Dentist billing in advance

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Good Listener
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Dentist billing in advance

Post by Good Listener »

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?
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ram
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Re: Dentist billing in advance

Post by ram »

Amazon has been charging me in advance for the goods for many years.
I wont be surprised if my dentist asks me for my portion in advance.
Last edited by ram on Mon Nov 23, 2020 9:11 pm, edited 2 times in total.
Ram
Carguy85
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Re: Dentist billing in advance

Post by Carguy85 »

Hmmm. If anything goes to lab the pt is required to pay half of their portion the day of impressions ...although nothing would get submitted to insurance until the day of delivery (crown/bridge/denture). The few times I’ve been burned by patients are when this hasn’t happened for whatever reason. Otherwise payment is due on day of completion (fillings, exams etc). Submitting claims to insurance BEFORE completion is not legal but collecting patient portions before is different..fully refundable before work is done of course if they wanted to pay in advance (a few do but it’s certainly not required). We work hard to predict patient portions as best we can so there are no surprises and never pressure patients to do anything... works well for us.
Last edited by Carguy85 on Mon Nov 23, 2020 9:09 pm, edited 1 time in total.
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8foot7
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Re: Dentist billing in advance

Post by 8foot7 »

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.
tj
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Re: Dentist billing in advance

Post by tj »

For as long as I've been going to a dentist, they have always charged my portion at the appointment.
runner3081
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Re: Dentist billing in advance

Post by runner3081 »

Very common for procedures.
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Nate79
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Re: Dentist billing in advance

Post by Nate79 »

I have always heard that dentists have a difficult time collecting so this is not surprising. There are a lot of deadbeats out there not paying their bills.
sawhorse
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Re: Dentist billing in advance

Post by sawhorse »

How far in advance do they want you to pay? If it's when you check in for the procedure, then I wouldn't have a problem with it. But if it's weeks in advance, that sounds fishy. I've had providers take a credit card number and charge it if you cancel the procedure outside the allowed time window. That sounds reasonable. Prepaying well in advance for the entire procedure does not.

I had a doctor charge my credit card for the consultation fee the day I booked the appointment. When I noticed it on my statement, I called them to ask why they did that and what would happen if I canceled before the 72 hour time limit, and they said they would refund it automatically. I ended up canceling more than 2 weeks in advance. It took more than a month and several phone calls to get refunded.
investingdad
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Re: Dentist billing in advance

Post by investingdad »

I had emergency work done on vacation a few years back that preceded my dental implant, which I discussed on here.

They requested to swipe my credit card before they started which was fine. Their work was a stop gap until I got home and it did the trick.

Sounds reasonable.
jacksdad0401
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Re: Dentist billing in advance

Post by jacksdad0401 »

Most of the time, it is to prevent no-shows and gaps in the schedule. Prepaying discourages people from scheduling who do not intend on coming to the appointment. I will do this for new patients and those who are unreliable. Any surgery over $1000 gets paid in advance. Otherwise, we collect in full on the day of the appointment. People try to get out of paying when you bill. As pressures in the industry continue to advance and older dentists retire, you will see less and less leniency in payment options.
J295
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Re: Dentist billing in advance

Post by J295 »

jacksdad0401 wrote: Tue Nov 24, 2020 7:55 am Most of the time, it is to prevent no-shows and gaps in the schedule. Prepaying discourages people from scheduling who do not intend on coming to the appointment. I will do this for new patients and those who are unreliable. Any surgery over $1000 gets paid in advance. Otherwise, we collect in full on the day of the appointment. People try to get out of paying when you bill. As pressures in the industry continue to advance and older dentists retire, you will see less and less leniency in payment options.
Well stated.
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Re: Dentist billing in advance

Post by sawhorse »

jacksdad0401 wrote: Tue Nov 24, 2020 7:55 am Most of the time, it is to prevent no-shows and gaps in the schedule. Prepaying discourages people from scheduling who do not intend on coming to the appointment. I will do this for new patients and those who are unreliable. Any surgery over $1000 gets paid in advance. Otherwise, we collect in full on the day of the appointment. People try to get out of paying when you bill. As pressures in the industry continue to advance and older dentists retire, you will see less and less leniency in payment options.
You maintain a list of patients who get billed in advance?
SpideyIndexer
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Re: Dentist billing in advance

