Medical and hospitals are completely different from dental. Medical and hospitals have a ridiculous list price that virtually no one pays. Not so with dental. 80+% off patients in the typical practice pay the normal fee.
Dental overhead does not vary by more that 10%. It can’t The biggest expense is wages. You think one guy can hire employees for 30% less than the guy down the street? You think some guys can buy supplies for 20% cheaper than others? How much do you think dental equipment price varies? Not much, unless you buy it used.
The ONLY way to treat deep discount plan patients is to decrease time spent with them. Don’t spend any time on the orthodontic workup- just punt it. Don’t even try to do difficult root canals- refer them out to specialists who charge 50% more. Same for extractions. Everything you cannot do fast refer out. Lie to patients and say you cannot do them. That is what I was told to do in a clinic chain.
How to cut the time spent with patients? Cut the talk time. Give them a paper explanation, if any, rather than talking to them. Don’t waste time talking to them on the phone. Every minute doing so is lost revenue.
Make patients wait. Double or triple book appointments. Run around like a chicken with your head cut off. Anything to turn a profit with low fees. Been there, done that. Guys burn out in short order doing that. And they make mistakes
Do what you want. The beauty of private practice is that their are market niches for everyone. Some patients want a high level of service, some are satisfied with any level to save money.
I’d have to side w/Henrius on this one. I have known lots of dentists and lots of insurance salesmen in my life and when you get to know them well enough they’ll share the real scoop with you.
The real scoop is that good dentists build up a patient list by providing good dental work to their patients. They give good advice and perform good work and their patients keep coming back and recommending them to their friends and family. Most good dentists are too busy to take on very much added hassle from middle-man insurance outfits.
The insurance guy probably has the same relationship with his/her dentist that I described. The insurance guy gets paid to sell insurance and biggest commissions are not likely to be paid by the most reputable insurance companies.
Same issue with Dental Savings Plans as with PPO plans. Guys can’t make any money giving 20-30% off. So they upcode procedures or bill for things they ordinarily don’t charge for to make up the difference. There is no free lunch.
No offense, ratbert2k, but how come you don’t trust Suze Orman? Clark Howard has said some kind things about Suze, but he has essentially admitted that she has her faults.
Clark doesn’t always know what he is talking about. I have worked in offices taking such plans, and know first hand how the patients are treated. Does Clark have the same experience as a licensed dentist like me with 42 years of clinical practice?
Dental HMOs (DMOs like Cigna DMO) are a joke. No good dentists mess with them. It is impossible to turn a profit on them, except by making appointments nearly impossible to obtain, and collecting the monthly capitation fee. Another trick management told us to use is referring patients out to specialists for everything. If we did a root canal, we would only get 20% of our usual fee. We lost money. Specialists got a different deal. Even so, specialists that would mess with DMO patients were few and far between. We did not care. Our clinic just wanted to avoid losing money any way we could.
A few dentists offer their own “Dental savings plans” administered in house. They are tricky lest the state insurance agency decide to regulate them. For a monthly fee, you get free REGULAR cleanings ( NOT periodontal maintenance nor scalings) and x-rays and exam, plus typically a 10% discount on other stuff. You are effectively defraying the expenses by buying down the price monthly.
A lot of times you can negotiate 10% reduction by paying CASH, not card nor check.
Dental overhead being what it is, it just is not possible to offer discounts above 20% and stay solvent. That is why guys and gals have to resort to upcoding procedures and adding miscellaneous fees (like lab bills which are usually included in the procedure code) to make up the difference.
I prefer to pay cash. It’s easier for dentists and it’s easier for me.
How do I get dentists not to charge me more because I am paying cash?
I have a horror story that I would like to share.
I had Medicare Advantage (MA) insurance, and I tried to schedule a routine cleaning with a valley dental clinic. Since I had MA, they refused to give me a routine cleaning. Instead they insisted I get a “deep cleaning.” When I went in for deep cleaning, they said the procedure need to be done in two sessions, one that day, and one another day. Their objective was to maximum what MA would pay, not what I needed. One dentist drilled on my upper right teeth and put in fillings. It felt very different from what I experienced in the prior 60 years. I was all numb, so I didn’t know whether the procedure was good or bad. The next day I went back for the left side. Original dentist wasn’t there. His mom introduced herself to me. I initially was trying to avoid that woman, but since she’s his mom, I let off my guard. She drilled two of my teeth on left side, and due to her incompetence, she broke them. I was like drowning in water they filled in my mouth while she was panicky trying to undo her mistake. It couldn’t be undone. Once good teeth are broken, they are broken. For the profit of $1000 they were willing to destroy my healthy teeth. Now I need root canals to fix the problem she caused.
So, I am trying very hard to avoid bad dentists and yet still got tricked into one.
Again, how do I get dentists to charge me no more than they charge others?
What is remarkable is you are on a Medicare Disadvantage plan and not complaining about the poor treatment you receive on the medical side of the house.
