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The Dental Insurance Myth

June 26, 2013

Filed under: Business of Dentistry — Tags: , — Barry @ 10:00 AM

222686138_ed1d0a1381_zIf you are a dentist who never participated with dental plans and live in a geographic area that has been hit hard by the recession, and if you are like me, then the thought of participating has probably crossed your mind a few times over the last couple of years.

Last week I heard a veteran dental consultant admit they she changed her tune.  In the past she advised dentists not to participate but lately found herself advising her clients to selectively participate.

I have thought long and hard on this issue…even about the future of fee for service dentistry as a continuing viable model.  The gut reaction is that fee for service has seen its last days, and the more plans you affiliate with, the better prepared you will be.

Readers of this blog know that I am a big fan of thinking…thinking critically, rather than reacting to my gut.

I live in Jersey, a highly competitive area for dentists.  Geography is important when looking at this issue.  For example, if I lived in a town where 75% of the population was covered by insurance, that would be a major factor in my decision-making process.

But I live in Jersey…lots of people…lots of dentists.  A level, competitive market.

Looking at the stats, probably only 47% of the population has dental insurance.  Fifty three percent do not.  I can live with that.  What do those 53% of patients have in common?  If you said that they have to pay for dentistry, you would be right.

And the 47%…well, they each have different ideas about who pays for their dentistry.  No two people think alike.  We can’t generalize about values.  I hear a lot of talk these days about entitlement issues, but let’s not get political.  In better economic times people have a less difficult time paying “out of pocket.”  But let’s not kid ourselves —out of pocket expenses are the issue…they always have been, and always will be.  Whether insurance is a factor or not…values trump everything.

The biggest difference is the size of the pockets.

I heard a statistic once that claimed that 95% of dental benefits are left on the table each year because people don’t want to pay after they reach their limit.  Hmm!  That bothered me on many levels.  The effect of dental insurance on actual treatment seems to be less than what most people believe.

So why does the insurance question cloud our thinking…and I mean everyone’s thinking…doctors, patients, businessmen and politicians?

Why do dentists allow this illusion to interfere with their life’s work?  By participating the dentist will certainly get an increase in patients.  They will come from that 47%…and bring with them the questions about who pays what and what gets covered, and what is excluded, and when they can do it and, and, and…

Those that don’t participate, only have to deal with one patient at a time, one case at a time.  By not participating the dentist maintains his autonomy (freedom to make all decisions), his ability to create meaningful dentistry on people who value the dentistry (they pay for it) and his level of competence by doing procedures that may not be covered by insurance companies…ever!

When I look at it like that, I feel better, knowing I am doing the right thing.  Economies change…but people remain constant…people want to keep their teeth.  When our culture finally wakes up to realize that it’s the dental profession that wears the white hats…not the insurance companies, then we may put insurance into the proper perspective.

Just my thoughts.

60 Comments

  1. Amen, Barry. The big question then becomes how we implement strategies to let people know that we are the guys in the white hats AND to assure that our behavior remains consistent with our vision of making people’s lives better

    Comment by Alan Stern — June 26, 2013 @ 12:02 PM

  2. It’s interesting how the more things change the more things stay the same. Successful dentists need to rely on their leadership skills more than ever. It’s funny how I continue to see advisors telling dentists to learn new skills…like implants and sleep medicine, as if these new skills will make them better when they can’t get their fundamental skills off the shelf. In the meantime economic conditions continue to worsen and so many people need dentistry today…basic, routine, fundamental dentistry.
    The profession must destroy the myth of insurance.
    Thanks as always,
    Barry

    Comment by Barry — June 26, 2013 @ 12:22 PM

  3. Having spent the last year few years as a dental consultant and studying business after 16 years as a practicing dentist, I have a less skewed perspective as it pertains to dental business models. Dentists in the fee-for-service model base their practice philosophy on the notion that high quality patients will pay for high quality care and insurance patients are not worth the time. Having completed C1 Pankey, I think Fee-for-service only dentists would concede this point. There are many assumptions that one needs to accept to make that argument valid.
    1. Patients that have dental insurance are different than patients without dental insurance.
    2. Patients with dental insurance will not pay out of pocket for high quality dentistry.
    3. Only fee-for-service, non participating dentists are successful dentists.
    I believe that all of the above are wrong.

    Lets evaluate this statement:
    ” And the 47%…well, they each have different ideas about who pays for their dentistry. ”
    These are the consumers that all of us deal with.
    So lets say we did a survey on the “47%” and asked patients with Dental plans how much they expect to pay out- of-pocket for their total dental treatment patient must pay x% of the total bill 100% down to 0% where the insurance will pay everything. Wouldn’t you like to treat the patients in the upper part of that graph? Then why would you shun them?
    2. Survey the public: T or F dentists that participate with dental plans provide inferior care and quality as compared to dentist that do not accept these plans? I think you would find patients judge their dentists based upon other factors. Do we actually believe patients knowingly go to bad dentists because they accept insurance ? That’s insane!
    So who’s fault is it that patients won’t pay for dental treatment? The answer is dentists. Why? well for one we allowed these plans to exist for years and now they have taken roots. Obama care is here and we are next so it’s too late!
    Secondly, we have no strategy to change or address these issues. So we need to deal with what is happening.
    Here is some free advice. Listen to the public. Create a strategy to address their wants and needs. Analyze the plans and create a strategy and make a plan. Then execute that plan. Evaluate the results and make changes to improve those results. So, take the plans, treat the patients,and get referrals. You do not have to compromise your dentistry. Top companies adapt to the environment they don’t hope things will change. Just my 2 cents 🙂

