Fee Schedules for Specialists

[Contach]

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Is there a different fee schedule for specialists and general dentists? ie. an orthodontist who places braces and a general dentist who places braces: do they get paid the same?

Is my understanding of billings correct? In each state there is a different fee schedule, and depending on the type of procedure and even the specifics like which part of the mouth, or which tooth, or which materials were used - there is a different charge to the patient?

Do all dentists in private practice abide by the State's Dental Governing Body's fee schedule? or do some dentists deviate from this schedule?

Thanks.

 

[pietrodds]

Your fee schedule is whatever you say it is. If you become a participant in a specific insurance then your fee is whatever they say it is. Specialists are given higher fee schedules for the same procedures when participating in an insurance plan relative to GPs.

In business, everything is supply and demand. If you're fees are not competitive or you can't convince customers that your service is worth the extra money then you have no customers.

 

[gryffindor]

Contach, are you referring to setting fees in Canada? I think it works differently there and there are fee guidelines so hopefully a Canadian student on here can give you more info. pietrodds gave a quick summary of how fees work in the US.

 

[Contach]

Your fee schedule is whatever you say it is. If you become a participant in a specific insurance then your fee is whatever they say it is. Specialists are given higher fee schedules for the same procedures when participating in an insurance plan relative to GPs.

In business, everything is supply and demand. If you're fees are not competitive or you can't convince customers that your service is worth the extra money then you have no customers.

So the fee schedules for private dentists are regulated through insurance companies? What about if a patient has no insurance company and is paying out of his/her own pocket? Which schedule do you use in that instance?

Does this mean a patient comes in for an appointment and they have no idea how much they will be charged for the first routine inspection? It could be 50$ or 1000$ depending on the what the dental office wants to charge?
In Canada, I'm pretty sure it's regulated, in that all the dentists in a province charge the same amount of money for the same service. A root canal on tooth 6 costs you the same at any place you go within a province. And I'm pretty sure all insurances have agreed to reimburse the dental office according to the province's fee schedule..

Can your fee change from patient to patient? ie. if patient 1 comes in with RedApple Health and they deem $40 for an amalgam filling is the appropriate fee, then you can charge this patient $40, but if another patient comes in with Healthplan X and this fee schedule indicates $55 then you charge this amount?

Wouldn't this lead to dentists picking and choosing which patients they want to treat?

What are the pros for this method?

Contach, are you referring to setting fees in Canada? I think it works differently there and there are fee guidelines so hopefully a Canadian student on here can give you more info. pietrodds gave a quick summary of how fees work in the US.

I think I understand how it works in Canada, but something came up in my Buffalo interview that made me realize it works differently in the USA. So I'm trying to understand this system..

 

[aphistis]

So the fee schedules for private dentists are regulated through insurance companies? What about if a patient has no insurance company and is paying out of his/her own pocket? Which schedule do you use in that instance?

pietrodds said if you participate in a given insurance plan, you agree to abide by its fee schedules. If you don't contract with insurance plans, you can charge whatever you wish.

Does this mean a patient comes in for an appointment and they have no idea how much they will be charged for the first routine inspection? It could be 50$ or 1000$ depending on the what the dental office wants to charge?

Exactly.

In Canada, I'm pretty sure it's regulated, in that all the dentists in a province charge the same amount of money for the same service. A root canal on tooth 6 costs you the same at any place you go within a province. And I'm pretty sure all insurances have agreed to reimburse the dental office according to the province's fee schedule..

That's the difference between socialization and free market. If people think you charge too much, they go somewhere else. If they decide you're worth it, they keep coming to you.

Can your fee change from patient to patient? ie. if patient 1 comes in with RedApple Health and they deem $40 for an amalgam filling is the appropriate fee, then you can charge this patient $40, but if another patient comes in with Healthplan X and this fee schedule indicates $55 then you charge this amount?

Yes.

Wouldn't this lead to dentists picking and choosing which patients they want to treat?

Yes.

What are the pros for this method?

By contracting with insurance providers, you increase your patient base since patients have to be treated by participating dentists in order to pay the lowest fees.

 

[moolah]

In Canada, I'm pretty sure it's regulated, in that all the dentists in a province charge the same amount of money for the same service. A root canal on tooth 6 costs you the same at any place you go within a province. And I'm pretty sure all insurances have agreed to reimburse the dental office according to the province's fee schedule.

This statement is actually false. In Canada, it is true that there is a guide from the provincial associations of dentists but you do not have to adhere to it. It only serves as a guideline. It is true that most dentists follow it because it is easier and it is the guide on which the insurances base their percentage of reimbursement.
However, as a dentist, you can choose to go lower (i.e. for a long-time patient that has no insurance) or higher (i.e. you encountered difficulties during your treatment that would, in your opinion, increase your costs)
Basically, in Canada, fees are at the discretion of the dentist, even if there is a fee guide.
Then again, depending on your fees and the market, will you have patients to charge?