Post by SpideyIndexer »

You mentioned that "run through your insurance" in advance. I am not sure what that means. Are you saying they collect from your dental insurance in advance? If they enter a date prior to your procedure that would be fraud. OTOH if they submit a claim for a future procedure, I doubt any dental insurance would pay on a claim for a procedure scheduled for a future date.
SpideyIndexer
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Re: Dentist billing in advance

Post by SpideyIndexer »

jacksdad0401 wrote: Tue Nov 24, 2020 7:55 am Most of the time, it is to prevent no-shows and gaps in the schedule. Prepaying discourages people from scheduling who do not intend on coming to the appointment. I will do this for new patients and those who are unreliable. Any surgery over $1000 gets paid in advance. Otherwise, we collect in full on the day of the appointment. People try to get out of paying when you bill. As pressures in the industry continue to advance and older dentists retire, you will see less and less leniency in payment options.
Sad that dentistry is now an industry.
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GerryL
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Re: Dentist billing in advance

Post by GerryL »

I pay for my basic treatment a year in advance. My long-time dentist offers this option as a loyalty plan, because he hates dealing with insurance companies. I've been paying a flat fee each year for all of my cleanings, x-rays and exams. The fee has not changed since we started at least 3 years ago. The plan includes a discount on other procedures, like the one I got yesterday.
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mmmodem
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Re: Dentist billing in advance

Post by mmmodem »

I've never heard of this. I'm surprised so many replied it's common. I always pay my portion at the conclusion of my visit. If insurance does not pay what the dentist bills and this happens often, the dentist will bill me the difference. It's usually a small sub $100 difference.

I'd suggest going to another dentist but according to the replies here, that's how it is now?
toofache32
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Re: Dentist billing in advance

Post by toofache32 »

Dental specialist here. I have not read the responses yet. About 7 years ago we started collecting half of the patient's portion just to schedule them, with the other half due on the day of treatment prior to being seated. We learned that the only patients upset at this were the ones who never intended to pay to begin with. We did this as a response to many people no-showing on the day of treatment. They had paid nothing in advance and therefore had no skin in the game to keep their appointment. Then I had to pay staff to sit around and do nothing. It wasn't very Boglehead.

You have to train your patients. Now it is normal for them to pay before being seated. When you drive through McDonalds, they have trained us to have our credit card waiting before they hand us the food.
toofache32
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Re: Dentist billing in advance

Post by toofache32 »

SpideyIndexer wrote: Tue Nov 24, 2020 9:42 pm You mentioned that "run through your insurance" in advance. I am not sure what that means. Are you saying they collect from your dental insurance in advance? If they enter a date prior to your procedure that would be fraud. OTOH if they submit a claim for a future procedure, I doubt any dental insurance would pay on a claim for a procedure scheduled for a future date.
Not insurance. This is talking about collecting the patient's portion in advance. Dental insurance (unlike medical insurance) actually provides fee schedules and payment percentages to this can be calculated in advance fairly accurately in most cases.
toofache32
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Re: Dentist billing in advance

Post by toofache32 »

sawhorse wrote: Tue Nov 24, 2020 6:03 pm
jacksdad0401 wrote: Tue Nov 24, 2020 7:55 am Most of the time, it is to prevent no-shows and gaps in the schedule. Prepaying discourages people from scheduling who do not intend on coming to the appointment. I will do this for new patients and those who are unreliable. Any surgery over $1000 gets paid in advance. Otherwise, we collect in full on the day of the appointment. People try to get out of paying when you bill. As pressures in the industry continue to advance and older dentists retire, you will see less and less leniency in payment options.
You maintain a list of patients who get billed in advance?
There is no list. But practice management software allows previous no-shows or outstanding balances to be documented and flagged. These come into play when scheduling future appointments. Sometimes it means full payment prior to scheduling. Sometimes it means cash only and no checks. Sometimes it means the next available appointment is 8 months out. What would you recommend to protect your business?
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Re: Dentist billing in advance

Post by sawhorse »

toofache32 wrote: Tue Nov 24, 2020 11:36 pm Dental specialist here. I have not read the responses yet. About 7 years ago we started collecting half of the patient's portion just to schedule them, with the other half due on the day of treatment prior to being seated. We learned that the only patients upset at this were the ones who never intended to pay to begin with. We did this as a response to many people no-showing on the day of treatment. They had paid nothing in advance and therefore had no skin in the game to keep their appointment. Then I had to pay staff to sit around and do nothing. It wasn't very Boglehead.

