Successful First Three Years in my Career

[aznriptide859]

Here's another one I've seen recommended on dentaltown:

Amazon product

Nice, well I mean if it gets the job done then it's worth it

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Members don't see this ad.

 

[CLAZO121]

@p4cific2012 you said that you do everything, including OS.

I thought dental insurance doesn't pay GP much for OS procedures. How much % of your income is from OS?

Would it be more practical to start connecting with an OS and referring to him, so he can refer to you?

 

[Soleus715]

@p4cific2012 you said that you do everything, including OS.

I thought dental insurance doesn't pay GP much for OS procedures. How much % of your income is from OS?

Would it be more practical to start connecting with an OS and referring to him, so he can refer to you?

insurances don't pay much for anything tbh... I work front desk and seriously the fee schedules have been going down the crapper for some networks.
this one ins covers only $233 for anterior endo and post & core covered at 80%. it's a joke now... a lot of insurances cover less than $80 for simple extractions at 80%.

 

[p4cific2012]

@p4cific2012 you said that you do everything, including OS.

I thought dental insurance doesn't pay GP much for OS procedures. How much % of your income is from OS?

A majority of my patients are on the older side, and therefore operate on the FFS basis. So I don't deal with insurance THAT much. Maybe 30-40% of my patients are insurance?

It's true, PPO rates are falling. But I'm pretty well insulated from it...for now.

 

[Soleus715]

It's a strange dilemma... one on hand you'd like for your patients to have insurance because then they wouldn't have to pay out of pocket as much and can afford what they need...
on the other hand.. these insurances are ripping off GP's real hard and dentists lose money with PPO patients due to low fees, waiting periods, limitations, miss tooth clause, etc.

Good thing not many patients at our office has the really crappy network fees I mentioned earlier

 

[CLAZO121]

Im seriously considering OMS,

Are insurances ripping off OMS too?

 

[Soleus715]

Im seriously considering OMS,

Are insurances ripping off OMS too?

I work for a GP so I personally have no idea how things work on that end... my guess is that it's the same thing but they probably don't accept a lot of the low fee schedule insurances... I wouldn't if I spent that much money/time on specializing.

 

[ajj70]

First few years, take every insurance you can, build up your patient pool, slowly bow out of insurance networks .

 

[Domenick12]

It's a strange dilemma... one on hand you'd like for your patients to have insurance because then they wouldn't have to pay out of pocket as much and can afford what they need...
on the other hand.. these insurances are ripping off GP's real hard and dentists lose money with PPO patients due to low fees, waiting periods, limitations, miss tooth clause, etc.

Good thing not many patients at our office has the really crappy network fees I mentioned earlier

Would you be able to explain how insurances decide to pay a dentist? I work in an office as an assistant, but I have no idea how the insurance aspect works. I always thought that if a dentist charges $250 for an extraction and the insurance covers 50% of extractions, that insurance pays $125 to the dentist and the patient pays $125 to the dentist, but I'm beginning to think that that's not how it works most of the time.

 

[catoshiro]

Would you be able to explain how insurances decide to pay a dentist? I work in an office as an assistant, but I have no idea how the insurance aspect works. I always thought that if a dentist charges $250 for an extraction and the insurance covers 50% of extractions, that insurance pays $125 to the dentist and the patient pays $125 to the dentist, but I'm beginning to think that that's not how it works most of the time.

That's what I thought too. But I guess collection and production are different numbers at the end of the month because of the type of insurance that some patients have. Can anyone explain this clearly?

 

[Soleus715]

Would you be able to explain how insurances decide to pay a dentist? I work in an office as an assistant, but I have no idea how the insurance aspect works. I always thought that if a dentist charges $250 for an extraction and the insurance covers 50% of extractions, that insurance pays $125 to the dentist and the patient pays $125 to the dentist, but I'm beginning to think that that's not how it works most of the time.

That's what I thought too. But I guess collection and production are different numbers at the end of the month because of the type of insurance that some patients have. Can anyone explain this clearly?

Insurance companies belong to "dental networks" such as Dental Network of America (for some Blue Cross ins).
Dental Network of America will have a "fee schedule" which is a list of the cost of all the procedures covered under the plan.

