dental practices.docx

dental practices.docx

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dentalpractices

Thedifferenttypesofpractices,HowFeesareset,&HowDentalinsuranceworks

Index

1.Thedifferingnatureofdentalpractices

2.Generaldiscussionoffeesandhowtheyareset

3.dentalinsurance

∙WhatifIhavenodentalinsurance?

∙generalinformationconcerninghowdentalinsuranceworks

∙Capitationplans

∙HMO's

∙PPO's

∙Privateinsurance

∙DirectReimbursement

∙Referralservices（insurancethatisn'tinsurance）

   4.Importantquestions

∙Whatisapre-treatmentestimate?

∙Ismyinsurancecompanygood?

∙Whydoesn'tyourofficeacceptmyHMO（PPO,dentalcontract）?

Thedifferingnatureofdentalpractices

Notwodentalpracticesarealike!

Eachtakesonthecharacteristicsofthepractitionerwhoownsit. Thepersonalityoftheownerisprobablythe keytohowthatoffice"feels"whenyouwalkinthedoor. Somepracticesmayfeel"clinicalandefficient",whileothersfeelsomewhatmorehomespunandlaidback. Thedentist'spersonalityisreflectedinhisorhertreatmentpreferencesaswell. Thefactthatdifferentdentistswillsuggestdifferentplanstotreatyourconditiondoesnotnecessarilymeanthatoneplanisbetterthananother. Inmyexperience,alldentistswillsuggestwhattheyfeeltobetheverybestplanforanygivenpatient. Thedifferencesbetweenthetreatmentsuggestedbyonedentistandthatofanotherreflectsthatdentistspreferencesbasedonhisorherexperience.Thusdifferingtreatmentplansdonotnecessarilyreflectanydeficiencyineitherdentist'sjudgment.   

Itisimportanttorememberthattherearenumerouswaystotreatthesamesituation,anditisalwaysimportantforthedentisttotailorthetreatmentplanforeachpatient'sspecificcircumstances. Amajorpartofthosecircumstancesmaybefinancial,andsincedifferenttreatmentplanscanvaryagreatdealincost,itishelpfulifthedentisttakesthepatient'sabilitytopayintoaccount.  

Thinkoftreatmentplanslikevariousmodelsofcarsofferedbydifferentdealers. Allofthemodelsarenew,havewarrantiesandwillworkwelloutofthelot. Thehigherendmodels,howeverhavesomeadvantagesnotfoundinthelessexpensivemodels. Someoptionsaddyearstothelifeofthecar.Someaddtotheappearanceandenjoymentofdrivingit. Dentaltreatmentplansarelikethattoo. Savingabadlydamagedtoothwitharootcanalandacrownwillpreserveitforalongtime,butitisexpensive,andthepatientmayoptforamuchlessexpensiveextractioninstead. Replacinga missingtoothmaybedonewithanexpensivefixedbridge（whichremainsinthemouthandisnotremovable）, oramuchlessexpensiveremovablepartialdenture. Adentistshouldbeabletoexplaintheadvantagesanddisadvantagesofthevariousoptions,andallowthepatienttomakethedecision.  

Alldentistswhohavegraduatedfromanaccrediteddentalschoolshouldbetechnicallycompetenttoperformanyprocedurethattheypersonallyfeel comfortableperforming. Butitisimportanttorememberthateachoneisanindividual,andnotwodentistscanperformexactlythesametechnicalprocedureinexactlythesameway. Asamatteroffact,nosingledentistcanperformexactlythesameprocedureexactlythesamewaytwiceinarow!

 Howwellyourfillingturnsoutdependsasmuchonhowwideyoucanopenyourmouthasitdoesonthetechnicalqualificationsandskillsofthedentisthimself.  

OvertheyearsIhavedevelopedarespectforthosewhopracticedentistry. Byandlarge,thesearehonestpeoplewhohavethebestinterestoftheirpatientsatheart. Foraninterestingperspectiveontheoverallstateofethicsinthedentalprofession,pleaseseemypageonbleachingteeth,andespeciallythesectiononwhyittooksolongformanyofustoacceptbleachingasastandardpartofdentaltreatment.

Feesandhowtheyareset

Tounderstandfeesindentistry,itisimportantfirsttounderstandthedifferencebetweengoodsandservices.Goodsarethingslikeclothing,sinksandautomobiles.Servicesarethehumanlaborinvolvedintheirproduction,installationoralteration.Thesinkisthegood.Theplumberprovidesaservicebyinstallingitforyou.Goodscanbemassproducedanddistributedallovertheworld.Aservicemaydependuponthelaborandintelligenceofasingleperson.

Thepriceforanitem（agood）dependsonitsavailabilityasmuchasonitsquality.ApairofpennyloafersproducedbyafactoryinTaiwansoldintwodifferentstoreswidelyseparatedmaybeidentical,butpriceddifferentlydependingonthelocationwhereyouboughtthem.Thesamepairofshoesmaybemuchmoreexpensiveifyoupurchasetheminanupscalebotiqueunderafashionablebrandname,thanifyouboughttheminK-martunderanoff-brandname.Inthiscase,therelativewealthofthelocalpopulationdetermineswhatthepricewillbe.Ontheotherhand,adifferentbrandofpennyloafermaybehandsewnandcouldbeexpectedtobeofsuperiorquality,andyetbesoldatK-martforlessthantheTaiwaneseshoessoldattheupscalemall.Again,thepriceissetby"whatthelocalmarketwillbear".Comparisonshoppingmakesagreatdealofsensewhenshoppingforgoods.