You have to train your patients. Now it is normal for them to pay before being seated. When you drive through McDonalds, they have trained us to have our credit card waiting before they hand us the food.
Do you allow them to cancel before a certain date and get a refund? What if they have end up in the emergency room or have Covid (and can provide documentation of that)?

A doctor I had made an appointment with charged the consultation fee to my card as soon as I made the appointment. They said that if I canceled before 72 hours of the appointment, they would automatically refund it. I canceled more than 2 weeks in advance, and it took more than a month and several phone calls to get refunded.

I now am wary of doctors who charge as soon as the appointment is made. I don't have any problem with them taking a credit card number and charging if I don't cancel before the time window with documented medical emergencies excepted, but I do have a problem with them charging the card in advance because of how difficult it was to get refunded.
toofache32 wrote: Tue Nov 24, 2020 11:46 pm
sawhorse wrote: Tue Nov 24, 2020 6:03 pm
jacksdad0401 wrote: Tue Nov 24, 2020 7:55 am Most of the time, it is to prevent no-shows and gaps in the schedule. Prepaying discourages people from scheduling who do not intend on coming to the appointment. I will do this for new patients and those who are unreliable. Any surgery over $1000 gets paid in advance. Otherwise, we collect in full on the day of the appointment. People try to get out of paying when you bill. As pressures in the industry continue to advance and older dentists retire, you will see less and less leniency in payment options.
You maintain a list of patients who get billed in advance?
There is no list. But practice management software allows previous no-shows or outstanding balances to be documented and flagged. These come into play when scheduling future appointments. Sometimes it means full payment prior to scheduling. Sometimes it means cash only and no checks. Sometimes it means the next available appointment is 8 months out. What would you recommend to protect your business?
Why don't you just not allow a patient to make a future appointment if they have a balance, and also to kick patients out of the practice if they didn't pay in full within a certain amount of time?
toofache32
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Re: Dentist billing in advance

Post by toofache32 »

sawhorse wrote: Wed Nov 25, 2020 12:33 am
toofache32 wrote: Tue Nov 24, 2020 11:36 pm Dental specialist here. I have not read the responses yet. About 7 years ago we started collecting half of the patient's portion just to schedule them, with the other half due on the day of treatment prior to being seated. We learned that the only patients upset at this were the ones who never intended to pay to begin with. We did this as a response to many people no-showing on the day of treatment. They had paid nothing in advance and therefore had no skin in the game to keep their appointment. Then I had to pay staff to sit around and do nothing. It wasn't very Boglehead.

You have to train your patients. Now it is normal for them to pay before being seated. When you drive through McDonalds, they have trained us to have our credit card waiting before they hand us the food.
Do you allow them to cancel before a certain date and get a refund? What if they have end up in the emergency room or have Covid (and can provide documentation of that)?

A doctor I had made an appointment with charged the consultation fee to my card as soon as I made the appointment. They said that if I canceled before 72 hours of the appointment, they would automatically refund it. I canceled more than 2 weeks in advance, and it took more than a month and several phone calls to get refunded.

I now am wary of doctors who charge as soon as the appointment is made. I don't have any problem with them taking a credit card number and charging if I don't cancel before the time window, but I do have a problem with them charging the card in advance because of how difficult it was to get refunded.
toofache32 wrote: Tue Nov 24, 2020 11:46 pm
sawhorse wrote: Tue Nov 24, 2020 6:03 pm
jacksdad0401 wrote: Tue Nov 24, 2020 7:55 am Most of the time, it is to prevent no-shows and gaps in the schedule. Prepaying discourages people from scheduling who do not intend on coming to the appointment. I will do this for new patients and those who are unreliable. Any surgery over $1000 gets paid in advance. Otherwise, we collect in full on the day of the appointment. People try to get out of paying when you bill. As pressures in the industry continue to advance and older dentists retire, you will see less and less leniency in payment options.
You maintain a list of patients who get billed in advance?
There is no list. But practice management software allows previous no-shows or outstanding balances to be documented and flagged. These come into play when scheduling future appointments. Sometimes it means full payment prior to scheduling. Sometimes it means cash only and no checks. Sometimes it means the next available appointment is 8 months out. What would you recommend to protect your business?
Why don't you just not allow a patient to make a future appointment if they have a balance, and also to kick patients out of the practice if they didn't pay in full within a certain amount of time?
Yes if you cancel we refund while you are still on the phone since these are usually credit card transactions.

