Dentist billing in advance

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wander
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Re: Dentist billing in advance

Post by wander »

Soon2BXProgrammer wrote: Mon Mar 01, 2021 3:18 pm Our dental office files with our insurance for a "claim authorization" or something like that.. which is like a "tenatative" claim. The insurance company tells them if they file all the paperwork this way, what they will be paid, and what i will owe.

I can see these online at the insurance company, they are basically previews of what will end up being a EOB.

Our dentist asks us to pay our part at the time of appointment. (the end of the appointment, but at the appointment).
I think I like that setup. As long all the numbers are lined up correctly in the itemized bill. My spouse always warns me about dental bills because they are not so clear cut like medical bills. :D
tj
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Re: Dentist billing in advance

Post by tj »

SlowMovingInvestor wrote: Mon Mar 01, 2021 3:38 pm
tj wrote: Mon Mar 01, 2021 1:00 am
wander wrote: Mon Mar 01, 2021 12:36 am This is an old thread but I am curious and don't want to open a new thread for maybe an obvious answer. If a dentist is in a dental network, when he bills dental insurance $400, insurance allows $300 and mails a $300 check to the dentist. Insurance marks "patient owes nothing". Can the dentist go after the patient and charges him that $100 because he thinks the insurance underpays him?
No. The dentist is in network and thus contractually required to accept it
Slightly off topic, but my in network dentist added an extra PPE fee the last time I visited, and I was billed for it, the insurance didn't cover it. Given that dentist offices were shut for several months and that extra equipment was needed, I can understand that they need some extra payments, but should insurance be covering it either indirectly (via increased rates) or as a line item ?
PPE is not contractually covered service by your dental insurance, so I don't see why it would matter. If you don't want to pay the PPE fee, you can find a different dentist who doesn't charge it.
SlowMovingInvestor
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Re: Dentist billing in advance

Post by SlowMovingInvestor »

tj wrote: Mon Mar 01, 2021 4:37 pm
SlowMovingInvestor wrote: Mon Mar 01, 2021 3:38 pm
tj wrote: Mon Mar 01, 2021 1:00 am
wander wrote: Mon Mar 01, 2021 12:36 am This is an old thread but I am curious and don't want to open a new thread for maybe an obvious answer. If a dentist is in a dental network, when he bills dental insurance $400, insurance allows $300 and mails a $300 check to the dentist. Insurance marks "patient owes nothing". Can the dentist go after the patient and charges him that $100 because he thinks the insurance underpays him?
No. The dentist is in network and thus contractually required to accept it
Slightly off topic, but my in network dentist added an extra PPE fee the last time I visited, and I was billed for it, the insurance didn't cover it. Given that dentist offices were shut for several months and that extra equipment was needed, I can understand that they need some extra payments, but should insurance be covering it either indirectly (via increased rates) or as a line item ?
PPE is not contractually covered service by your dental insurance, so I don't see why it would matter. If you don't want to pay the PPE fee, you can find a different dentist who doesn't charge it.
Interestingly, my insurance this year is Delta (it was different last year when I last went to the dentist), and apparently in network dentists at delta can't charge extra for PPE.

https://www.deltadental.com/grinmag/us/ ... id-19.html
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30west
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Re: Dentist billing in advance

Post by 30west »

Just saw a $10 PPE charge on my last bill too.
bwalling
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Re: Dentist billing in advance

Post by bwalling »

SlowMovingInvestor wrote: Mon Mar 01, 2021 4:40 pm
tj wrote: Mon Mar 01, 2021 4:37 pm
SlowMovingInvestor wrote: Mon Mar 01, 2021 3:38 pm
tj wrote: Mon Mar 01, 2021 1:00 am
wander wrote: Mon Mar 01, 2021 12:36 am This is an old thread but I am curious and don't want to open a new thread for maybe an obvious answer. If a dentist is in a dental network, when he bills dental insurance $400, insurance allows $300 and mails a $300 check to the dentist. Insurance marks "patient owes nothing". Can the dentist go after the patient and charges him that $100 because he thinks the insurance underpays him?
No. The dentist is in network and thus contractually required to accept it
Slightly off topic, but my in network dentist added an extra PPE fee the last time I visited, and I was billed for it, the insurance didn't cover it. Given that dentist offices were shut for several months and that extra equipment was needed, I can understand that they need some extra payments, but should insurance be covering it either indirectly (via increased rates) or as a line item ?
PPE is not contractually covered service by your dental insurance, so I don't see why it would matter. If you don't want to pay the PPE fee, you can find a different dentist who doesn't charge it.
Interestingly, my insurance this year is Delta (it was different last year when I last went to the dentist), and apparently in network dentists at delta can't charge extra for PPE.

https://www.deltadental.com/grinmag/us/ ... id-19.html
Delta is restricting it because Delta is paying dentists a $10 reimbursement on the back end. Not all payers are doing this, and many are leaving it up to the dentist to charge or not charge.

The reality is that the cost of PPE has gone up significantly (both in terms of actual cost, and in terms of the effort needed to find it).
bwalling
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Re: Dentist billing in advance

Post by bwalling »

wander wrote: Mon Mar 01, 2021 4:06 pm
Soon2BXProgrammer wrote: Mon Mar 01, 2021 3:18 pm Our dental office files with our insurance for a "claim authorization" or something like that.. which is like a "tenatative" claim. The insurance company tells them if they file all the paperwork this way, what they will be paid, and what i will owe.

I can see these online at the insurance company, they are basically previews of what will end up being a EOB.