    Comment by Joseph Salkind DMD — June 26, 2013 @ 8:40 PM

  4. Thanks for chiming in Joel.
    You make some good points—and I would take issue with some. The blog post makes no assumptions. I really don’t know how patients with or without insurance feel. Nor do I know how “fee-for-service” doctors feel. But I do know how I feel. I am not sure what you mean by quality patients. I was referring more to the value people place in dentistry—both patients and doctors.
    When I refer to the 47% I am not saying that all of them would not pay out of pocket—that would be a ridiculous statement—but the insurance factor clouds things up. Most dentists understand the complicating and confusing discussions that surround the insurance issue. Sixteen years of practice should have exposed you to some of thoise discussions.
    In a nutshell—for what most insurance companies pay—it is way over-rated compared to the treatment most people receive (hence money is left on the table).
    You make a good point about not being able to unring the bell—the insurance die has been cast. To the public they look like heroes. But this blog is written for dentists who are trying to surveyt the landscape—I made my choice—it’s good for me…and I know what I had to do to carry it out.
    Practicing dentistry in an independent mode is the reason I chose to go into dentistry—selling out is not in my bones.
    Thanks,
    Barry

    Comment by Barry — June 26, 2013 @ 9:04 PM

  5. This link to this on FB caught my eye. And, your article describes me (and my practice) to a “T.” I have never participated in ANY form of managed care, including PPOs. I’m always amused at dentists who say they don’t participate in managed care… They claim to be FFS… and then say they are in some PPOs. If you signed a contract with a fee schedule, you’re in managed care.

    I’m in a VERY competitive area with many dentists on the plans. There are at least 25 dentists on my STREET.

    That said, only about 8% of my patients have some sort of benefit plan (it’s NOT insurance).

    My challenge as a completely FFS practice is that I have to get patients to come to me… FOR ME. Not because I’m “in the booklet.”

    I’ve briefly pondered the notion of joining plans, as I’ve struggled to build my practice. But, I realize that those who come to you because you’re on the plan… WILL LEAVE YOU FOR THE SAME REASON (when you aren’t on the plan).

    So, I have stayed the non-managed care course. It’s not been an easy road. But, I know myself, and I know my head would EXPLODE if I had to deal with the SHIT I hear about (from dentists on plans). I value my autonomy more than anything. My autonomy defines me. I cannot betray what I know to be right (for me) and even righteous. Like you… I just can’t sell out. “Damn the torpedoes!”

    Comment by The Dental Warrior — June 26, 2013 @ 9:35 PM

  6. We seem to have similar philosophies. I love the word autonomy—I wish more dentists appreciated the concept. Thanks for disclosing that building this type of practice is difficult—I have found the same. But–I feel it is worth it—if only for the freedom it brings and the meaningful work we can perform. If only dentists would or could unite on these issues, maybe the insurance companies would lose some of their power. And they do have power because they have set up this illusion that they actually do some good.
    Thanks Mike.

    Comment by Barry — June 26, 2013 @ 9:45 PM

  7. Barry in my Six sigma journey I learned that everything is a PROCESS. They use an overall high level map called a SIPOC MAP. A kind of “What are we trying to do” chart.
    Suppliers, Inputs ,Process, Outputs and Customers. We start at Customers (who’s it for) and Outputs (what we want out of it). So that would be you and your patients. Then you create a basic Process , (Inputs)what goes into it and (Supply’s)what you need too accomplish it. You can make one for Dentistry, Life, Dog Shows etc. My point is when you make choices, it’s not about “selling out” It’s about what you get out of it. I bet there are a lot of people missing out on having you as their dentist and a lot of dentist missing out on what dentistry has to offer them as far as happiness in their practice. I am not saying “sell out” , I am asking you you rethink what selling out is.

    Comment by Joseph Salkind DMD — June 26, 2013 @ 9:53 PM

  8. Selling out is eschewing your own principles (whatever they may be) in exchange for something. For me… and I suspect Barry… Our principles prevent us from joining plans. That’s NOT to say that OTHERS are “selling out” or that their principles are “wrong.” It’s PERSONAL.

    Let me put it this way… If a PPO would agree to pay my full fees (at 100%), I would NOT sign the contracts due to the stipulations in such contracts. Likewise, if Medicaid offered to pay me DOUBLE my regular fees, I would NOT sign the dotted line, as it requires a suspension of my Constitutional Rights. My principles and values are simply not for sale.

    I realize that I have paid a price… literally… for my principles. And, many probably think of me as a fool. That’s OK. I know who I am and what I stand for. No amount of money or promises or being “busy” can compensate me enough to change who I am.

    Comment by The Dental Warrior — June 26, 2013 @ 10:04 PM

  9. Joe–I’m all about process. My first book is based on a process—in writing the Art of Case Presentation I became almost militant about third party interference of any type. I need to have the freedom to make decisions in the interest of my patients without interference either real or imagined. If anyone has ever heard the expression—“does my insurance cover it?” that clouds the discussion.
    Manufacturing and retail thinking have no place in health care—ay some level, I believe that has created many of the problems we see today in dentistry.
    Thanks

    Comment by Barry — June 26, 2013 @ 10:06 PM

  10. Mike–I couldn’t have said it better myself. Your words strike to the heart of the matter. I don’t understand why dentists don’t see it that way.

