If you want to hear dentists gripe, ask them about dental insurance.
They hate the discounts from their regular fees that insurers force on them, the frustration of fighting over claims, the annual limits on benefits, and the lack of transparency for patients.
But now, Kleer LLC, a Wayne start-up, has given dentist Brian Wilk, who owns three offices in Montgomery and Bucks Counties, hope that he can get some relief by dumping the worst of the dental insurance plans he now accepts.
Kleer has a technology platform that allows dentists to offer "membership" plans to uninsured patients. Patients pay an annual fee of about $300, which covers two cleanings and exams, plus other services such as routine X-rays and one emergency exam. Dentists typically discount those preventive services 40 percent to 50 percent.
Additional treatments, such as fillings, crowns, and root canals, are available at a discount set by dentists, instead of by insurers who take 50 percent to 60 percent off dentists' regular fees, Wilk said.
"It's ridiculous. I'd rather attract an uninsured patient and give them a good deal on their cleanings and exams. If they need treatment, you give them a 25 or 30 percent discount," Wilk said.
Kleer, one of 30 finalists in the Inquirer's third annual Stellar StartUps contest, has set out to help both uninsured consumers and dentists, said company founder and chief executive Dave Monahan.
Among Kleer's investors is Chase Lenfest, who became interested in the $118 billion U.S. market for dental care when he owned a television station that often ran infomercials from dentists.
"My goal is to have a much higher percentage of people in the U.S. see their dentist regularly, to be compliant, thus reducing pain, ugliness, cost, and increasing overall health for a price much lower than currently offered," Lenfest, son of philanthropist H.F. "Gerry" Lenfest, who died last month, said in an email.
Americans without dental insurance — estimated at 74 million in 2016 by the National Association of Dental Plans — are far less likely to go to the dentist than people with insurance, Monahan said. That is bad for the patient, whose oral health suffers.
Meanwhile, "dental insurance has become very, very difficult for dental practices to manage and make money from," Monahan said. The average income for dentists was $188,580 in 2016, about where it was in 1997, according to a May presentation by Morgan Stanley.
The economics of dental practices are impacted by relatively lax rules on dental insurance plans, which do not have to comply with the Affordable Care Act rule that forces health insurers to spend 80 percent of premiums on medical care. "That's a big problem for dentists. Profits can be held in the insurance company," said Mark Wolff, dean of Penn Dental Medicine.
Dental membership plans have been around for years and have been shown to make participants more likely to visit a dentist, the American Dental Association said. The advantage for the dentist is that even though dentists willingly discount their prices, "their discounted fee is still higher than what a commercial carrier would pay," the association said.
"The biggest thing to me is people are more willing to accept treatment," said Lon R. Kessler, of Kessler Dental Associates in Phoenixville. "It's all transparent. There's no hidden agenda."
Historically, Kessler and other dentists have managed their own membership plans, but keeping track of benefits quickly becomes a nightmare for office staff, said Kessler, who was among Kleer's first participants.
Kleer's online platform allows dentists to offer care plans directly to patients, set their own prices and discounts, and even call the plan whatever they want. Kleer keeps $4 per member of the monthly membership fee while the dentist receives the remainder, or $22 for a plan with a $312 annual fee.
Competitors to Kleer include firms that simply sell software to help dentists administer their membership plans.
Kleer has fashioned itself as a broader platform with social-media overtones, allowing users to log on using their Facebook or Google accounts. Monahan envisions adding more services that make "the connection between the dentist and the patient closer."
Insurers such as Aetna and Cigna offer discount plans, but they are not as popular with dentists because the membership fee goes to the insurer and dentists are still stuck with payments dictated by the insurers, Monahan said. Monahan said Kleer, which began testing its platform a year ago with 30 dentists before launching publicly Jan. 1, has nearly 1,000 participating dentists in 40 states.
Monahan declined to say how many patients have Kleer memberships but did say the plans have been particularly popular with seniors.
"Because I'm older, on Medicare, I don't have dental insurance, so it makes a big difference for me to have certain things covered," said Berwyn resident Alice Curtis, a patient at Kessler Dental Associates.
Before signing up for Kleer six months ago, Curtis, 70, used to pay $180 each for two exams and cleanings a year. That means the $300 Kleer membership automatically pays for itself, not counting savings from the routine X-rays and other benefits that are included in the membership at no extra charge, she said.
Thomas Horan, 63, who lives in the Doylestown area and is one of Wilk's patients in Chalfont, recalled difficulties with employer-sponsored dental insurance.
"That was a hassle with the claims, I remember," Horan said. Wilk's office staff handles everything now with Kleer, he said: "I don't really see anything. They have the price and that's it. They take 30 percent off of your bill right there. Or if you have the free cleaning, you just walk out and don't pay anything."
Wilk is so enthusiastic about Kleer that he plans to hire someone to market the Kleer plans to local businesses.
The business owners can stop paying premiums for dental insurance, Wilk said. Instead, "they can help pay for the employee's membership plan. It's like giving them a membership to the gym," he said.