For your second question, we allow patients with a balance to make appointments because they usually pay the balance and get caught up. I only dismiss a couple patients a year from the practice and it's usually for egregious financial reasons. Most recently, a patient's insurance sent the $2600 check to the patient instead of us. The insurance sent us a copy of the cancelled check as verification and told us it was our problem. When we called the patient, he suddenly didn't speak English and eventually quit answering the phone. So I went to the police station to file for "theft of services" which is a felony in my state if over $2500. The police officer called the patient while I was standing there and the patient suddenly spoke perfect English. We had the money in the account by the end of the day. Prior to when we collected the patient portion in advance, I had a patient not pay his contractual amount listed on the insurance EOB. So I sent him a 1099-C for cancelled debt so he would have to pay taxes on it. You can run from me, but you can't run from the IRS.
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Re: Dentist billing in advance

Post by sawhorse »

toofache32 wrote: Wed Nov 25, 2020 12:46 am For your second question, we allow patients with a balance to make appointments because they usually pay the balance and get caught up. I only dismiss a couple patients a year from the practice and it's usually for egregious financial reasons. Most recently, a patient's insurance sent the $2600 check to the patient instead of us. The insurance sent us a copy of the cancelled check as verification and told us it was our problem. When we called the patient, he suddenly didn't speak English and eventually quit answering the phone. So I went to the police station to file for "theft of services" which is a felony in my state if over $2500. The police officer called the patient while I was standing there and the patient suddenly spoke perfect English. We had the money in the account by the end of the day. Prior to when we collected the patient portion in advance, I had a patient not pay his contractual amount listed on the insurance EOB. So I sent him a 1099-C for cancelled debt so he would have to pay taxes on it. You can run from me, but you can't run from the IRS.
:shock: That's outrageous! I know you're very price transparent when it comes to your office-based practice, something I appreciate. I'm very sympathic toward people who get surprise bills in the context of emergencies, surgeries, laboratories, and the like, and I'm also very sympathetic toward people who are in an emergency situation and not in a position to check the network status of the nearest emergency room.

But there is no excuse in a non-emergency situation when you get a binding written quote in advance, as I know you provide. I pay out of pocket for my psychiatrist and physical therapist. The prices are listed on the website. I found the prices acceptable and booked an appointment. I would never think to go to a session knowing the price and then refuse to pay.

I bet these are the same people who are serial squatters and who buy a dress for an occasion, wear it, and return it. Or who sneak out of a restaurant before the waiter brings the check.

Some people are so brazen. Including some doctors as well as the people who run hospitals and other medical institutions, and health insurance companies. Sunshine is a great disinfectant. Mandatory price transparency is desperately needed. Offices like yours are a step in the right direction.
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Re: Dentist billing in advance

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Nate79 wrote: Mon Nov 23, 2020 11:06 pm I have always heard that dentists have a difficult time collecting so this is not surprising. There are a lot of deadbeats out there not paying their bills.
The younger woman who bought the practice isn’t about to get stiffed on the bill after doing procedures like the prior owner surely was. This sounds like essentially they are asking for a deposit. I am sure if you don’t want to go through with the procedure and called to cancel, prepayment would be refunded. I wouldn’t have an issue with it.
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Re: Dentist billing in advance

Post by jacksdad0401 »

SpideyIndexer wrote: Tue Nov 24, 2020 9:44 pm
jacksdad0401 wrote: Tue Nov 24, 2020 7:55 am Most of the time, it is to prevent no-shows and gaps in the schedule. Prepaying discourages people from scheduling who do not intend on coming to the appointment. I will do this for new patients and those who are unreliable. Any surgery over $1000 gets paid in advance. Otherwise, we collect in full on the day of the appointment. People try to get out of paying when you bill. As pressures in the industry continue to advance and older dentists retire, you will see less and less leniency in payment options.
Sad that dentistry is now an industry.
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!). Older dentists can make more money from a DSO sale. The DSO can outbid the young dentist because they are limited by what the bank would lend and further limited by the amount of student debt they have. DSOs can also absorb the fee reduction better than a private practice. I believe that there will be a paradigm shift in the next twenty years in our profession that will parallel pharm or medicine.
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Re: Dentist billing in advance