    Comment by Barry — June 26, 2013 @ 10:11 PM

  11. As a manager of a comprehensive fee for service practice, I certainly see the dilemma facing a young dentist out of school. With the finances of family and staff members at risk, even if a young dentist knows what’s “right”, they often lack the practice and skills to deliver on a high level. It literally takes hundreds of hours and hundreds of thousand of dollars to become a master dentist.
    Recently met with new graduates facing 200k to 300k debt even before they started. What do you tell them?

    Comment by Mark Absher — June 26, 2013 @ 11:12 PM

  12. Great question Mark…actually the most important question. Considering that I have heard numbers that project in the future only 10% of practices will be fee-for-service/ 68% will be hybrids, accepting PPO,HMO and other insurance/ and the remaining 22% will be corporate, that says something about what dentists will need to do to stay independent.
    With all of the financial commitments the young dentist must fight “survival” issues. Not easy—a lot easier at another time and for older vets like myself. I feel for them. But I think it comes down to a mindset. I think they must learn a combination of technical and soft skills that will help them get through. They need to read books and attend courses away from dentistry—on leadership. Be careful of spending money on equipment and supplies that just aren’t necessary. Be careful of hi-tech. Be careful of salesmen (followers of this blog know that I now call them chauffeurs), who just try to sell them the latest fad. What a dentist needs more than anything is an other-focused attitude, plenty of empathy, great listening skills, and a lot of patience.
    I write this blog any many think I may have an elitist attitude—but I really do feel for young dentists—that’s why I write.
    Thanks for this great question.
    Barry

    Comment by Barry — June 27, 2013 @ 8:29 AM

  13. I agree with Barry about technology. Not only do salesmen push it, many dentists (who have to justify it in their own minds) chastise dentists who don’t have certain technologies.

    A friend of mine taught me a great phrase: “That’s a solution to a problem I don’t have.”

    A $140,000 milling machine is a solution to a problem I don’t have. (This ought to bring’em out!) They say, “Oh… it’s only $2500 / month, and you’re paying that to your lab, anyway.” Yeah? Well, I can FIRE my lab, if I’m not happy with the results. Will you take the machine back? No? Ah… I see. Never mind that I have no interest in becoming a lab tech in my own office. 😛

    That’s just ONE example. There are many others. I’ve actually looked at these technologies. I’ve played with them. I’ve taken courses about them. But, all you need to do is look at how many of these goodies are for sale on E-bay and dental forum classifieds sections.

    I’m a big fan of technology… especially those that don’t require a LOAN or cost 5 figures and more. But, the FIRST thing I look at is whether it’s actually a solution to a problem I have.

    I’ve made some big mistakes. I am VERY careful now. And, generally speaking… the sales reps don’t like me. And, that’s a good thing, IMO.

    Comment by The Dental Warrior — June 27, 2013 @ 9:40 AM

  14. I do not accept any insurance—if that makes me a fee for service dentist–that’s me. I have been practicing over 40 years, and still like what I’m doing. My reason for not accepting insurance is that I don’t like to be told—anything! My enjoyment of practicing is that so many of my patients are friends–some of them were before they became patients, some of them were patients before they became friends.. Financially I could stop any time..as long as my friends continue to see me, I will continue.

    Comment by Roger A. Mead,D.D.S. — June 27, 2013 @ 10:19 AM

  15. For Roger—Man after my own heart. After 40 years though we should be advising the youth—they’re the future.
    Oops–my bad — I just realized – you are advising the youth.

    Comment by Barry — June 27, 2013 @ 11:09 AM

  16. Joseph Salkind DMD said:
    “So who’s fault is it that patients won’t pay for dental treatment? The answer is dentists. Why? well for one we allowed these plans to exist for years and now they have taken roots. Obama care is here and we are next so it’s too late!
    Secondly, we have no strategy to change or address these issues. So we need to deal with what is happening.”

    I’m not sure I agree with this statement. Dentists may take some of the blame, but I think the way we deliver medical care has much more to do with it. You go to the doctor’s office and no one discusses costs. You go to the hospital, same thing. Then you wait weeks or months to find out “what your part is,” hoping it’s not too much. (Mike Barr…I know you go to a concierge physician, so I understand that’s not absolutely everyone.) Patients have been taken out of the payment arrangement part of things in so much of medicine that they assume dentistry is the same way. We always discuss fees and costs up front and we still get people that balk when it comes time to pay. It’s difficult to change what people value. Sometimes I get worn down caring more about people’s oral health than they do.

    Comment by Alan Mead — June 27, 2013 @ 10:29 AM

  17. To add to The Dental Warrior’s comments, the next model is always better…and those payments get very irritating when the gizmos don’t live up to expectations. Good dentistry can be provided with less technology.

    Comment by Yar — June 27, 2013 @ 10:42 AM

  18. For YAR—Watch out for the social mirror. The dental industry is very good at telling us how to get on the cutting edge.

    Comment by Barry — June 27, 2013 @ 11:10 AM

  19. On Mike’s comment— I totally agree—and I am glad that you said that you too have been a victim of sales pressure. Me too. Maybe it’s a lesson we all need to learn…but your advice is gold. Years ago dentists could afford to make some mistakes…but I shutter to think of how many lasers and CadCam machines are gathering dust. When I consult with practices–the first thing I look at is unnecessary expenses. Add to the list of salesman–investment advisers…caveat emptor.
    On Alan’s comment—Chicken or the egg? Does it really matter? Hard to blame the girl who gets pregnant — she thought she was in love. That’s the way we felt about insurance back in the seventies. Want another metaphor—who let the wolf in the door? The point is that now – if a dentist wants to practice without dealing with all of the other issues, it’s his responsibility—and it’s tough, let’s not kid ourselves. It’s also wrong (see Mike’s comments above-that have something to do with live free or die). Should patients have been taken out of the equation? Last time I checked the NFL and MLB don’t ask the fans for their opinion on rules or ticket prices.

