick them with a 6 to 12-month waiting period, which naturally leaves patients in a position where they can’t have work done. Afora’s meticulously curated network offers a direct patient-to-doctor experience from the moment you sign-up. With us, you don’t need to worry about developing a more serious issue because insurance wouldn’t provide coverage when the root symptoms began.
Our model at Afora is simpler for the dentist, more cost effective for the patient, cleaner from a cash flow perspective for the office, and we allow dentists to apply best practices not based on outside factors. Visit our website to learn more.
-Dr. Jeffrey Rappaport