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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!). Older dentists can make more money from a DSO sale. The DSO can outbid the young dentist because they are limited by what the bank would lend and further limited by the amount of student debt they have. DSOs can also absorb the fee reduction better than a private practice. I believe that there will be a paradigm shift in the next twenty years in our profession that will parallel pharm or medicine.

How about Delta and their reimbursements for new dentists?.....our DSO sale was somewhat of an anomaly due to it being a family biz/specialty blended practice, and my bros in our 30s. Honestly the best business decision we have ever made. I remember every day feeling we were getting squeezed on so many fronts in addition to servicing tons of debt. Dentistry has been exceptionally good to our family but I don’t think I’d recommend dental school to my kids though due to a downward trend in compensation and skyrocketing school costs among other things.
Last edited by Carguy85 on Wed Nov 25, 2020 8:29 am, edited 2 times in total.
unstartable
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Re: Dentist billing in advance

Post by unstartable »

If this happened to me, I would tell the dentist to get a new office manager and look for a new dentist.
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ClevrChico
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Re: Dentist billing in advance

Post by ClevrChico »

This is been the way my dentists have been the last 20 years.

I did have one that would over-estimate my part of the bill heavily, and then reimburse me once/year. It was a slow office, so I suspect they used the money they held to help get by. (A free, patient funded loan.) It was one of the reasons I ultimately left them.
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Re: Dentist billing in advance

Post by 8foot7 »

ClevrChico wrote: Wed Nov 25, 2020 8:32 am This is been the way my dentists have been the last 20 years.

I did have one that would over-estimate my part of the bill heavily, and then reimburse me once/year. It was a slow office, so I suspect they used the money they held to help get by. (A free, patient funded loan.) It was one of the reasons I ultimately left them.
I think that happens in basically every one of these instances. Otherwise a credit card number on file would be sufficient.
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Re: Dentist billing in advance

Post by jacksdad0401 »

Carguy85 wrote: Wed Nov 25, 2020 8:16 am
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!). Older dentists can make more money from a DSO sale. The DSO can outbid the young dentist because they are limited by what the bank would lend and further limited by the amount of student debt they have. DSOs can also absorb the fee reduction better than a private practice. I believe that there will be a paradigm shift in the next twenty years in our profession that will parallel pharm or medicine.

How about Delta and their reimbursements for new dentists?.....our DSO sale was somewhat of an anomaly due to it being a family biz/specialty blended practice, and my bros in our 30s. Honestly the best business decision we have ever made. I remember every day feeling we were getting squeezed on so many fronts in addition to servicing tons of debt. I don’t think I’d recommend dental school to my kids though due to a downward trend in compensation and skyrocketing school costs among other things.
Yeah, Delta is tough. I dropped Aetna and Metlife. UC is next. They are part of the issue and why you see so many ridiculous and aggressive treatment plans from the Aspens of the world. Which DSO did you sell to? I am a solo GP doing about 1.8-2 per year. I pay myself a associate type salary (120k) and everything else goes to debt/retirement.

I will discourage my kids from going med/dental. I think it would be a great profession but the cost to play the game is way too high. I came out with 280k in student loans (I paid them off last year), cost of buying a cash flowing office and the building. You are easily a million dollars in debt before you start.
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Re: Dentist billing in advance

Post by tj »

jacksdad0401 wrote: Wed Nov 25, 2020 9:19 am
Carguy85 wrote: Wed Nov 25, 2020 8:16 am
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!). Older dentists can make more money from a DSO sale. The DSO can outbid the young dentist because they are limited by what the bank would lend and further limited by the amount of student debt they have. DSOs can also absorb the fee reduction better than a private practice. I believe that there will be a paradigm shift in the next twenty years in our profession that will parallel pharm or medicine.