Our dentist asks us to pay our part at the time of appointment. (the end of the appointment, but at the appointment).
I think I like that setup. As long all the numbers are lined up correctly in the itemized bill. My spouse always warns me about dental bills because they are not so clear cut like medical bills. :D
Dental billing and insurance is far simpler than medical!
Lexx
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Re: Dentist billing in advance

Post by Lexx »

If you're being charged $10 for PPE, that likely doesn't even cover the actual cost. Go and price PPE these days and you'll be shocked at how expensive it is.
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Re: Dentist billing in advance

Post by Dottie57 »

8foot7 wrote: Mon Nov 23, 2020 9:06 pm I’ll pay day of procedure upon arrival, and perhaps for hardware/products that are custom made further in advance, but I am not prepaying for labor.
This!
toofache32
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Re: Dentist billing in advance

Post by toofache32 »

Dottie57 wrote: Tue Mar 02, 2021 8:34 pm
8foot7 wrote: Mon Nov 23, 2020 9:06 pm I’ll pay day of procedure upon arrival, and perhaps for hardware/products that are custom made further in advance, but I am not prepaying for labor.
This!
Nothing wrong with that....if you can find a sucker. Getting harder and harder these days with so many deadbeats.
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JonnyDVM
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Re: Dentist billing in advance

Post by JonnyDVM »

Lexx wrote: Tue Mar 02, 2021 8:29 pm If you're being charged $10 for PPE, that likely doesn't even cover the actual cost. Go and price PPE these days and you'll be shocked at how expensive it is.
I got the absolute worst box of nitrile gloves from my distributor recently and they cost $20. $20! For cheap garbage gloves that keep ripping. Someone’s making a fortune and it’s not health professionals.
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PowderDay9
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Re: Dentist billing in advance

Post by PowderDay9 »

SlowMovingInvestor wrote: Mon Mar 01, 2021 3:38 pm
tj wrote: Mon Mar 01, 2021 1:00 am
wander wrote: Mon Mar 01, 2021 12:36 am This is an old thread but I am curious and don't want to open a new thread for maybe an obvious answer. If a dentist is in a dental network, when he bills dental insurance $400, insurance allows $300 and mails a $300 check to the dentist. Insurance marks "patient owes nothing". Can the dentist go after the patient and charges him that $100 because he thinks the insurance underpays him?
No. The dentist is in network and thus contractually required to accept it
Slightly off topic, but my in network dentist added an extra PPE fee the last time I visited, and I was billed for it, the insurance didn't cover it. Given that dentist offices were shut for several months and that extra equipment was needed, I can understand that they need some extra payments, but should insurance be covering it either indirectly (via increased rates) or as a line item ?
Many dental insurance companies reimbursed dentists for PPE in 2020. The typical amount was $10.
PowderDay9
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Re: Dentist billing in advance

Post by PowderDay9 »

wander wrote: Mon Mar 01, 2021 1:33 pm
tj wrote: Mon Mar 01, 2021 1:00 am
wander wrote: Mon Mar 01, 2021 12:36 am This is an old thread but I am curious and don't want to open a new thread for maybe an obvious answer. If a dentist is in a dental network, when he bills dental insurance $400, insurance allows $300 and mails a $300 check to the dentist. Insurance marks "patient owes nothing". Can the dentist go after the patient and charges him that $100 because he thinks the insurance underpays him?
No. The dentist is in network and thus contractually required to accept it
Thank you! That's the answer I am looking for.
FYI, you have to make sure the dentist is in network. If they are out of network, they can balance bill you like in your example above.
PowderDay9
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Re: Dentist billing in advance

Post by PowderDay9 »

jacksdad0401 wrote: Wed Nov 25, 2020 7:38 am I very much agree with you that it's sad. This is mainly from the influx of private equity money from DSOs, younger dentists with upwards of 400k+ in student loan debt, and insurance cutting fees (i.e. Aetna just cut fees by about 40% across the board last month. Yes, forty!).
I realize you are a GP and I agree with the point you are making but your comment about insurance cutting fees is very rare in dental, let alone 40%. It's possible Aetna has multiple networks and is trying to kill off one of them if they dropped their fees by 40%. They definitely didn't do that nationally.

Dental fee schedules are very stable. They generally increase 0-3% overall per year. The increases sometimes are focused on certain CDT codes. Because of this, dental reimbursements and therefore member's premiums and costs stay consistent over the years.

Personally, I think dentists don't get enough of a fee schedule increase each year and it's definitely nothing like what medical doctors get.
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wander
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Re: Dentist billing in advance

Post by wander »

PowderDay9 wrote: Tue Mar 02, 2021 10:01 pm
wander wrote: Mon Mar 01, 2021 1:33 pm
tj wrote: Mon Mar 01, 2021 1:00 am
wander wrote: Mon Mar 01, 2021 12:36 am This is an old thread but I am curious and don't want to open a new thread for maybe an obvious answer. If a dentist is in a dental network, when he bills dental insurance $400, insurance allows $300 and mails a $300 check to the dentist. Insurance marks "patient owes nothing". Can the dentist go after the patient and charges him that $100 because he thinks the insurance underpays him?
No. The dentist is in network and thus contractually required to accept it
Thank you! That's the answer I am looking for.
FYI, you have to make sure the dentist is in network. If they are out of network, they can balance bill you like in your example above.
Yes, my question was strictly about in-network dentists. I dealt with out-of-network dental specialists before and accepted the fact that the amount on the bills must be paid 100% with or without insurance.
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8foot7
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Re: Dentist billing in advance

Post by 8foot7 »

toofache32 wrote: Tue Mar 02, 2021 8:41 pm
Dottie57 wrote: Tue Mar 02, 2021 8:34 pm
8foot7 wrote: Mon Nov 23, 2020 9:06 pm I’ll pay day of procedure upon arrival, and perhaps for hardware/products that are custom made further in advance, but I am not prepaying for labor.
This!
Nothing wrong with that....if you can find a sucker. Getting harder and harder these days with so many deadbeats.
Good luck with what I guess is your business model of getting people to pay in advance for your labor. Dentists are a dime a dozen around here; I'll go to one that doesn't turn me into his working capital line of credit.
toofache32
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Re: Dentist billing in advance

Post by toofache32 »

8foot7 wrote: Wed Mar 03, 2021 4:07 pm
toofache32 wrote: Tue Mar 02, 2021 8:41 pm
Dottie57 wrote: Tue Mar 02, 2021 8:34 pm
8foot7 wrote: Mon Nov 23, 2020 9:06 pm I’ll pay day of procedure upon arrival, and perhaps for hardware/products that are custom made further in advance, but I am not prepaying for labor.
This!
Nothing wrong with that....if you can find a sucker. Getting harder and harder these days with so many deadbeats.
Good luck with what I guess is your business model of getting people to pay in advance for your labor. Dentists are a dime a dozen around here; I'll go to one that doesn't turn me into his working capital line of credit.
This is not something you or I decide. The market decides. Vote with your feet and all that dumb stuff. Yeah that money sitting in my account 1 week in advance really generates lots of interest. Not sure what the fuss is about. Many patients unfortunately need skin in the game to show up for appointments. If you don't, the find the practice of your dreams.
Last edited by toofache32 on Wed Mar 03, 2021 6:27 pm, edited 2 times in total.
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FIREchief
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Re: Dentist billing in advance

Post by FIREchief »

I know of a hospital that does something similar for some surgical procedures, but rather than demand advance payment they offer a 10% discount on the patient's share if paid in advance. I'm guessing most Bogleheads would jump on that.
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Lexx
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Re: Dentist billing in advance

Post by Lexx »

Unfortunately insurances cutting fees is ALL TOO COMMON. Delta Dental, one of the largest insurers, has not allowed a fee increase in many many years. Then they cut fees across the board by 10%. That may not seem like much to most folks, but if your practice is running on 80% overhead, a 10% fee cut means you've just taken a 50% hit in profits. How many folks can survive that?

