Does your office take my insurance?

This is one of the most common questions we get, and the answer is a bit convoluted. The shortest answer is: if you are required to pick a dentist from a supplied list, we won’t be on it. I am not contracted with any PPO’s or other capitation plans. If you are curious why that is, see My thoughts on capitation plans (PPO’s, DMO’s, etc) located below.

However we have many patients with “real insurance” from Aetna, Metlife, etc. “Real insurance” is a term I give to plans that allow you to pick whomever you like. If you aren’t sure exactly WHICH type of plan yours actually is call your HR department. Or us.

And now, a caveat: We file insurance for our patients as a courtesy; we are not required to do it. As you might imagine, we deal with insurance a lot more than the average person so it’s easy for us to do it. But the ultimate responsibility for dealing with balky insurance companies lies with the patient, not our office. If your insurance is delaying payment it is up to you to keep your account current. We have found through hard experience that our patients are FAR more diligent about keeping up with insurance company correspondence if THEY are the ones waiting for the insurance company check. It is much easier for patients to put things off if it is our office waiting on payment. It’s just human nature.

My thoughts on capitation plans (PPO’s, DMO’s, etc)
When I was first in practice I worked for a dentist who took several different capitation plans. I learned firsthand why I never wanted to do dentistry under such conditions. I want to explain how they work from both your perspective and the dentist’s.

When the patient looks at the procedure “price list” supplied by the insurance company running the capitation plan, it looks like a pretty good deal. Routine exams, xrays and cleanings are free or darn close to it. Fillings and crowns are cheap, sometimes little more than half the price a “fee for service” dentist (like me) would charge. Sounds like a great deal, right?

Now the dentist’s perspective. When a dentist signs up for one of these plans he (or she) agrees to charge fees according to the fee schedule supplied by the contracting insurance provider. The carrots these providers use to entice a dentist to sign on are twofold. One, the dentist will be on a list of contracting dentists for the plan. This provides a source of new patients. Two, the dentist often receives a set amount of money per patient in his assigned patient pool. The approach the insurance company uses is “we’ll guarantee you a steady $4000-$5000 per month, plus you get what you bill on top of that”. Sounds like a great deal, right?

Now the reality. Nobody stays in business hemorrhaging money. That is the bottom line. When someone walks through the door of a dental office needing a cleaning, that patient takes employee time and consumes materials (prophylaxis supplies, sterilization supplies, etc). Dental hygienists don’t work for free (not even for me, and I’m a hoot to work for!). So if someone sits in my chair, and consumes $75 worth of supplies and employee wages, and yet I’m compensated less than $20, well, you do the math. That $4000-$5000 doesn’t even begin to cover the overhead caused by the prospect of seeing all those patients.

How does the dentist make it work then? Well, if you make it virtually impossible for the patient to come in it can work. The dentist gets that monthly stipend regardless of whether the patients come in or not. “Plan patients” are bumped for fee-for-service patients all the time. If you are stuck with a PPO and call a dentist on your list to schedule a cleaning, you might find out it will be weeks, maybe months, before you can be seen. If that happens, try this little test: call back again in a few minutes using a different phone number. Disguising your voice (or get a friend) identify yourself as a new patient, but not one on a capitation plan. You may find you can get in right away.

If seeing the patient becomes unavoidable the dentist can still make money if he is willing to diagnose a lot of work. If doing a conservative, inexpensive filling results in a net loss to the dentist, do you really think he is going to diagnose many of them? More likely he is going to tell you that a tooth is too far gone for a simple filling and that what you really need is a crown. Of course, with a discounted fee schedule you can’t clear much profit doing a crown unless you use a really cheap lab AND don’t spend much time with the patient. The result is usually a poor restoration.

I have discovered that I can make a decent living AND be a conservative dentist by staying away from capitation plans. You will pay more “up front” with a fee-for-service dentist but save a bundle in the long haul, not to mention spend less time in the chair.