How about Delta and their reimbursements for new dentists?.....our DSO sale was somewhat of an anomaly due to it being a family biz/specialty blended practice, and my bros in our 30s. Honestly the best business decision we have ever made. I remember every day feeling we were getting squeezed on so many fronts in addition to servicing tons of debt. I don’t think I’d recommend dental school to my kids though due to a downward trend in compensation and skyrocketing school costs among other things.
Yeah, Delta is tough. I dropped Aetna and Metlife. UC is next. They are part of the issue and why you see so many ridiculous and aggressive treatment plans from the Aspens of the world. Which DSO did you sell to? I am a solo GP doing about 1.8-2 per year. I pay myself a associate type salary (120k) and everything else goes to debt/retirement.

I will discourage my kids from going med/dental. I think it would be a great profession but the cost to play the game is way too high. I came out with 280k in student loans (I paid them off last year), cost of buying a cash flowing office and the building. You are easily a million dollars in debt before you start.
Is there a reason why a dentist would only take Dental? Where i am moving, one of the nearby dentists takes no insurance, the other one only takes Delta. If Delta's rates are low, I wonder why that's the one they choose to accept. I have GEHA medical and Metlife dental. I'm dropping the Metlife dental because the GEHA rates are higher and so the Metlife has paid nothing on my preventative work which is all i have needed to this point.
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F150HD
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Re: Dentist billing in advance

Post by F150HD »

Interesting info on becoming a dentist. Too bad too, a tooth emergency cannot wait.

As for prepay, my dentist does not, but I pay the bill onsite before leaving (whatever insurance does not cover)

As a compromise I'd have no issue paying $50 upfront for an appt and applied to the bill, then non-refundable if I am a no-show. Maybe $100 if a HCOL area.

My fear in pre-pay is fighting to get my $ back if things occur that are not my fault. Not big issue if $50 but if its a crown or something (more $$$$) different story.
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F150HD
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Re: Dentist billing in advance

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ram wrote: Mon Nov 23, 2020 9:02 pm Amazon has been charging me in advance for the goods for many years.
I wont be surprised if my dentist asks me for my portion in advance.
so when you eat at a nice restaurant, you pay and tip before your meal? :happy

(uh oh, may bridge to a BH tipping thread here.)
SlowMovingInvestor
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Re: Dentist billing in advance

Post by SlowMovingInvestor »

It's possible that many dental practices have been hit because of COVID shutdowns and subsequent slowdown. And extra expenses for PPE, special equipment etc.

That would make cash flow even more critical. Perfectly reasonable to charge 50% in advance. My dentist does not do that, except for crowns, but I've been with him for a long time.
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Re: Dentist billing in advance

Post by dcd72 »

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.
My daughter's orthodontist quotes a flat fee at the beginning of a phase of the treatment (we're now on the third, and hopefully final, phase). It includes all charges for that phase - hardware, appointments, retainers, etc. It's really nice - when they want to schedule a special follow-up that is outside of the normal schedule, it's all included, and there's no worry that they're doing it just to squeeze some extra $$ out of me or my insurance company.
toofache32
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Re: Dentist billing in advance

Post by toofache32 »

tj wrote: Wed Nov 25, 2020 9:29 am
jacksdad0401 wrote: Wed Nov 25, 2020 9:19 am
Carguy85 wrote: Wed Nov 25, 2020 8:16 am
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!). Older dentists can make more money from a DSO sale. The DSO can outbid the young dentist because they are limited by what the bank would lend and further limited by the amount of student debt they have. DSOs can also absorb the fee reduction better than a private practice. I believe that there will be a paradigm shift in the next twenty years in our profession that will parallel pharm or medicine.

How about Delta and their reimbursements for new dentists?.....our DSO sale was somewhat of an anomaly due to it being a family biz/specialty blended practice, and my bros in our 30s. Honestly the best business decision we have ever made. I remember every day feeling we were getting squeezed on so many fronts in addition to servicing tons of debt. I don’t think I’d recommend dental school to my kids though due to a downward trend in compensation and skyrocketing school costs among other things.
Yeah, Delta is tough. I dropped Aetna and Metlife. UC is next. They are part of the issue and why you see so many ridiculous and aggressive treatment plans from the Aspens of the world. Which DSO did you sell to? I am a solo GP doing about 1.8-2 per year. I pay myself a associate type salary (120k) and everything else goes to debt/retirement.