    Comment by Barry — June 27, 2013 @ 11:05 AM

  20. There will in Dentistry and Medicine be tiers of care. Only the few on top will get the “insane high cash practice fees” some of which are not even worthy. But the day is coming where you will be selling your practice to an “investor” because young dentists have high debt/ low income. The future is not Ring…., Ring….Dr. X’s office can I help you?. It’s Aetna Dental can I help you?

    Comment by Joseph Salkind DMD — June 27, 2013 @ 7:11 PM

  21. “Only the few on top will get the “insane high cash practice fees” some of which are not even worthy.”

    Wow… that sentence is telling of the derision you harbor for other dentists.

    I disagree with the rest of the comment, as well. I’ve been hearing the admonition of corporate dentistry for my entire 25-year career. Sears Dental was the “future.” Meh! I’m quite confident that there will always be a significant market for private care dentistry.

    Comment by The Dental Warrior — June 27, 2013 @ 8:02 PM

  22. There will be coming a day where we will be selling our practice to a chiropractor, accountant, or a physical therapist. How can a new dentist step into 30+ years of private non insurance no-compromise private practice? Without us selling our soul.

    Comment by Mark Absher — June 27, 2013 @ 8:04 PM

  23. Joe— there are already tiers of care. Avrum King and Chris Sager described this years ago…btw there is a caste system in our society as well in case you haven’t noticed.

    Mike—I was there when Sears opened the department store in El Monte Ca in 1978… It didn’t work. They went after Medicaid market and it was a better economy. This iteration…Heartland, is a better model and seems to be working.

    Mark…the dentists who can step in had better be a Super-G….a Super generalist. He will really have to separate himself from the pack…not just talk about it.

    Comment by Barry — June 27, 2013 @ 8:40 PM

  24. In Florida, dental offices must be owned by a dentist.

    Comment by The Dental Warrior — June 27, 2013 @ 8:50 PM

  25. Same in Jersey—but they workaround.

    Comment by Barry — June 27, 2013 @ 9:10 PM

  26. @Dental Warrior I did not mean it like that. I love dentists and dentistry. I simply meant there are dentist that get high fees based upon location, office design, marketing, salesmanship and local social connections as well as physical appearance. There are dentists here, less known, and they are brilliant! Not getting what they deserve. There are others selling elective procedures like crazy without regard for the dynamics of occlusion and stability. All cash fees. Giving 40k treatment quotes during the pre exam interview! My point is we have a wide array of “freedom” and “Autonomy” and none of it is based on knowledge and skill…….

    Comment by Joseph Salkind DMD — June 28, 2013 @ 1:23 AM

  27. Joseph… You say you didn’t mean it “that way.” But, then you go on even MORE about your disdain for high fee dentists and imply they don’t deserve it based on assumptions.

    If in a pre-exam interview a patient asks for a ballpark figure for a full-mouth rehab, is it wrong, depraved, or unethical to actually answer the patient’s question? Or is it that you’re not comfortable presenting $40k plans (because you don’t do them)?? Or, is it simply unpalatable to you that some dentists present big cases like that and command and collect fees commensurate with the magnitude of the treatment?

    I’ve certainly had patients ask. They’ve got no clue what it might cost, and there’s no sense doing a full work-up if the patient can’t afford the treatment. Some come in thinking it might cost a couple thousand dollars to fix their entire mouth. So, it can be a good thing to get that discussion right up front.

    There are great dentists and not-so-great dentists. Some are great businessmen. Some aren’t. Some dentists are comfortable doing big cases. Some aren’t. The cool thing about dentistry is that we can tailor our practices to our own preferences, philosophies, predilections, training, and comfort-zones. Nothing new there.

    Comment by The Dental Warrior — June 28, 2013 @ 8:03 AM

  28. Got to agree with Mike on this. Fees come down to what the market will bear. As a matter of fact the original post which we are beginning to lose sight of was about insurance interfering with dentist’s freedom of doing business. That being said—doing the best job is still the ethical and moral obligation of the dentist.

    Comment by Barry — June 28, 2013 @ 8:48 AM

  29. Yes. I agree, Barry. But, I can’t help pointing out that so many dentists resort to what George Carlin aptly described in one of his stand-up bits..

    “You ever notice how anyone driving faster than you is an idiot and anyone driving slower than you is an asshole?”

    Comment by The Dental Warrior — June 28, 2013 @ 9:03 AM

  30. Now you’re really getting to the heart of the issue.
    Fix this…fix everything.
    Carlin knew, and we spend so much $ on education.

