Now onto \u201cShould I take dental\u00a0 insurance or not?\u201d Part 1<\/strong><\/p>\nPersonally, I\u2019ve seen both sides of the dental insurance question\/equation having seen 80%+ dental insurance participation in my general practice followed by 0% dental insurance participation\/100% fee for service in my niche practice. It\u2019s a pretty unique position and have yet to meet another consultant who has clinically lived in both worlds and thus understand the ins and outs of how to make both work.<\/p>\n
Being 100% fee-for-service is an aspiration that many claim to want but few consider what\u2019s truly involved to make it a reality for the long term. In a minute a doc who\u2019s been affiliated with us for some time will share his \u201cchair-side story\u201d on what has allowed him to remain fee-for-service in one of the toughest markets in the U.S.<\/p>\n
From a business stability perspective, \u201cblended\u201d practices are almost always the best option where there are some niche cases (if that\u2019s something you like doing), some dental insurance based cash flow, and some fee for service cash flow. Why blended? Because it is the scenario that most dentists are capable of achieving and managing effectively for decades. It\u2019s no surprise that most of our members have blended practices.<\/p>\n
Why not a universal rallying cry of \u201cfee for service\u201d for everyone? Well, because the reality is few dentists are equipped to be completely fee for service from a clinical and an administrative\/customer service perspective. They aren\u2019t going above and beyond the norm for what patient\u2019s expect from a professional service experience nor are they equipped with the right clinical background nor do they have the administrative mindset or have hired the right administrative help. The 100% fee for service model requires bigger \u201cset-up\u201d required for patients to see the difference between one that is discounted under contracts versus one that is not and then be willing to pay for the one that isn\u2019t discounted.<\/p>\n
What follows is a story from a doctor\u2019s practice in Southern California that has navigated the waters of being fee-for service in 2015.<\/p>\n
\u201cWe have been out of network for about 10 years – when we dropped our last couple PPO plans including Delta “premier”. So since then we have had one fee schedule. We collect what we produce. No write offs other than pre-pay discounts or bank financing fees.<\/p>\n
Southern Cal is managed care mecca. The race to the bottom is in full swing and the cost of living is high enough that many people are struggling financially – so they go to XXX Dental until they have a bad experience, then they look for something else. So far, we don’t have any reputable corporate clinics – such as Heartland (James’ comment\u2026take a look at their reviews!). I’m sure they will come, but for now all the corporate offices are mills that abuse both the patient and the dentist employee. We hear about it first hand from all of my son’s classmates that are working in that environment.<\/p>\n
Some thoughts:<\/p>\n
It is a constant effort that requires the right team and continual reinforcement with that team – led by me and the office manager\/treatment coordinator who is on the front lines dealing with it every day to create the value in coming to us “out of network”.<\/p>\n
We “lose” about 1\/3 of the new patients that call, so we need numbers high enough to allow for that shrinkage. We are transparent about being out of network, however we let them know that we have lots of patients with their dental insurance who choose to come to us anyway. The reason we are so open is because, as you teach, we don’t want to waste everyone’s time with an insurance dependent patient that will only do what their dental insurance will pay. It sucks the wind out of you to spend an hour with a patient who is never going to move forward because they don’t see the value of our care. We bill the insurance for them and we do accept assignment – in a way – but we estimate super conservatively – for example if the insurance says it pays 80% of their fee schedule we are not getting just 20% – we ask the patient to pay 50% or more depending on the plan and we will reimburse them if the insurance pays better than expected.\u201d<\/p>\n<\/div>
<\/div><\/div><\/div><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":6,"featured_media":5183,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[191,9,190],"tags":[],"yoast_head":"\n
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