Consider that the typical dental maximum is $1000/yr. Back in the 1960's the maximum was the same $1000. Gold was $35/oz in 1965. You could get 3 or 5 crowns for $1000 back then. Now gold is at $1800/oz and the same $1000 maximum still applies.

Furthermore Delta is eliminating their Delta Premier product. They're pushing everyone into Delta DPO, which is PPO with a 40-50% haircut on typical fees. How do you survive on that?

It gets worse than that. Insurance companies would prefer you get on their HMO program. Why? It's simple economics. If you have a typical indemnity plan like Delta Premier, if you need a crown the insurance will pay 50% of the negotiated fee (let's call it $1000 for round numbers sake), and the patient pays 50%. That means the payout from the insurance co is $500.

On a PPO pan, that same fee might be $600, and the insurance liability is $300.

With a HMO plan, the fee is oftentimes something like $300 out of which the insurance company pays a fixed fee of around $40. For other things like fillings they may pay a few bucks. With cleanings and xrays they pay nothing.

So when you look at the economics of the situation, it's no wonder insurance companies would rather you sign up for their PPO or HMO plans. Their payout is very limited if anything and the fees they take in are almost pure profit.

On the dental end of things, quality dental offices simply can not afford to take the cheapie plans. A reasonable amount of overhead per chair hour (the cost to have one dental chair available during open hours) is about $150-200/hr. That means if you're not producing $150-200/hr (and that figure is probably low), you're actually losing money. In the case of the crown from the HMO patient for $300, that means you're going to lose money. It's unlikely you'll be able to anesthetize the patient, prepare the tooth, take an impression, and temporize it, in much less than 1 hour. Cementing it will take another 15-30 min. Throw in the cost of the setup and breakdown for the room and the cost of PPE. So reasonably it takes you 1.5 hrs to do the crown in total. Lab fee is going variable depending if you're using a quality lab or sending it to one in China. A good quality crown will cost up to the cost of the total $300 crown. So if you're committed to delivering quality care, use a good lab, follow proper safety protocols, etc., it's costing you $350 in overhead chair time plus $300 for the crown. Now you're into it for $650 and you've yet to pay yourself. And indeed you won't be paying yourself, because in this case you're actually PAYING the patient to sit in your chair to deliver care. How many folks can survive with that business model???
PowderDay9 wrote: Tue Mar 02, 2021 10:25 pm
jacksdad0401 wrote: Wed Nov 25, 2020 7:38 am I very much agree with you that it's sad. This is mainly from the influx of private equity money from DSOs, younger dentists with upwards of 400k+ in student loan debt, and insurance cutting fees (i.e. Aetna just cut fees by about 40% across the board last month. Yes, forty!).
I realize you are a GP and I agree with the point you are making but your comment about insurance cutting fees is very rare in dental, let alone 40%. It's possible Aetna has multiple networks and is trying to kill off one of them if they dropped their fees by 40%. They definitely didn't do that nationally.

Dental fee schedules are very stable. They generally increase 0-3% overall per year. The increases sometimes are focused on certain CDT codes. Because of this, dental reimbursements and therefore member's premiums and costs stay consistent over the years.

Personally, I think dentists don't get enough of a fee schedule increase each year and it's definitely nothing like what medical doctors get.
DesertGator
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Re: Dentist billing in advance

Post by DesertGator »

SpideyIndexer wrote: Tue Nov 24, 2020 9:44 pm Sad that dentistry is now an industry.
Not sure what you are implying. Dentistry has always been an industry. Dental school isn't free, dental supplies & equipment is purchased retail, the power & water utilities make the dental office pay for A/C & water, landlords don't give free rent, insurance must be purchased and staff won't work for free. Could it be anything else, unless dentistry became a government only service model (like you know, communism)?

To the OP, I don't think anything is wrong with paying at time of service, or in advance if the dentist incurs expenses in advance, but as always if this doesn't work for you other offices may have more relaxed financial polices.
PowderDay9
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Re: Dentist billing in advance

Post by PowderDay9 »

Lexx wrote: Wed Mar 03, 2021 6:21 pm Unfortunately insurances cutting fees is ALL TOO COMMON. Delta Dental, one of the largest insurers, has not allowed a fee increase in many many years. Then they cut fees across the board by 10%. That may not seem like much to most folks, but if your practice is running on 80% overhead, a 10% fee cut means you've just taken a 50% hit in profits. How many folks can survive that?
With all due respect, this is not true. Cutting fees is rare. There are many Deltas by state and they roll up to a few companies. Some may have held fees, particularly on the dental premier network, but it's not common to hold them every year then give a 10% decrease. If what you're suggesting we're true, dental offices would be closing very fast. That's not happening.

Lexx wrote: Wed Mar 03, 2021 6:21 pm Consider that the typical dental maximum is $1000/yr. Back in the 1960's the maximum was the same $1000. Gold was $35/oz in 1965. You could get 3 or 5 crowns for $1000 back then. Now gold is at $1800/oz and the same $1000 maximum still applies.
Dentists using gold for crowns in the 1960s was common. It's very rare today. D2740 is by far the most commonly billed crown code. It's made from porcelain/ceramic, not gold.

I do agree that the $1000 annual max is outdated but still used a lot. That trend has been changing lately. The buzz in the industry is Humana's unlimited maximum dental plan. Other carriers have started to offer $2,000 and $3,000 maximums. I've seen some $5,000 maximums as well. I think these changes are needed and glad to see it happening.