    Comment by Barry — June 28, 2013 @ 12:21 PM

  31. I have done $60,000 cases I’ve never been uncomfortable with doing large cases. Now that my ego is satisfied , I agree with what you are saying. So let me just say I got into Dentistry to treat patients. You practice Denteiocentric . I made that up. You practice is about you. Your comfort zone and your paradigm of what you want dentistry to be. You can and have that right. I did the same thing. I now see that dentistry needs to be about people and the needs of the population. Dentists have been indoctrinated to see themselves as the center of the universe . That George carlin reference is what divides us. As funny as it is it is painfully true. I hope I can lead dentistry into a new era. One that addresses patients and insurance . Can we work with insurance if they change a few things? Can we work with them as partners instead of adversaries. I think very highly of Barry and Dental warrior. These dentists are the role models I aspired to as far as dentistry. In 2007 I was paralyzed in an accident. I now work as a consultant. Being on the outside, dealing with my peers that pay for my help is rewarding. I have to use Barry’s book on dentist to raise their business iq lol. Some only want me to pat them on the back and say good job and refuse to change anything. I get frustrated. The same as that patient back in my practice that tells me I charge too much. I cannot change everyone especially when they say no matter what I will never change. I wish I could spend a week with dental warrior and really get to know him. If I could see what he sees maybe I could share my vision and revise it to fit that mold. Then again I am and optimist and a dreamer. I want good insurance and good dentistry working hand in hand. I believe it can.

    Comment by Joseph Salkind DMD — June 28, 2013 @ 3:04 PM

  32. This is Barry commenting from my wife’s iPhone….
    Thanks for the kind words Joe, the plight of most dentists is fairly simple. I like to call it “reconciling the paradox between duty and desire. The desire to live a great life however one defines that and the duty to our patients to be the best we can be.”
    That said, Mike calls himself a warrior because sometimes reconciling the paradox can be a struggle. I call the blog the TAO because reconciling the paradox takes a newer ( or older) level of thought. Either way quoting Carlin was good because artists seem to understand the fight and have a deeper level of thought.

    Comment by Anonymous — June 28, 2013 @ 3:15 PM

  33. @Joe…

    I do take issue with your implication that my practice and philosophy revolve all around me and that I don’t serve my patients… That the universe revolves around me. Those are some pretty big leaps for someone who doesn’t know me or has never spent a day with me.

    If I wasn’t serving my patients, they wouldn’t be coming to my practice.

    Now… is my goal to be everyone’s dentist? Hell no. Is THAT what you see as the noble calling of a dentist? To be EVERYONE’S dentist?

    Your position on working with “insurance” is based on an assumption that it IS insurance. It’s not. Dental benefit plans are NOT, by ANY stretch of the definition of “insurance.” I could get into the definition of insurance, but I suspect you already know it. So, the FIRST thing we MUST do is call it what it is… a pre-paid dental BENEFIT. It’s not insurance. Another dentist friend and blogger aptly calls it, “a gift card from a control freak.”

    And, those plans have done nothing but DEVALUE the service of dentistry. So, you’ll have to excuse me for having absolutely NO DESIRE to join the quest to “work with insurance.” It’s NEVER been a good thing. It’s gotten WORSE over the years. And, it’s will continue to go down the tubes. I have no desire to go down the tubes with it. I have no compunction about not working with the “control freak.” So, yeah… there’s your “proof” that I think the universe revolves around me. 🙂

    @Barry…

    I think of ALL of us (dentists) as “warriors.” It’s not just me. 🙂

    Another quote (with no attribution) that can be related to Carlin’s quote is: “The only thing two dentists can agree on is that the third dentist is an idiot.” LOL!

    Comment by The Dental Warrior — June 28, 2013 @ 3:53 PM

  34. Mike–I agree with your assessment of dental insurance (I was making that point in the blog post). I will go so far as saying the “I HATE DENTAL INSURANCE.” The concept has single handedly destroyed the profession and you can make a case for destroying professional ethics ( companies keep files on dentists for potential fraud). Insurance has some benefits for patients—very helpful for families trying to maintain good health. The negatives far outweigh the positives especially for people who need significant treatment. Insurance companies, as Mike said–DEVALUE what we are supposed to be valuing. When I buy a car the financial institution doesn’t give their opinion on the make or model.

    Comment by Barry — June 28, 2013 @ 5:21 PM

  35. The fact that the maximum annual “benefit” has remained the same ($1,000) for FIFTY YEARS is prima facie evidence that “dental insurance” is a JOKE. To sing its praises as a “help” to patients is simply delusional or naive.

    That’s why we now call it “Tooth-of-the-year club!”

    Comment by The Dental Warrior — June 28, 2013 @ 5:36 PM

  36. I am judging no one. I did not mean to imply you did not serve your patients. I think you are selective reading and interpreting my statements then internalizing it as an attack on you!
    examples:
    I said [ There are others selling elective procedures like crazy without regard for the dynamics of occlusion and stability.]

    you said
    [If in a pre-exam interview a patient asks for a ballpark figure for a full-mouth rehab, is it wrong, depraved, or unethical to actually answer the patient’s question? Or is it that you’re not comfortable presenting $40k plans (because you don’t do them)?? Or, is it simply unpalatable to you that some dentists present big cases like that and command and collect fees commensurate with the magnitude of the treatment?]
    I said [ELECTIVE] you said [REHAB].
    I said [without regard for the dynamics of occlusion and stability.]
    You said [is it wrong, depraved, or unethical to actually answer the patient’s question? Or [ here you attack] is it that you’re not comfortable presenting $40k plans (because you don’t do them)?? Or, is it simply unpalatable to you that some dentists present big cases like that and command and collect fees commensurate with the magnitude of the treatment?]

    I said [ Only the few on top will get the “insane high cash practice fees” some of which are not even worthy. ] Some! not all! and everyone cannot be that guy!
    you said[, then you go on even MORE about your disdain for high fee dentists and imply they don’t deserve it based on assumptions. ] I disdain all high fee dentist? I was one of them!
    Please stop selectively reading and drawing baseless conclusions!