Let's say that you charge $250 for a Simple Extraction. But the insurance fee schedule lists D7140 Simple Ext as $140 covered at 50%.
The insurance will pay out $70 total. The patient portion is $70. For most PPO insurances, the PPO agreement states that you are NOT allowed to charge anything more than $70 to the patient.
Thus incurring you a loss of $110 for the procedure compared to a "no insurance" patient.

This is why you hear of dentists on Dentaltown that will not take Delta Dental anymore due to fee schedule reductions.
If you can charge the patient $110 that wasn't covered, dentists would accept all insurances because they would just charge the patient the leftover amount.
But sadly, this is not how it works.

Also, the fees vary drastically based on your location. While some areas charge less than $400 for anterior endo, some areas will charge over $1000.

 

[Domenick12]

Insurance companies belong to "dental networks" such as Dental Network of America (for some Blue Cross ins).
Dental Network of America will have a "fee schedule" which is a list of the cost of all the procedures covered under the plan.

Let's say that you charge $250 for a Simple Extraction. But the insurance fee schedule lists D7140 Simple Ext as $140 covered at 50%.
The insurance will pay out $70 total. The patient portion is $70. For most PPO insurances, the PPO agreement states that you are NOT allowed to charge anything more than $70 to the patient.
Thus incurring you a loss of $110 for the procedure compared to a "no insurance" patient.

This is why you hear of dentists on Dentaltown that will not take Delta Dental anymore due to fee schedule reductions.
If you can charge the patient $110 that wasn't covered, dentists would accept all insurances because they would just charge the patient the leftover amount.
But sadly, this is not how it works.

Ohh ok. So the only real point of dentists having their own fee schedule is for patients that have insurance that they don't take and patients that don't have insurance? Does everything you said also go for premier dental offices?

 

[Soleus715]

Ohh ok. So the only real point of dentists having their own fee schedule is for patients that have insurance that they don't take and patients that don't have insurance? Does everything you said also go for premier dental offices?

Yes, that's correct.
At my work, the patients usually don't have insurance and my boss charges less than the fee schedule so insurances actually seem better to have.
So I guess it all depends on how much you plan on charging your patients.

For premier dental office, are you talking about the network or type of insurance? I guess the answer would be yes for both.
Insurances are marketed to employers in this manner:

"Delta Dental Premier is our original network-based fee-for-service plan. This program is ideal for group purchasers that wish to offer their employees and dependents unfettered access to any licensed dentist in the world while providing sound protection from unnecessary expenses."

 

[ajj70]

Insurance companies belong to "dental networks" such as Dental Network of America (for some Blue Cross ins).
Dental Network of America will have a "fee schedule" which is a list of the cost of all the procedures covered under the plan.

Let's say that you charge $250 for a Simple Extraction. But the insurance fee schedule lists D7140 Simple Ext as $140 covered at 50%.
The insurance will pay out $70 total. The patient portion is $70. For most PPO insurances, the PPO agreement states that you are NOT allowed to charge anything more than $70 to the patient.
Thus incurring you a loss of $110 for the procedure compared to a "no insurance" patient.

This is why you hear of dentists on Dentaltown that will not take Delta Dental anymore due to fee schedule reductions.
If you can charge the patient $110 that wasn't covered, dentists would accept all insurances because they would just charge the patient the leftover amount.
But sadly, this is not how it works.

Also, the fees vary drastically based on your location. While some areas charge less than $400 for anterior endo, some areas will charge over $1000.

Most dentists, around us anyway, "take" any insurance, meaning they will be happy to file the claim on your behalf, but that doesn't mean they are in your network and they can then balance bill you the difference between what they charge and what the usual and customary is in your area. My dentist technically isn't in our network but he's amazing so we still see him and for the few times in our family that we need something other than our cleanings, we just pay the extra. The PPO agreement is only if they are in-network.

My mom works as a financial planner and works with health and dental insurance as part of her job. She said that many of her clients company plans are moving to dental HMO's. She suggested looking at joining the HMO networks in whatever area I end up practicing, at least to start, because the HMO networks are VERY small....thus, huge potential to build up a good client base early on. We will research network availability when the time comes obviously, but getting on to the websites for the various dental providers in your area, Delta, Cigna, Prudential, etc. when you figure out where you are going to practice, and checking out the number of in-network dentists in whatever area is a good research tool for you.