Lexx wrote: Wed Mar 03, 2021 6:21 pm Futhermorermore Delta is eliminating their Delta Premier product. They're pushing everyone into Delta DPO, which is PPO with a 40-50% haircut on typical fees. How do you survive on that?
If by "typical fees" you mean "billed charges" then yes the discount may be in the 30-40% range for DPO. The Premier network is the high cost network with roughly an average discount of 15-25%. Nobody is going to pay billed charges as there's no point in building a dental network then. The DPO network fees are not 40-50% lower than the Premier network. It's probably more like 5-15% lower. Delta is slowly moving away from Premier because those fees are some of the highest paid in the industry.

Lexx wrote: Wed Mar 03, 2021 6:21 pm It gets worse than that. Insurance companies would prefer you get on their HMO program. Why? It's simple economics. If you have a typical indemnity plan like Delta Premier, if you need a crown the insurance will pay 50% of the negotiated fee (let's call it $1000 for round numbers sake), and the patient pays 50%. That means the payout from the insurance co is $500.

On a PPO pan, that same fee might be $600, and the insurance liability is $300.

With a HMO plan, the fee is oftentimes something like $300 out of which the insurance company pays a fixed fee of around $40. For other things like fillings they may pay a few bucks. With cleanings and xrays they pay nothing.
You're mixing up the products. True indemnity products pay a set amount and have no network or discount. There's no negotiated fee.

For PPO, a typical D2740 crown allowance will be in the $800-$1000 range most of the time. HMO might be lower but I'd be shocked to see $300 as an allowance. HMO is paid with capitation to the attributed dentist, therefore there would be no fees or fee schedule.

Lexx wrote: Wed Mar 03, 2021 6:21 pm So when you look at the economics of the situation, it's no wonder insurance companies would rather you sign up for their PPO or HMO plans. Their payout is very limited if anything and the fees they take in are almost pure profit.

On the dental end of things, quality dental offices simply can not afford to take the cheapie plans. A reasonable amount of overhead per chair hour (the cost to have one dental chair available during open hours) is about $150-200/hr. That means if you're not producing $150-200/hr (and that figure is probably low), you're actually losing money. In the case of the crown from the HMO patient for $300, that means you're going to lose money. It's unlikely you'll be able to anesthetize the patient, prepare the tooth, take an impression, and temporize it, in much less than 1 hour. Cementing it will take another 15-30 min. Throw in the cost of the setup and breakdown for the room and the cost of PPE. So reasonably it takes you 1.5 hrs to do the crown in total. Lab fee is going variable depending if you're using a quality lab or sending it to one in China. A good quality crown will cost up to the cost of the total $300 crown. So if you're committed to delivering quality care, use a good lab, follow proper safety protocols, etc., it's costing you $350 in overhead chair time plus $300 for the crown. Now you're into it for $650 and you've yet to pay yourself. And indeed you won't be paying yourself, because in this case you're actually PAYING the patient to sit in your chair to deliver care. How many folks can survive with that business model???
If they can't afford the lower cost fee schedules then why do so many dentists participate? It's because they need people in the chairs and a $700 crown is better than an empty chair. I've already said up thread that I think fee schedules should go up more and I feel bad for dentists.
Last edited by PowderDay9 on Wed Mar 03, 2021 10:14 pm, edited 4 times in total.
Carguy85
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Re: Dentist billing in advance

Post by Carguy85 »

Depressing Lexx! Soo glad we sold. Also glad that I’m to the point that I don’t have to put up with anything/anyone I don’t want to deal with. After factoring in lab fees and chair time, the amount that is allowed by some in network on such procedures is laughable if not down right infuriating. There have certainly been cases where we have been paid more by insurance by being out of network. Many that leave due to insurance changes end up coming back even though they are out of network after experiencing what places try to do to survive the terrible reimbursements.
Lexx
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Re: Dentist billing in advance

Post by Lexx »

PowderDay9 wrote: Wed Mar 03, 2021 7:55 pm With all due respect, this is not true. Cutting fees is rare. There are many Deltas by state and they roll up to a few companies. Some may have held fees, particularly on the dental premier network, but it's not common to hold them every year then give a 10% decrease. If what you're suggesting we're true, dental offices would be closing very fast. That's not happening.
Cutting fees has been happening with increasing frequency. Delta tried the lower the fees first in Washington state and a couple of others. The head of Washington's Delta, went on television proclaiming that Dentists were making too much money and golfing on Wednesdays - this coming from a guy who makes millions and millions per year. Each Delta is a separate entity. Delta is now lowering their fees state by state.

As for offices closing their doors, what's happening is people are either having to work very much more quickly, use cheaper labs, cut staff, or DROP their participation in Delta and other cheapie insurances. The offices that take these insurances are increasingly owned by large Dental Service Organizations (DSO) i.e. big corporate outfits. We had one near us. Every patient on a PPO/HMO plan was "upgraded" to a Cerec in-house porcelain crown that was "off the fee schedule", meaning they didn't have to abide by the negotiated fee schedule. Patients were told their insurance covered crown was "inferior" and that the in-house Cerec crown was "the best". Magically all sorts of their patients needed Scaling and Root Planing, yet when my hygienist measured their pocket depths they were within normal limits.

Make no mistake, private practice dentistry is going away. It's just not possible to provide quality service and participate in these discount insurance plans. Increasingly dental graduates burdened with $500k or more in student loans are forced to grovel and work for corporate dental offices where they MUST meet production quotas.


PowderDay9 wrote: Wed Mar 03, 2021 7:55 pm
Dentists using gold for crowns in the 1960s was common. It's very rare in today. D2740 is by far the most commonly billed crown code. It's made from porcelain/ceramic, not gold.
Whether the crown is made of gold or porcelain, the laboratory cost for a GOOD quality crown is substantial. A milled zirconia crown for example, can be made with the cheapest monolithic single layer zirconia or it can be made with a better material and then custom stained. You really think a volume production discount lab is going to offer the same quality as a smaller high quality lab with well trained technicians who have years of experience? Insurance companies would love you to think that dentistry is a product not a service, and all "providers" are the same.
PowderDay9 wrote: Wed Mar 03, 2021 7:55 pm If by "typical fees" you mean "billed charges" then yes the discount may be in the 30-40% range for DPO. The Premier network is the high cost network with roughly an average discount of 15-25%. Nobody is going to pay billed charges as there's no point in building a dental network then. The DPO network fees are not 40-50% lower than the Premier network. It's probably more like 5-15% lower. Delta is slowely moving away from Premier because those fees are some of the highest paid in the industry.
Totally false. I've seen the DPO fee schedule and their fees were fully 40-50% lower than my Delta Premier fee schedule. BTW the Delta Premier fee schedule is at least 10% lower than my fee for service schedule. Delta Premier by design is already a fee cut. DPO is another 40-50% off of Delta Premier. Delta is indeed moving away from Premier. The reason is it CUTS INTO THEIR PROFITS.
PowderDay9 wrote: Wed Mar 03, 2021 7:55 pm You're mixing up the products. True indemnity products pay a set amount and have no network or discount. There's no negotiated fee.