    I AM SAYING JUST THIS: DENTIST TREAT PATIENTS. HOW THAT PROCESS WORKS IS CHANGING FOR THE WORSE AS FAR AS DENTIST GO. WE GET MORE TECHNOLOGY IN EQUIPMENT AND MATERIALS AND GET PAID LESS! SO WHAT IS THE PLAN? HANG ON UNTIL YOU CANNOT EXIST OR EVALUATE DENTISTRY NOW AND MAKE A PLAN.
    PS
    I am here to help. I am not you enemy!

    Comment by Joseph Salkind DMD — June 28, 2013 @ 6:09 PM

  37. I just got off the phone with a publisher who wants to republish the post. Obviously organized dentistry finds dental insurance equally as appalling as I do. Try to find the right words I keep coming up with “trust.” Anything that interferes with the trust necessary for a doctor-patient relationship can’t be good. We already have a trust crisis in this country and the last thing health care of any kind needs is a third party that breaks down trust. Of course they will argue that is not their intent, but that hasn’t been my experience. I guess that is why Mike says we are all warriors.

    Comment by Barry — June 28, 2013 @ 6:10 PM

  38. Joseph,

    I don’t feel you’re “attacking” me. My skin is far thicker than that. I am simply interpreting what you’re saying.

    FWIW, rehabs ARE elective. Unless there is an infection or acute pain, all dentistry is elective.

    My plan remains the same. I started without contractually enslaving myself to inscos, and I plan to continue that path. Many dentists have become dependent on their insurance-based patients with as much as 85% of their patients on a single plan (Delta). Then Delta pulls the rug out and LOWERS fees by 15%. Those dentists are SCREWED. If I never get in bed with inscos, they can’t “screw” me.

    Comment by The Dental Warrior — June 28, 2013 @ 6:54 PM

  39. Barry said, “Obviously organized dentistry finds dental insurance equally as appalling as I do.”

    WHAT??? The ADA dental “insurance” appalling?? Seriously?? The ADA leadership is rife with insco moles! Most of them used to work for the inscos. The ADA could not give a shit about what the inscos are doing to dentists. The ADA has done nothing and WILL DO NOTHING.

    I used to be a member of the ADA (for many years). I even served on the local affiliate association board all the way to President. I dropped my membership about 10 years ago. They have yet to do anything that will lead me to consider rejoining. The ADA is a dying organization. I’m not the only member they’ve lost. They are HEMORRHAGING members in droves. It’s a BIG problem. I’m still friends with many of the local association board members. Close friends with a few. They have NO interest in truly understanding the REAL reasons dentists like me have dropped out.

    What makes you think the ADA feels the same way you do? I’m genuinely curious.

    Comment by The Dental Warrior — June 28, 2013 @ 6:59 PM

  40. My bad. I meant to say the dental community… Definitely not organized dentistry.

    Comment by Barry — June 28, 2013 @ 7:11 PM

  41. Good golly, Barry! You could have saved me from typing that rant about the ADA! LOL! 😉

    Comment by The Dental Warrior — June 28, 2013 @ 10:08 PM

  42. It needed to be said. The thought I was trying to express is that the feelings about insurance that we are writing about seem universal.
    There really isn’t any organization that represents fee for service dentistry.

    Comment by Barry — June 28, 2013 @ 10:18 PM

  43. “There really isn’t any organization that represents fee for service dentistry.” That is very disconcerting.
    The real scary question here is why?

    Comment by Joseph Salkind DMD — June 28, 2013 @ 10:51 PM

  44. It really is strange. Other industries have “independent owner organizations.” Not that is would do anything but what shot do dentists have when Delta lowers their benefits by 15%.

    Comment by Barry — June 28, 2013 @ 10:55 PM

  45. As a child who had to get several teeth pulled, I grew up with a fear of dentists even though our dentist was a family friend. As an adult, and advertising sales rep, I began avoiding or dreading appointments with dentists.. they had no sense of humor and they always wanted to sell me on invisalign during MY appointment to SELL THEM! When the time came for some serious dental work I had avoided for years I ended up seeing the dentist my friends worked for. They sat me down to view a detailed video on dental insurance benefits, or lack of it thereof, followed by a longer video of every possible disease that could result from poor oral health. I was frightened to say the least! 6k after my insurance was maxed and a few appointments later, my dentist apologized for believing I needed the root canal i had already paid for instead of and mid procedure said to come back the following day for just a filling. I was horrified and confused and needless to say, I had another bad dental experience and when the time came to take my son to his first dentist appointment I told my husband I was more comfortable scheduling him for an ob/gyn exam…. yeap! My fear of the dentist had consumed all logic!

    As karma would have it, I work in the dental infustry now and I love it!! I’m fascinated!!

    THE POINT I’D LIKE TO MAKE IS THAT MY PERCEPTION OF A DENTIST IN GENERAL WAS WAY OFF!!! THIS BLOGPOST WAS A GREAT READ, AND I LAUGHED MY BUTT OFF READING ALL THE COMMENTS! YOU GUYS WERE EACH HILARIOUS IN YOUR OWN WAY AND I LOVED READING EVERYONES OPINIONS ON THE MATTER OF DENTAL “INSURANCE”. MY PERCEPTION OF THE DENTIST WAS WRONG MY WHOLE LIFE, BUT WORKING IN THE DENTAL INDUSTRY, EXCLUSIVELY/DIRECTLY WITH THE DENTISTS, OPENED MY EYES AND CHANGED MY PERCEPTION.