Don’t understand. You are describing a situation where you got flim-flammed with dental insurance, yet you say you are paying cash. Which is it? The shenanigans you describe are typical of those who go to the dentists with crappy, low-paying dental plans.
Uninsured cash paying patients should be charged less than insured ones, because they pose less of a paperwork burden. Unfortunately most states regard this as “overbilling insurance” and make it a dental practice act violation.
In the old days, patients patronized dentists based on their reputation for honest dealings in the community. Now for most patients the “prostituting provider” insurance list is the most important qualification. No wonder so many patients get bamboozled. The most important qualities are honesty and competence.
To find a good general dentist, ask any candidate the following questions:
Do you still use silver amalgam for fillings on back teeth, even it you only do it occasionally?
Do you still do partial coverage gold crowns on back teeth? (Even if you as a patient do not want one.)
Do you use rubber dam on the majority of your restorative procedures? (It keeps you from the “drowning in water” experience.)
If a dentist can answer all three of these questions affirmatively, you probably have a competent and honest dentist. A rather small number of dentists, and even fewer young ones, will answer all questions “yes.”
But if you want you could check disciplinary actions with your state board of dentistry.
Google reviews are often doctored. One spiteful patient sent to collections can write a whole bunch of one star reviews under different aliases, so they are not so accurate.
I’m rarely in agreement with Henrius… but on this one I agree… ya need to be friend with your dentist and get to know him… (or her, as the case may be.)
I went today to a Delta Dental provider. Yes they upsold me. They tried to get me in for a deep cleaning which my Medicare Advantage plan would pay a little and quoted me $4K after insurance for 3 crowns and a cavity filling. I am cautious that I need crowns on front teeth so I will seek another opinion from an indep dentist. My former dentist stopped accepting insurance. We all have to be real careful.
I recommend the second opinion. I had a dentist propose to crown 2 front teeth and touch up a cavity on a neighboring tooth because I had decay around some 40-year-old fillings. This dentist had the fancy machine that makes same-day crowns. $4400. A friend who is a retired dental assistant said crowns are big money makers for dentists and told me to get a second opinion. Second dentist said he’d fix the old fillings for $800. I don’t have dental insurance and pay out-of-pocket.
good information. We finally went with a discount program in a dental office. Smile Dental or something. It simply gives a discount. The Delta Dental provider great expressions wanted to upsell everything. Deep cleaning for hundreds of dollars instead of what is covered free cleaning, $4K for crowns and cavity etc. Sure has changed in the last several years. We had good luck with Humana until our dentist left the program
In one post, you summarized the problems with Dental plans.
On low paying plans, the only practices that sign up are corporate practices owned by investors. Why do they sign up? Such plans are unprofitable if patients are treated honestly. Corporate practices like Great Expressions, Aspen, and other seedy chain clinics have no problem with overtreatment, upcoding procedures, and even outright billing fraud.
Why did your old dentist leave the Humana network? Young dentists sign up for these things when they are desperate for new patients, then drop them as soon as possible. Nobody can afford to take a 20-30% hit in fees, when overhead is 60 to 70%… Overhead is just too high.
You won’t believe me of course, but on various discount plans dentists have to either upcode procedures or add fees they usually don’t charge to make up for the huge discount. An example is cleanings. Hygienists demand wages of between $40 and $60 an hour in Atlanta. Some discount plan promises cleanings for $30. How can a dentist avoid losing money? The practice owner bills a routine cleaning as a “scaling and root planing” which carries a much higher fee, on a discount plan. I see this racket on a daily basis from incoming patients, especially from sleazy corporate dental clinics.
Everyone thinks there is so much fat that can be trimmed in dental treatment, and there really isn’t.
Believe it or not, Henrius, money expert Dave Ramsey has endorsed 1Dental. By his own admission, Mr. Ramsey is “not a fan of dental insurance.” He also despisescredit cards.
Great! I am happy for Dave Ramsey. Was he paid something for the endorsement? How would you know if he was or wasn’t?
Has he dealt with dental insurance on a day to day basis in a dental practice for 35 years, as I have? Has he reviewed insurance contracts as I have?
1 Dental ads advertise their lists are the “Best Dentists.” There is no basis in fact for these claims. In fact, the most competent dentists never sign up for plans like this.
Tell me, wise one. You seem to think discounts of 30% or more on dental treatments is routinely possible. What percentage do you think is overhead in a typical dental practice?
Do you actually think dentists would be willing to lose money on treating patients?
Dave Ramsey gets money for all of his “Best (fill in the blank) Lists.” When I was in the real estate business I called and applied. I was told that I had to periodically cough up several hundreds of dollars to “qualify” for, and remain on, his “best real estate broker list.”
A few months later he signed up a broker as his “best in the area real estate broker” a person who was arguably an individual with one of the worst reputations and track records in that market area. THAT’s when I stopped listening to Dave Ramsey.