 

[HuyetKiem]

Is there a different fee schedule for specialists and general dentists? ie. an orthodontist who places braces and a general dentist who places braces: do they get paid the same?

Is my understanding of billings correct? In each state there is a different fee schedule, and depending on the type of procedure and even the specifics like which part of the mouth, or which tooth, or which materials were used - there is a different charge to the patient?

Do all dentists in private practice abide by the State's Dental Governing Body's fee schedule? or do some dentists deviate from this schedule?

Thanks.

I charge whatever I wish at my office. For braces, my fees are pretty similar to my next door orthodontist. For dentures and other removeables, my fees are around 50% higher than my local prosthodontists because I do my own wax up, setting teeth.... and I don't wanna do too many of them 😀😀 so far, I have done only 1 set of denture since graduation. I'm out of network in many dental insurances, so my patients have to pay the portion that is uncoreved by insurance companies.

 

[DrJeff]

I charge whatever I wish at my office. For braces, my fees are pretty similar to my next door orthodontist. For dentures and other removeables, my fees are around 50% higher than my local prosthodontists because I do my own wax up, setting teeth.... and I don't wanna do too many of them 😀😀 so far, I have done only 1 set of denture since graduation. I'm out of network in many dental insurances, so my patients have to pay the portion that is uncoreved by insurance companies.

That's the key part with respect to insurance and fees, your participation. If you don't participate with a patient's insurance plan, you can bill whatever you want(heck you can bill whatever you want even if you DO participate, you'll just have to write the "over the contract fee" portion off).

That's the great thing about practicing dentistry, YOU set your fee schedule to what you feel is a fair price taking into account what you feel your "local market" will tolerate and any contractual obligations you may have chosen to sign.

 

[doc toothache]

I charge whatever I wish at my office. For braces, my fees are pretty similar to my next door orthodontist. For dentures and other removeables, my fees are around 50% higher than my local prosthodontists because I do my own wax up, setting teeth.... and I don't wanna do too many of them 😀😀 so far, I have done only 1 set of denture since graduation. I'm out of network in many dental insurances, so my patients have to pay the portion that is uncoreved by insurance companies.

With a fees schedule as described there should be no problem maintaining the batting average for yearly production of dentures.

 

[aphistis]

With a fees schedule as described there should be no problem maintaining the batting average for yearly production of dentures.

Perhaps you missed the part of his post mentioning "I don't want to do them"?

 

[Dukie]

I charge whatever I wish at my office. For braces, my fees are pretty similar to my next door orthodontist. For dentures and other removeables, my fees are around 50% higher than my local prosthodontists because I do my own wax up, setting teeth.... and I don't wanna do too many of them 😀😀 so far, I have done only 1 set of denture since graduation. I'm out of network in many dental insurances, so my patients have to pay the portion that is uncoreved by insurance companies.

Out of curiosity, why would you charge the same as the orthodontist when you know your work will be inferior? I know that, of course, you CAN do this, but it seems unfair to the patient.

 

[HuyetKiem]

With a fees schedule as described there should be no problem maintaining the batting average for yearly production of dentures.

yeah, I don't wanna do too many of them. My other 2 associates don't like to do denture either. My first denture patient was so happy that she did refer her friend to my office. I will start another case this coming Monday. 👍

 

[HuyetKiem]

Out of curiosity, why would you charge the same as the orthodontist when you know your work will be inferior? I know that, of course, you CAN do this, but it seems unfair to the patient.

It is patient choice to choose me over other orthodondists and I cannot stop that. Duh, I even declare verbally, on our brochure and contract agreement that I'm a general dentist and not a specialist.

"My work will be inferior" 🙂🙂 so you mean as a general dentist I can't do perio cleaning, extraction, dentures, crown and bridge and treating pedo ?

 

[HuyetKiem]

That's the key part with respect to insurance and fees, your participation. If you don't participate with a patient's insurance plan, you can bill whatever you want(heck you can bill whatever you want even if you DO participate, you'll just have to write the "over the contract fee" portion off).

That's the great thing about practicing dentistry, YOU set your fee schedule to what you feel is a fair price taking into account what you feel your "local market" will tolerate and any contractual obligations you may have chosen to sign.

I am in-network with only Delta Premier and Metlife as of now. I did drop Delta PPO and Cigna last Dec and haven't experienced any slow-down in this Jan month.

 

[doc toothache]

Perhaps you missed the part of his post mentioning "I don't want to do them"?

Perhaps.