    —> THE SAME THING GOES FOR A FEW OF YOU WHO COMMENTED. THERE ARE PRO’S AND CON’S TO ACCEPTING INSURANCE. HAVING WORKED WITH PRACTICES WHO VARY DRAMATICALLY IN % OF PATIENTS WITH OR WITHOUT INSURANCE (OR RATHER DENTAL PLAN) I SEE THE POINTS EACH OF YOU MAKE, AS WELL AS THE FLIPSIDE OF YOUR OPINIONS. AT THE END OF THE DAY, THE MAIN THING EACH DOCTOR and YOUR OFFICE STAFF SHOULD FOCUS ON, IS THE QUALITY OF CARE YOU PROVIDE YOUR PATIENTS. SELL YOUR DENTISTRY, SELL YOURSELF, YOUR CHARISMA, YOUR DEDICATION TO THEIR ORAL HEALTH… IF THEY HAVE INSURANCE EXPLAIN WHAT IT COVERS AFTER YOU VERIFY THEIR BENEFITS AS PART OF THEIR TREATMENT PLAN INSTEAD OF THE COVERAGE BEING THE BASIS OF THE DECISION. IF MONEY IS A MAJOR FACTOR DONT JUST DEVELOP A TREATMENT PLAN, DEVELOP A PLAN FOR PERFORMING THE PROCEDURES IN STAGES TO HELP THE PATIENTS DIGEST THE COSTS THEYRE GOING TO INCUR, PRESENT EACH “SEGMENT OF TREATMENT” WITH SEPARATE COSTS SO THEY SEE IN BLACK AND WHITE OK I CANT AFFORD 10K TODAY BUT I CAN MAKE THIS WORK OVER THE NEXT 8 MONTHS IF WE START HERE…

    MY COUSIN CANCELED HER APPOINTMENT ONCE BECAUSE THE COST WAS TOO HIGH. SHE ISNT A NATURAL AT PROBLEM SOLVING, OR FORWARD THINKING SO SHE JUST SULKED AND COMPLAINED ABOUT COST BECAUSE NO ONE OFFERED HER A “PLAN” . LUCKILY MY AUNT WORKED FOR ANOTHER DENTIST AND KNEW HOW THE INSURANCE WORKED. IT WAS ROUGHLY AROUND OCTOBER SO SHE SUGGESTED MY COUSIN MOVE FORWARD WITH HALF THE TREATMENT PLAN AND FOLLOWUP WITH THE REMAINING PROCEDURES AFTER JANUARY WHEN THE ANNUAL BENEFITS WERE AVAILABLE. THE OFFICE DIDNT OFFER FINANCING OR PAYMENT OPTIONS BUT ALL IT TOOK WAS ASKING FOR THE ABILITY TO PAY IN 3 MONTHLY PAYMENTS AND MAXIMIZING EVERY DOLLAR AVAILABLE THRU INSURANCE TO COMPLETE EVERY PROCEDURE NEEDED..

    YESSSS YOU ARE ALL DENTISTS, BUT PATIENT DECISIONS ARENT ALWAYS BASED ON ORAL HEALTH.. A PATIENT DOESNT TRULY SEE WHAT EACH OF YOU SEE INCLUDING THE ATROCITIES IN THEIR OWN MOUTHS!! TRAIN YOUR STAFF TO SELL YOU AND YOUR KNOWLEDGE AND YOUR EXPERT DENTISTY.

    WHETHER YOU CHOOSE TO ACCEPT INSURANCE OR NOT, EDUCATE YOURSELF ON TRENDING DENTAL BENEFIT PLANS BECAUSE PATIENTS APPRECIATE KNOWLEDGE AND ALTHOUGH THEY NEED A DENTIST, ITS UP TO YOU TO SELL THEM ON MAINTAINING HEALTHY ORAL CARE WITH YOUR PRACTICE INSTEAD OF BASING SUCH A HUGE DECISION ON JUST WHAT THEIR INSURANCE COVERS… IF THE PATIENT DECLINES, ITS THEIR LOSS, THEY ARENT THE KIND OF PATIENT YOU WANT OR NEED. YOU WANT PATIENTS TO CHOOSE YOU BASED ON YOUR EXPERTISE AND KNOWLEDGE NOT JUST BECAUSE YOU ACCEPT THEIR INSURANCE.. YOU CANT BUILD LOYALTY AND TRUST WITHOUT SELLING YOURSELF….

    That said, I’ve spent enough time commenting on a post that in many ways makes an argument against my personal philosophy, BUT I genuinely appreciate and value the opinion as well. Insurance can be a real bitch to deal with and if you can successfully run a practice without accepting it, more power to you!! The KEY to accepting insurance or rather “benefit plans” as it really should be marketed as, is to understand them and use to your practices advantage.

    WELL ITS BEEN GREAT READING THIS POST, YOUR OPINIONS HAVE GOTTEN MY BRAIN TICKING, BUT I MUST SAY GOODBYE FOR NOW… I NEED TO BEGIN THE EVER GRUELING CREDENTIALING PROCESS FOR A NEW DENRAL OFFICE AS I WONDER WHYYY EACH COMPANY IS SO DIFFERENT IN ACCEPTING NEW PRIVIDERS.. SERIOUSLY? CAN WE GET A UNIVERSAL APPLICATION PROCESS? YES, MY CAREER IS BASED ON MAINLY DENTAL INSURANCE, BUT WE STILL HAVE CLIENTS WHO ACCEPT ONLY CASH AND JUST NEED ASSISTANCE WITH A/R AND CLEANING UP PAST DUE PATIENT BALANCES…

    Who would have guessed I’d ever be so interested in the mind of a Dentist, the way each practice operates differently, and all things dental? I love the diversity!