I will discourage my kids from going med/dental. I think it would be a great profession but the cost to play the game is way too high. I came out with 280k in student loans (I paid them off last year), cost of buying a cash flowing office and the building. You are easily a million dollars in debt before you start.
Is there a reason why a dentist would only take Dental? Where i am moving, one of the nearby dentists takes no insurance, the other one only takes Delta. If Delta's rates are low, I wonder why that's the one they choose to accept. I have GEHA medical and Metlife dental. I'm dropping the Metlife dental because the GEHA rates are higher and so the Metlife has paid nothing on my preventative work which is all i have needed to this point.
I'm not sure why dentists would want to get involved in the medical insurance fiasco. Lack of transparency (unlike dental) and having to fight to get paid for every claim.
toofache32
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Re: Dentist billing in advance

Post by toofache32 »

sawhorse wrote: Wed Nov 25, 2020 4:23 am
toofache32 wrote: Wed Nov 25, 2020 12:46 am For your second question, we allow patients with a balance to make appointments because they usually pay the balance and get caught up. I only dismiss a couple patients a year from the practice and it's usually for egregious financial reasons. Most recently, a patient's insurance sent the $2600 check to the patient instead of us. The insurance sent us a copy of the cancelled check as verification and told us it was our problem. When we called the patient, he suddenly didn't speak English and eventually quit answering the phone. So I went to the police station to file for "theft of services" which is a felony in my state if over $2500. The police officer called the patient while I was standing there and the patient suddenly spoke perfect English. We had the money in the account by the end of the day. Prior to when we collected the patient portion in advance, I had a patient not pay his contractual amount listed on the insurance EOB. So I sent him a 1099-C for cancelled debt so he would have to pay taxes on it. You can run from me, but you can't run from the IRS.
:shock: That's outrageous! I know you're very price transparent when it comes to your office-based practice, something I appreciate. I'm very sympathic toward people who get surprise bills in the context of emergencies, surgeries, laboratories, and the like, and I'm also very sympathetic toward people who are in an emergency situation and not in a position to check the network status of the nearest emergency room.

But there is no excuse in a non-emergency situation when you get a binding written quote in advance, as I know you provide. I pay out of pocket for my psychiatrist and physical therapist. The prices are listed on the website. I found the prices acceptable and booked an appointment. I would never think to go to a session knowing the price and then refuse to pay.

I bet these are the same people who are serial squatters and who buy a dress for an occasion, wear it, and return it. Or who sneak out of a restaurant before the waiter brings the check.

Some people are so brazen. Including some doctors as well as the people who run hospitals and other medical institutions, and health insurance companies. Sunshine is a great disinfectant. Mandatory price transparency is desperately needed. Offices like yours are a step in the right direction.
You have no idea how common this is. People pay their Netflix and cell phone first and pay the doctor last. It's our culture. We collect prior to the procedure because after the procedure, we even get the "let me go get my wallet from my car" trick and they don't come back.
jacksdad0401
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Re: Dentist billing in advance

Post by jacksdad0401 »

Is there a reason why a dentist would only take Dental? Where i am moving, one of the nearby dentists takes no insurance, the other one only takes Delta. If Delta's rates are low, I wonder why that's the one they choose to accept. I have GEHA medical and Metlife dental. I'm dropping the Metlife dental because the GEHA rates are higher and so the Metlife has paid nothing on my preventative work which is all i have needed to this point.
[/quote]

He is probably Delta Premier which has a higher fee schedule. He is most likely grandfathered in as they are phasing out Premier in most states. For example, I have my license in MD and in VA. I am PPO in MD and Premier in VA. I get 300 dollars less per crown in MD.

The only other reason would be a large employer in the area uses delta and he would rather have the volume. Out of network Metlife usually pays full fee for preventive unless it is an HMO.
adamthesmythe
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Re: Dentist billing in advance

Post by adamthesmythe »

I don't have a problem paying in advance, especially for elaborate scheduled procedures (i.e. implants) or procedures that require lab work (crowns). I don't expect much from dental insurance so if I get a reimbursement later I consider that a good day and I'm happy.