Servicesareaverydifferentstory,andsinceeverythingyougetinadentalofficeisaservice（andnota"good"）thereisagreatdealofconfusioninthepublicmindaboutitsrelativevalue.Thevalueofdentalservicesisnotmeasuredinthesizeofarestoration,orthephysicalvalueofthegold,silverorplasticusedinitsproduction.Thetimeittakestoperformtheserviceiscertainlyafactor,andsoisthetechnicalexcellenceofthefinishedproduct,buttheyarenottheonlyfactorsthatcount.Forexample,adentistmayproduceaperfectlyexecutedcrowntocorrectyoursmile,buthemayhavethepersonalityofaweaselandhandleyoulikeaconcentrationcampguard.Howmuchshouldyoupaytobetreatedlikeahumanbeingwhilereceivingtheservice?

  Theanswertothisquestiondependsuponthepatientyouask. Comparisonshoppingbasedonfeeswillalwaysnetyouadifference,butnotnecessarilytheonethatyouexpected.

Finally,thereisthefactorof"overhead". Itcostsalotofmoneyforadentistsimplytopurchaseandinstallthenecessaryequipment. Theinitialoutlayisusuallyborrowedfromabankatinterest,andtakesmanyyearstorecoup. Mostdentistswhostartapracticefromscratchnevermakeaprofitduringthefirsttwotofiveyears,andmustworkparttimeforanotherdentistjusttofeedthefamily. Inaddition,theregularmonthlyexpensesarequitelarge. Mostpracticesemployseveralassistants,anofficemanager,andatleastonehygienist. Thesepeoplemustearnalivingwage,andthecostofyourfillingreflectsthisfact.  

Thedentistmustpayrent,ormortgageonhisoffice,purchasemanytypesofinsurance,periodicallyupgradeequipment,andprovidehimselfandhisstaffwithcontinuingeducation.Therearealsomanyincidentalssuchaslighting,snowplowing,trashremovaletc. Onefactorthathasescalatedtremendouslyoverthelastfewyearsisthecostofinfectioncontrol. Eachpatientrequiresseveralpairsoflatexglovesperoperator（dentistandassistants）aswellasexpensivedisposablessuchasneedles,surgicalmasks,headrestcovers,autoclavebags,andaslewofotherthingstoonumeroustomention. Don'tforgetthecostoftheexpendablessuchasanesthetic,fillingmaterials,thecostoflabproduceditems,toothpaste,floss,andmuch,muchmore.  Thefinalpriceofthedentalservicesyoupurchasemusttakethisoverheadintoaccount.  

Missedappointmentsareamajorcontributortotheofficeoverhead,andtheyraisethecostofdentistryforeveryone. Inouroffice,wedonotdoublebook（booktwoormorepatientsforthesametimeslot）. Ifapatientdoesnotshowupfortheappointment,thattimegoesunfilled. Nothingisproducedtooffsettheofficeoverhead,andingeneral,eachmissedappointmentcoststhatofficeaconsiderableamountofmoneywhichmustberecoupedbyraisingthefeesforallprocedures. （Wedonotoverbookinourofficeasamatterofcourtesytoourpatients. Iftwopatientsarebookedforanygiventimeslot,thenobviously,someonehastowaitalongtimetoseethedentist.）

Location,location,location

Theindividualfeesforanygivenservice,suchasafilling,acleaning,bitewingx-rays,oraporcelaincrownmayvaryfromonedentist'sofficetoanotherinanygivenarea.Youwillfind,however,thatwithina20to30mileradiusfromanysingleoffice,theAVERAGEofallthefeesinvolvedinanentiretreatmentplan（knownasafeestructure）tendtobeaboutthesame.Youmightpaylessforacleaningatoneofficethanatanother,butyoumaypaymoreforthex-rays.Orthecostofacrownmaybelowerinoneofficethaninaneighboringdentist'soffice,butyoumaypaymorefortheadjunctiveservicessuchaspostandcoreorrootcanals.Ingeneral,thisisthelawofsupplyanddemandinaction.Adentistchargingmuchhigheroverallfeesthanhislocalcompetitorswouldfindhispatientsgravitatingtootheroffices.

Therecan,however,beaveryLARGEdifferenceinfeestructurebetweendentistsindifferentareas.Asamatteroffact,thereisadefinitegradientinfeesasyougetcloserandclosertoalargemetropolitanarea. Thisdoesnotnecessarilyreflectamajorincreaseinvalueoftheservicessuppliedinthoseareas（althoughtherentonthepropertyisgenerallymuchhigherandaddstothedentist'soverhead）.Instead,itisthelawofsupplyanddemand.Asyoudrawclosertocities,thepopulationtendstocontainalargerpercentageofverywealthycitizens,andthesepeoplearewillingtopaymoreforserviceswithambiance.