    Comment by Oh Myyyy!! — July 18, 2013 @ 4:51 AM

  46. Thanks OhMyyy,
    Your comment contains much wisdom. You seem quite passionate about dentistry. Although your comment is long you seem to have an understanding of the issues in the dental industry.
    I wish the readers of the TAO could read your comment.
    Thanks for taking the time.
    Barry

    Comment by Barry — July 18, 2013 @ 8:31 AM

  47. I love this story. “OhMyyy” addresses a critical issue that goes beyond dental insurance: How willing are we in dentistry to have the difficult conversations with patients about choices, and the implications of those choices? How willing are we to enter into a real dialogue with them (without rescuing) about the cost of treatment and the cost of not treating? How skilled are we at helping them work through the process providing our best care, skill, and judgment “prior to any consideration of self interest,” as Dr. Pankey advised?

    Comment by Mary Osborne — July 19, 2013 @ 3:56 PM

  48. Thanks for your input Mary. I totally agree that the discussion goes way beyond insurance. Ohmyyy is in sales as she explains. And what this comes down to is basic sales. Don’t like that word? Okay. How about persuasion or influence. The job of everyone in health care and eduacation is to move people. Ethical persuasion is my preferred means. I have been studying it and applying Dr. Pankey’s principles for over 25 years. The task is more difficult throuigh the “white noise” of insurance. I agree with Ohmyyy and Mary that it comes down to conversation—simple, yes…easy, no. Those conversations require today’s dentist to become much more proficient at the softer communication skills. Those dentists that don’t will probably not survive in a tougher fee for service structure.
    And– so why is that important?
    Well, most dentists choose dentistry so they can make their own decisions—they enjoy the freedoms that come along with autonomy.
    Great conversation—hope the dental world is listening.

    Comment by Barry — July 19, 2013 @ 7:30 PM

  49. I think we all can agree on one thing. The future of medicine will not be decided by Physicians and the future of Dentistry will not be decided by Dentists.
    That is unless we step out of our practices and do something about it.

    Comment by Joseph Salkind DMD — July 22, 2013 @ 1:06 AM

  50. Joe, I wrote about this in my new book. I agree that for the first time, every dentist does not effect the future of dentistry, BUT, I will say for dentists that they still control their own future.

    Comment by Barry Polansky — July 22, 2013 @ 9:11 AM

  51. Actually, Joseph, I don’t agree. First of all the future of medicine has largely already been decided without the physicians, who gave up a LONG time ago. That ship has SAILED.

    Dentistry, on the other hand, remains a cottage industry. We don’t need to step OUT of our practices. We only need to be assertive in what we do IN our practices. Dentistry can’t be delegated. We’re IT! Without US, there is no dental care. We only need to individually refuse to participate in any federal programs or “managed care” programs. It is a CHOICE. We don’t need to “step out.” We simply need to step UP and OPT OUT.

    Comment by The Dental Warrior — July 22, 2013 @ 9:13 AM

  52. Well said Mike…
    The only thing I might add is that maintaining your independence is a bit more difficult in this environment. That’s why so many dentists are caving in, as well as the demographics of today’s younger dentists.

    Comment by Barry — July 22, 2013 @ 9:16 AM

  53. Nobody said it would be easy, Barry! 😉

    Caving IS the “easy” way. But, it carries a far greater COST down the line. And, I’m not talking just about money. Autonomy. Independence. Freedom of choice. Intellectual honesty. Ethics. Professional integrity. Job satisfaction. Happiness. Reduced stress. “Captain of your own ship!”

    Comment by The Dental Warrior — July 22, 2013 @ 9:42 AM

  54. We’re speaking the same language. Even beyond the money—this is really the true argument.

    Comment by Barry — July 22, 2013 @ 10:19 AM

  55. You can be “Captain of your own ship” but it takes a fleet to win a war. To raise a fleet you must make a case to all the other captains as to why to join your cause and whats at stake…………

    Comment by Joseph Salkind DMD — July 22, 2013 @ 5:35 PM

  56. Actually Joe–there is no cause. There is no control over the market— the market does what it wants, and as long as dentistry is subject to market forces–the only thing dentists can do is to practice according to their own hearts. The minute they submit—it’s over. There will always be room for competent caring dentists.

    Comment by Barry — July 22, 2013 @ 5:46 PM

  57. Hi Joe,

    Have you ever tried to get dentists to work in concert??? LOL! And, never mind the ADA’s refusal to do anything. Pussies! All of them.

    I can only do what I can do. If other dentists decided to drop a set, they’d follow their conscience, too. But, after 25 years in this profession, I know better than to try to rally the troops.

    I’m not looking to win the war (against insurance and social programs). I’m fighting my own battles and not waiting for someone else to do it for me.

    Comment by The Dental Warrior — July 22, 2013 @ 6:14 PM

  58. You are so right Mike—I am thinking about writing about fear based dental practices. Not the fear that patients harbor but the fear the doctors have of their patients—and staff.

    Comment by Barry — July 22, 2013 @ 6:17 PM

  59. There’s one other fear that may dwarf the others in magnitude: The fear of other dentists (and what other dentists think).

    Comment by The Dental Warrior — July 22, 2013 @ 7:36 PM

  60. The story of life Mike. If I could give just one presentation to dentists it would be about fear. Everyone would walk out dumbfounded.

    Comment by Barry — July 22, 2013 @ 9:54 PM

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