For PPO, a typical D2740 crown allowance will be in the $800-$1000 range most of the time. HMO might be lower but I'd be shocked to see $300 as an allowance.
No mix up at all. You're simply WRONG. Delta Premier does NOT pay your normal fee for service fees. No way. Now how. Delta Premier is a NEGOTIATED fee schedule where a dentist submits their normal fee for service schedule to Delta, who then pays a percentages of those fees. IOW if your fee for service fee for a crown is $1200, Delta will say "we have determined that the usual customary and reasonable (UCR) fee is $1000". Then $1000 becomes your negotiated Delta fee. They pay 50% of that. So where you would bet $1200 for a non-Delta fee for service patient, you get $1000 for a Delta Premier patient. No one knows how these UCR fees are created. They are NOT disclosed, and every insurance company has different UCR fees.

DPO fees for crowns are typically $600 range. I've NEVER seen a DPO fee schedule where their negotiated fee was anywhere near $1000 lol lol lol. HMO fees are indeed as low as $300. I've seen even lower.

BTW, the HMO issue is a game for the corporate dental offices. HMO dental plans pay a "capitated" rate per patient per month. Let's say an office gets $10/head per HMO patient. In return they are responsible for providing free x-rays and cleanings. Everything else is at huge discounts. So the corporate offices will figure out their needed profit margin for patient, figure out how many chair hours are available per capitated rate plan, and then they'll ration the chair hours for that insurance plan's patients. For example if you have a DPO plan capitation payment check of $1000 per month, and you're overhead per hour per chair is $200, you allot 5 hours of chair time per month. Once that gets filled, the patient is not offered an appointment until the next available slot. That's why if you have an HMO plan it can take months to get an appointment.

PowderDay9 wrote: Wed Mar 03, 2021 7:55 pm If they can't afford the lower cost fee schedules then why do so many dentists participate? It's because they need people in the chairs and a $700 crown is better than an empty chair. I've already said up thread that I think fee schedules should go up more and I feel bad for dentists.
Simple. Most dentists are very poor businessmen/women. They think that simply filling their chairs with bodies means they're making money. That's a complete falsehood. The big corporate offices have figured this out. That's why they ration care. That's why they upsell all their services. That's why there's discrepancies on things like the necessity for some procedures.

Many dentists try to live up to the image of the successful wealthy doctor who takes lots of vacations, drive fancy cars, live in big houses, and take Wednesdays off. The head of Washington's Delta used that very stereotyped image to sell his plan to cut reimbursement rates. The fact of the matter is dentists are now graduating with extraordinarily burdensome debt. It's easily $400k to graduate from dental school. Then you have to borrow money to open an office. Guys are starting off with over a million in debt. It's no wonder so many young dentists are forced to go into servitude for the dental corporations (DSOs).

I can tell you from being in private practice for 30+ years that you get what you pay for. If you think that somehow you'll magically get a better product and service for a lower fee by going with a cheaper dental plan, then that's just wishful thinking. Now there may be some offices where they'll do the same service for a much lower rate. I did that for my Delta Premier patients. I just ate the difference. But that was the only insurance plan I took. Everything else was fee for service. I provided high quality care for my patients. I did full mouth restorations, implants, surgery, lots of stuff most GPs were afraid to do because I took the time to get trained at great expense. I refused to take the cheap plans because after running the numbers, it was plain to see that I would either have to compromise the level of care I delivered, or I would be working for free.

That's why I was able to retire at 56 and walk away, while other guys are still working at 65 with mounds of debt. I went to bed every night knowing that I did the best I could for my patients. And I make no apologies for making a reasonable profit. I refused to allow the insurance companies to dictate my career path. Sadly this is becoming less and less of an option for the young guys. That's why I'm telling my kids to forget about going into dentistry. It's just not worth it anymore.
PowderDay9
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Re: Dentist billing in advance

Post by PowderDay9 »

Lexx wrote: Wed Mar 03, 2021 8:41 pm
PowderDay9 wrote: Wed Mar 03, 2021 7:55 pm If by "typical fees" you mean "billed charges" then yes the discount may be in the 30-40% range for DPO. The Premier network is the high cost network with roughly an average discount of 15-25%. Nobody is going to pay billed charges as there's no point in building a dental network then. The DPO network fees are not 40-50% lower than the Premier network. It's probably more like 5-15% lower. Delta is slowly moving away from Premier because those fees are some of the highest paid in the industry.
Totally false. I've seen the DPO fee schedule and their fees were fully 40-50% lower than my Delta Premier fee schedule. BTW the Delta Premier fee schedule is at least 10% lower than my fee for service schedule. Delta Premier by design is already a fee cut. DPO is another 40-50% off of Delta Premier. Delta is indeed moving away from Premier. The reason is it CUTS INTO THEIR PROFITS.
I'm sure you know that Delta Dental is a non-profit and therefore profit isn't their motive. They cut high fee schedules to try to be competitive and offer lower premiums for their members. I realize you are a single dentist and have seen the fee schedules offered to you at your practice but I have seen them across tens of thousands of dentists in many states and can tell you that only a tiny percentage of dental claims are paid at more than 50% off of billed charges. Maybe your billed charges were above the 90th percentile of FAIR health before you retired but when I look at billed charges and fee schedule allowances across the country, it's not the picture you paint.

Lexx wrote: Wed Mar 03, 2021 8:41 pm
PowderDay9 wrote: Wed Mar 03, 2021 7:55 pm You're mixing up the products. True indemnity products pay a set amount and have no network or discount. There's no negotiated fee.