I don't see dental offices as the kind of business where I am worried about them suddenly closing down and moving out of state.
tj
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Re: Dentist billing in advance

Post by tj »

jacksdad0401 wrote: Wed Nov 25, 2020 11:44 am Is there a reason why a dentist would only take Dental? Where i am moving, one of the nearby dentists takes no insurance, the other one only takes Delta. If Delta's rates are low, I wonder why that's the one they choose to accept. I have GEHA medical and Metlife dental. I'm dropping the Metlife dental because the GEHA rates are higher and so the Metlife has paid nothing on my preventative work which is all i have needed to this point.


He is probably Delta Premier which has a higher fee schedule. He is most likely grandfathered in as they are phasing out Premier in most states. For example, I have my license in MD and in VA. I am PPO in MD and Premier in VA. I get 300 dollars less per crown in MD.

The only other reason would be a large employer in the area uses delta and he would rather have the volume. Out of network Metlife usually pays full fee for preventive unless it is an HMO.
Interesting. My current dentist was in network for GEHA Connection and Metlife, and the Metlife had lower rates, so since metlife was secondary, it had paid nothing. Good to know that they pay more than their contracted rates out of network for preventative. What about restorations? Is there an insurer that is better paying for out of network?

As a federal employee, we can choose from Aetna, BCBS, Delta, GEHA Connection Dental, Metlife, UHC, United Concordia.
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MrBobcat
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Re: Dentist billing in advance

Post by MrBobcat »

I don't really see this as a big deal one way or the other. If paying up front bothers one, then find another practitioner. I can almost guarantee you the practitioner has factored in losing some clients with the change of policy. They will end up eventually with clients who like and respect the work they do and don't have a problem paying for it.

Clients/patients need to come to the realization that not all clients/patients are as upstanding about paying bills as they are personally and when billing procedures need to be changed to account for the financially strapped clients it's just not practical to do piecemeal policies depending upon the client.
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ram
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Re: Dentist billing in advance

Post by ram »

F150HD wrote: Wed Nov 25, 2020 9:45 am
ram wrote: Mon Nov 23, 2020 9:02 pm Amazon has been charging me in advance for the goods for many years.
I wont be surprised if my dentist asks me for my portion in advance.
so when you eat at a nice restaurant, you pay and tip before your meal? :happy

(uh oh, may bridge to a BH tipping thread here.)
Yes. Sometimes
Depends on the size of the group. In many nice restaurants the tip is something like 18% for a moderate to large size group.
Ram
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wander
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Re: Dentist billing in advance

Post by wander »

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?
tj
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Re: Dentist billing in advance

Post by tj »

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
Bama12
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Re: Dentist billing in advance

Post by Bama12 »

I have changed dentist three times in the last four years because of this.

I will only pay the day of.
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wander
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Re: Dentist billing in advance

Post by wander »

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.
Soon2BXProgrammer
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Re: Dentist billing in advance

Post by Soon2BXProgrammer »

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?
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).
bwalling
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Re: Dentist billing in advance

Post by bwalling »

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).
Preauths are still estimates, and not a guarantee of reimbursement. They also frequently don't account for clinical documentation, etc.
toofache32
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Re: Dentist billing in advance

Post by toofache32 »

Soon2BXProgrammer wrote: Mon Mar 01, 2021 3:18 pm
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?
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).
This is a pre-authorization. These are only helpful if they deny the authorization, but not so helpful if they approve it. At the bottom of every pre-auth is the fine print "pre-authorization of services is not a guarantee of payment" which means they reserve the right to change their minds later, which I have seen multiple times. Therefore my office rarely bothers with these.
SlowMovingInvestor
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Re: Dentist billing in advance

Post by SlowMovingInvestor »

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 ?
Portfolio: 50% DOGE, 10% SPACs, 10% Frozen OJ futures, 10% MOON ETF, 10% NFTs , 5% FOMO ETF, 5% New Jersey Delis with $100M market cap :)
bwalling
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Re: Dentist billing in advance

Post by bwalling »

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 ?
Medicaid is very strict - you can do only these procedures, we'll pay this much, and you can't charge the patient for anything else.

Other plans are lenient to varying degrees. Some are fairly open, and you can bill for "extras". Some require that the patient sign something first clarifying what insurance covers on their treatment plan and what it does not. In those cases, as long as they showed you what was not covered, and you were given the option of only doing what insurance covers, they're fine to charge you.
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