The other day we got a phone call from a new dental insurance company attempting to build their panel of dentists in the Salt Lake area. My office manager asked them to send us their fee schedule and we would consider joining.

The fee schedule came, and we made a close observation to see if they cover our top forty codes we use the most. We noticed they had fees associated with them, but the real question was this, “do you pay out on all the fees you are showing on your contracted fee schedule”?

The representative engaged in conversation with my office manager, and the real discovery began. We asked her the above question as a starting point. For example, we saw that diagnostic casts, oral facial images, and emergency palliative treatment were some of the codes they had fees associated with. When asked if they pay out on them, the answer was, “those are codes that we do not typically cover with our insured clients.

My office manager then said, “you realize as of January 1st of 2018, any service you do not cover, even when you have associated a fee with it, can be charged to your client, our patient, at our fee-for-service fee schedule.” She indicated that she was familiar with the new law, but said, “Our panel of dentists will almost always ‘honor’ our contracted fees regardless of whether we cover them or not.”

Does anyone reading this see the problematic epidemic? Is there any reason why we continually see dental insurance companies run all over us? Imagine all the hard work, passing the above said law in my state, that was performed on our behalf by those in our profession to protect us from non-covered benefits which are fee-controlled by third party administrators so that we can be profitable, only to find members of our own profession continually discounting their hard work by “honoring” insurance dictates.

Every one of you know dang well what I’m writing about. If you want to deny, or really don’t know what I’m saying, what most of you do in your practices, let me remind you of the phrases I typically here as I do dental consulting with practices all over this country:

Hi Mrs. Jones, here is your treatment plan, and as a courtesy to you, we are honoring your insurance fees on all of your needed procedures, which are less than our standard fees, even though your insurance company doesn’t cover the charges, which by law, would allow us to charge you our higher fees.

  1. Hello Mr. Smith, your insurance company allows us to charge for several of the procedures you require, but our office is going to do them at no charge as a courtesy to you.

Many of the business decisions we make within our practices would give us failing marks if we were pursing an MBA program, let alone any upper division business courses. For heaven’s sake people, it’s absolutely fine to charge for what you do! When some of our state representatives, both in and out of our profession, pass laws that help protect our ability to be profitable, why would you not apply those laws within the scope of your practice? If you choose not to put your business hat on, then stop complaining about not making the kind of profits you use to, or hoped to make.

Hardline points to consider and implement:

  1. When your state law says, “if an insurance company only allows $20 for a procedure, and does not cover the benefit, and your fee-for-service fee is $30, you can charge the patient $30 for said procedure, not the $20 they allow”, then charge the patient the $30!
  2. If you contract with an insurance company, and their fee schedule shows a code as a covered benefit, charge for it! In other words, don’t bake your build-ups into your crown codes, like they try to make you do. Push back, remind them that you contracted with them according to their reimbursement fee schedule, and you never signed a contract to have your procedures baked into other codes. You can tell them “no”, and they will comply, as they can’t practice dentistry without a license, and they have to honor the CDT Codes you are contracted for.
  3. If your office manager feels the need to give your services away as a courtesy to your patients, remind them from whence their wages come from. If they feel you make enough money, and they suffer from “codes and fees blindness”, and “give-it-away-itis”, then release them from your practice.
  4. Office managers, if your doctor suffers from “codes and fees blindness”, and “give-it-away-itis”, and feels the need to give your potential raises away to look good in front of the patient, remind them from whence your future raises come from, and who keeps them in practice. Maybe the doc needs to be fired. And if the doctor feels they make enough money, ask them to review their retirement portfolio a bit closer, or impart some of it to the staff in the form of bonuses. It goes both ways…right?

So, when an insurance company attempts to bully, or guilt you into giving away your services, put your business hat on and quickly conclude that it’s alright to make a good living. If we continue to make statements to the insured indicating we will “honor” the insurance fee schedule, even though they do not honor paying us in behalf of their clients, we will continue to set a precedence of the devaluation of our services. And as most know, PPO plans already take away on average 40% of our UCR Fees. I would think that is courtesy enough.

Rob Thorup, DDS

Clinical Director/Co-Founder

My Practice My Business

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