For PPO, a typical D2740 crown allowance will be in the $800-$1000 range most of the time. HMO might be lower but I'd be shocked to see $300 as an allowance.
No mix up at all. You're simply WRONG. Delta Premier does NOT pay your normal fee for service fees. No way. Now how. Delta Premier is a NEGOTIATED fee schedule where a dentist submits their normal fee for service schedule to Delta, who then pays a percentages of those fees. IOW if your fee for service fee for a crown is $1200, Delta will say "we have determined that the usual customary and reasonable (UCR) fee is $1000". Then $1000 becomes your negotiated Delta fee. They pay 50% of that. So where you would bet $1200 for a non-Delta fee for service patient, you get $1000 for a Delta Premier patient. No one knows how these UCR fees are created. They are NOT disclosed, and every insurance company has different UCR fees.

DPO fees for crowns are typically $600 range. I've NEVER seen a DPO fee schedule where their negotiated fee was anywhere near $1000 lol lol lol. HMO fees are indeed as low as $300. I've seen even lower.
I think we just mixed each other's comments up here. I never said Delta Premier pays fee for service for in-network. I said it had a discount of about 15-25% off of billed charges on average. From the perspective a single dentist, you have a fee schedule you've agreed to. You may be paid a UCR as well. Those are created from a database, usually FAIR health, that aggregates all of the dentist billed charges by 3 digit zip. Delta can then use that to know what is the 50th, 60th, 70th, 80th, 90th, 95th, percentile of billed charges. I know for a fact that most dentists, on average, get about $800-$1000 per D2740 claim. Very few get less than $600 for D2740. You can look at the average on FAIR health's website. I don't know where in Washington you used to practice but I put in a zip code for Seattle and the average allowance is $1055. The average billed charge is $1512, which makes the discount about 30%, well within a reasonable expected range for a fee schedule.

https://www.fairhealthconsumer.org/dental/results

Lexx wrote: Wed Mar 03, 2021 8:41 pm BTW, the HMO issue is a game for the corporate dental offices. HMO dental plans pay a "capitated" rate per patient per month. Let's say an office gets $10/head per HMO patient. In return they are responsible for providing free x-rays and cleanings. Everything else is at huge discounts. So the corporate offices will figure out their needed profit margin for patient, figure out how many chair hours are available per capitated rate plan, and then they'll ration the chair hours for that insurance plan's patients. For example if you have a DPO plan capitation payment check of $1000 per month, and you're overhead per hour per chair is $200, you allot 5 hours of chair time per month. Once that gets filled, the patient is not offered an appointment until the next available slot. That's why if you have an HMO plan it can take months to get an appointment.
All spot on. I agree that a member should most often avoid signing up for a capitated product like a HMO. Unfortunately this is happening on the medical side much more often.

Lexx wrote: Wed Mar 03, 2021 8:41 pm
PowderDay9 wrote: Wed Mar 03, 2021 7:55 pm If they can't afford the lower cost fee schedules then why do so many dentists participate? It's because they need people in the chairs and a $700 crown is better than an empty chair. I've already said up thread that I think fee schedules should go up more and I feel bad for dentists.
Simple. Most dentists are very poor businessmen/women. They think that simply filling their chairs with bodies means they're making money. That's a complete falsehood. The big corporate offices have figured this out. That's why they ration care. That's why they upsell all their services. That's why there's discrepancies on things like the necessity for some procedures.

Many dentists try to live up to the image of the successful wealthy doctor who takes lots of vacations, drive fancy cars, live in big houses, and take Wednesdays off. The head of Washington's Delta used that very stereotyped image to sell his plan to cut reimbursement rates. The fact of the matter is dentists are now graduating with extraordinarily burdensome debt. It's easily $400k to graduate from dental school. Then you have to borrow money to open an office. Guys are starting off with over a million in debt. It's no wonder so many young dentists are forced to go into servitude for the dental corporations (DSOs).

I can tell you from being in private practice for 30+ years that you get what you pay for. If you think that somehow you'll magically get a better product and service for a lower fee by going with a cheaper dental plan, then that's just wishful thinking. Now there may be some offices where they'll do the same service for a much lower rate. I did that for my Delta Premier patients. I just ate the difference. But that was the only insurance plan I took. Everything else was fee for service. I provided high quality care for my patients. I did full mouth restorations, implants, surgery, lots of stuff most GPs were afraid to do because I took the time to get trained at great expense. I refused to take the cheap plans because after running the numbers, it was plain to see that I would either have to compromise the level of care I delivered, or I would be working for free.

That's why I was able to retire at 56 and walk away, while other guys are still working at 65 with mounds of debt. I went to bed every night knowing that I did the best I could for my patients. And I make no apologies for making a reasonable profit. I refused to allow the insurance companies to dictate my career path. Sadly this is becoming less and less of an option for the young guys. That's why I'm telling my kids to forget about going into dentistry. It's just not worth it anymore.
If the only dental insurance you took was Premier then you are a small portion of the dentists. Most dentists participate with many other carriers. Maybe you were in a remote area or had a really good client base. You probably were a well respected dentist and appropriately charged higher than average fees. I agree with your other comments here. The debt comment is a bit extreme but the point still stands. It's harder for young dentists to be financially successful and a good chunk of them are going into DSOs for their first job. It is a sad trend, no doubt.
Lexx
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Re: Dentist billing in advance

Post by Lexx »

PowderDay9 wrote: Wed Mar 03, 2021 9:44 pm I'm sure you know that Delta Dental is a non-profit and therefore profit isn't their motive. They cut high fee schedules to try to be competitive and offer lower premiums for their members. I realize you are a single dentist and have seen the fee schedules offered to you at your practice but I have seen them across tens of thousands of dentists in many states and can tell you that only a tiny percentage of dental claims are paid at more than 50% off of billed charges. Maybe your billed charges were above the 90th percentile of FAIR health before you retired but when I look at billed charges and fee schedule allowances across the country, it's not the picture you paint.
Just because a business takes advantage of the IRS code to classify themselves as "non-profit", does not mean they don't turn a profit. They can declare themselves a non-profit and with accounting just zero everything out. The CEO of Washington state's Delta made $2.1 million in salary last year. California's Delta CEO made $14.3 million. I have practiced in two separate locations in Northern California, and I can tell you what I've seen as far as what my reimbursements were and what they were for my colleagues.
PowderDay9 wrote: Wed Mar 03, 2021 7:55 pm
I think we just mixed each other's comments up here. I never said Delta Premier pays fee for service for in-network. I said it had a discount of about 15-25% off of billed charges on average. From the perspective a single dentist, you have a fee schedule you've agreed to. You may be paid a UCR as well. Those are created from a database, usually FAIR health, that aggregates all of the dentist billed charges by 3 digit zip. Delta can then use that to know what is the 50th, 60th, 70th, 80th, 90th, 95th, percentile of billed charges. I know for a fact that most dentists, on average, get about $800-$1000 per D2740 claim. Very few get less than $600 for D2740. You can look at the average on FAIR health's website. I don't know where in Washington you used to practice but I put in a zip code for Seattle and the average allowance is $1055. The average billed charge is $1512, which makes the discount about 30%, well within a reasonable expected range for a fee schedule.

https://www.fairhealthconsumer.org/dental/results
I took a look at the FAIR website. The fees are not accurate. No one I know charges $1400 for a 2740 crown, at least not in our area. Maybe if you go to downtown San Francisco, that's the fee. But there's no one I know of that charges that. So I question the validity of the fees represented by that website.

The guys getting $600 for a crown are the ones taking the DPO/PPO plans. That's very different from Delta Premier and other indemnity plans.


PowderDay9 wrote: Wed Mar 03, 2021 7:55 pm If the only dental insurance you took was Premier then you are a small portion of the dentists. Most dentists participate with many other carriers. Maybe you were in a remote area or had a really good client base. You probably were a well respected dentist and appropriately charged higher than average fees. I agree with your other comments here. The debt comment is a bit extreme but the point still stands. It's harder for young dentists to be financially successful and a good chunk of them are going into DSOs for their first job. It is a sad trend, no doubt.
You're right there. Most dentists participate in too many plans. The smart ones are starting to drop the discounted plans after they run the numbers and realize they're not worth participating in. My fees were in the upper 20% maybe. I decided to not charge the absolute top dollar and I delivered what I think was excellent value for the level of service my patients received.

The comments about debt are pretty much spot on. The tuition at my alma matter is now at least $400k. You can not build out a practice for much less than $500k these days. It's more like $700k and up. And that's not even counting any debt accumulated while in college. I read about it all the time in my professional forums. Folks are starting out with over $1 mil in debt. It's an awful position to be in at the start of your career.
toofache32
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Re: Dentist billing in advance

Post by toofache32 »

PowderDay9 wrote: Wed Mar 03, 2021 9:44 pm
I'm sure you know that Delta Dental is a non-profit and therefore profit isn't their motive.
You just lost all credibility by showing you don't know what non-profit means. It certainly doesn't mean they are not interested in a profit.
PowderDay9
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Re: Dentist billing in advance

Post by PowderDay9 »

Lexx wrote: Wed Mar 03, 2021 10:11 pm I took a look at the FAIR website. The fees are not accurate. No one I know charges $1400 for a 2740 crown, at least not in our area. Maybe if you go to downtown San Francisco, that's the fee. But there's no one I know of that charges that. So I question the validity of the fees represented by that website.

The guys getting $600 for a crown are the ones taking the DPO/PPO plans. That's very different from Delta Premier and other indemnity plans.
I'm not trying to argue, but these fees are accurate. They may not be your fees or your colleague's fees but they are the average billed and average allowed fees in that area. As you know, the allowed fee is the total reimbursement (member's share + insurance) that the dentist will receive.

FAIR health is the nation's leading expert in compiling actual paid dental claims. They have billions of actual paid dental claims submitted to them by the insurance companies. That data is compiled and summarized in a very basic way to the public or you can purchase a much more detailed database of that data.

https://www.fairhealthconsumer.org/#about

I'm in agreement with you that the fee allowances are too low in general. Dental reimbursements have barely kept up with inflation, if that, and definitely are nowhere near medical reimbursements.
PowderDay9
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Re: Dentist billing in advance

Post by PowderDay9 »

toofache32 wrote: Wed Mar 03, 2021 10:30 pm
PowderDay9 wrote: Wed Mar 03, 2021 9:44 pm
I'm sure you know that Delta Dental is a non-profit and therefore profit isn't their motive.
You just lost all credibility by showing you don't know what non-profit means. It certainly doesn't mean they are not interested in a profit.
So you're saying all non-profits are interested in earning a profit as their motive? That is the opposite of the definition of a non-profit. Maybe I should have clarified my post and said their "primary" motive.

I've worked for several non-profits and I can see the executives primarily making decisions where profit is clearly not the motive. Community health and well-being while offering a low price quality product for the member is the primary motive at the non-profits I have worked. Some of these companies actually return money to policyholders or groups if they make a profit that is in excess of what they need to add to their reserves to help maintain a stable long-term company that can stay solvent to pay out future claims. The for-profit companies I've worked for are completely different and their main purpose is to increase the stock price.

Delta has to pay their CEO a somewhat reasonable market-based compensation package to lead that size of an organization. It's no different than any of the other large non-profits (United Way, American Heart Association, Shriners Hospital, St. Jude's, Wildlife Conservation Society, etc).
Jeepergeo
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Re: Dentist billing in advance

Post by Jeepergeo »

Good Listener wrote: Mon Nov 23, 2020 8:55 pm This is a very interesting situation. I have been going to a dental practice for about 25 years and have been very satisfied with it. The owner, an older man, sold out to a younger woman. He still works there. I now see yet a different woman there who prefer. That's irreverent. . I am very happy with all of them. Anyway I have a lot of work that needs to be done and I got a call from the office staff today that they've changed their policies and they know run through your insurance and actually have you pay before you ever go for the procedure. It's only about $500 for my co-pay and I don't really care but is this something that is actually done or even legal?
I'd start looking for another dentist. Obviously the new owner of this practice does not value the long-term relationship that you had developed with the prior owner.

Payment after services have been rendered is what professionals require.
Lexx
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Re: Dentist billing in advance

Post by Lexx »

PowderDay9 wrote: Wed Mar 03, 2021 10:51 pm
So you're saying all non-profits are interested in earning a profit as their motive? That is the opposite of the definition of a non-profit. Maybe I should have clarified my post and said their "primary" motive.

I've worked for several non-profits and I can see the executives primarily making decisions where profit is clearly not the motive. Community health and well-being while offering a low price quality product for the member is the primary motive at the non-profits I have worked. Some of these companies actually return money to policyholders or groups if they make a profit that is in excess of what they need to add to their reserves to help maintain a stable long-term company that can stay solvent to pay out future claims. The for-profit companies I've worked for are completely different and their main purpose is to increase the stock price.

Delta has to pay their CEO a somewhat reasonable market-based compensation package to lead that size of an organization. It's no different than any of the other large non-profits (United Way, American Heart Association, Shriners Hospital, St. Jude's, Wildlife Conservation Society, etc).
Well Delta's actions for the past 30 years have been much more like those of a for-profit business rather than a non-profit. Their decisions are purely based on a profit motive, screwing over dentistry by using their dominance in the marketplace. This is why more and more dentists are starting to drop out of Delta. Had I not retired, I would have also dropped Delta. How else do you justify a 10% reimbursement reduction when their yearly maximum and fees haven't been raised in many years? If one were to do an analysis on fee reimbursements and the rate of their increase vs the cost of living, I bet you'd find that the COL far far exceeds the rise in the rate of reimbursement.
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Re: Dentist billing in advance

Post by Lexx »

Jeepergeo wrote: Wed Mar 03, 2021 10:54 pm Payment after services have been rendered is what professionals require.
We collected the copayment at the end of the appointment. We did NOT wait for insurance to pay first and then balance bill. Dentist that do that, will find that they have a high non-collections rate. Our collections rate was 100%.

You don't walk out of Macy's without paying for something either.
GG1273
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Re: Dentist billing in advance

Post by GG1273 »

My thought - anyone holding a power drill turned on in my mouth is getting paid - however, they want to be paid.

We found a super busy practice near us bit they are really good with us with hand scaling instead of that tool thing that drives me (and my gums) crazy. I gladly pay for that (and the fact that they listened). :mrgreen:

Another nice thing to do is to have a Harry/David fruit thing sent to the office once a year and definitely thank you notes for the staff. They always remember you even if only in 2x per year.
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8foot7
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Re: Dentist billing in advance

Post by 8foot7 »

Lexx wrote: Thu Mar 04, 2021 5:14 pm
Jeepergeo wrote: Wed Mar 03, 2021 10:54 pm Payment after services have been rendered is what professionals require.
We collected the copayment at the end of the appointment. We did NOT wait for insurance to pay first and then balance bill. Dentist that do that, will find that they have a high non-collections rate. Our collections rate was 100%.

You don't walk out of Macy's without paying for something either.
I have zero problem with that, or even payment as you enter the premises before the tech sees you. I also have zero problem prepaying in full for custom made stuff. I have zero problem prepaying my portion of the bill based on insurance estimate.

What I would never do is pay for an exam or labor for services before I am on the premises.
Lexx
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Re: Dentist billing in advance

Post by Lexx »

GG1273 wrote: Thu Mar 04, 2021 5:36 pm My thought - anyone holding a power drill turned on in my mouth is getting paid - however, they want to be paid.

We found a super busy practice near us bit they are really good with us with hand scaling instead of that tool thing that drives me (and my gums) crazy. I gladly pay for that (and the fact that they listened). :mrgreen:

Another nice thing to do is to have a Harry/David fruit thing sent to the office once a year and definitely thank you notes for the staff. They always remember you even if only in 2x per year.
We offered our sensitive patients a topical anesthetic mouth rinse. It totally numbs up the gums for about an hour so that the cleaning procedure is easy even for those patients who are very sensitive to the procedure. I used it myself whenever I had my teeth cleaned.

Being appreciative always helps. Offices look forward to pleasant patients. At the end of the day, people are just people. A smile and a positive attitude goes a long way.
PowderDay9
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Re: Dentist billing in advance

Post by PowderDay9 »

Lexx wrote: Thu Mar 04, 2021 5:12 pm Well Delta's actions for the past 30 years have been much more like those of a for-profit business rather than a non-profit. Their decisions are purely based on a profit motive, screwing over dentistry by using their dominance in the marketplace. This is why more and more dentists are starting to drop out of Delta. Had I not retired, I would have also dropped Delta. How else do you justify a 10% reimbursement reduction when their yearly maximum and fees haven't been raised in many years? If one were to do an analysis on fee reimbursements and the rate of their increase vs the cost of living, I bet you'd find that the COL far far exceeds the rise in the rate of reimbursement.
Delta Dentals target a 0-1% profit so that they can survive long-term. You can look at Delta Dental of WA's most recent 990. They had a profit of 1% over the last 2 years. If you don't count their investment earnings on their reserves, then they made 0.3% in profit. That doesn't sound like a for-profit business, or at least not a very profitable one after being in business for decades. Your argument would make more sense if you were talking about United or Humana.

https://projects.propublica.org/nonprof ... 01455/full

According to their 990, they are paying out about 89% of their revenue to pay dentists for their member's claims. Only about 4% goes to salaries. The vast majority of employees at Delta make between $30-75k. I think most people can agree that non-profits want to keep their expenses as low as possible. When 89% of your expenses are going to dentists and your fee schedule is one of the highest in the industry, the logical decision is to maintain or lower your fees. Dentists are allowed to drop the fee schedule if they want. Across the US, that is not happening. Very few dentists drop out of the networks.

I agree that the fee schedules probably aren't keeping up with inflation. I've said multiple times that dentist's fees should increase.
GG1273
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Re: Dentist billing in advance

Post by GG1273 »

Lexx wrote: Thu Mar 04, 2021 5:52 pm
GG1273 wrote: Thu Mar 04, 2021 5:36 pm My thought - anyone holding a power drill turned on in my mouth is getting paid - however, they want to be paid.

We found a super busy practice near us bit they are really good with us with hand scaling instead of that tool thing that drives me (and my gums) crazy. I gladly pay for that (and the fact that they listened). :mrgreen:

Another nice thing to do is to have a Harry/David fruit thing sent to the office once a year and definitely thank you notes for the staff. They always remember you even if only in 2x per year.
We offered our sensitive patients a topical anesthetic mouth rinse. It totally numbs up the gums for about an hour so that the cleaning procedure is easy even for those patients who are very sensitive to the procedure. I used it myself whenever I had my teeth cleaned.

Being appreciative always helps. Offices look forward to pleasant patients. At the end of the day, people are just people. A smile and a positive attitude goes a long way.
Thanks for the feedback.
I've had the topical stuff, wash and put on with a swab, neither numbs me enough.
Last time I had a filling replaced, they had to give me 4 Novocain shots before I was numb...
They are good with us there! :mrgreen:
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