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Wednesday, May 23, 2012

Dental Insurance- good,BAD and UGLY

I can't tell you how many times a week a walk up to the front desk at my office and think to my self - "I am so glad I don't work in this part of the office". I think its important to have a good understanding of what goes on in that department but I wouldn't want to deal with people and their money for 30+ hours a week- NO THANK YOU! (I'll take infected gums any day)

My office is fee for service which means that our patients pay us the day of their services and then we submit the claim for them and they get a reimbursement check in the mail from their insurance company.

I think it is easiest for me to understand and explain why this is a good way to operate for dental offices by comparing it to medical insurance.

Take my sons recent visit to the doctor: (this is the actual breakdown of my insurance EOB)

My sons MD is a participating provider with our insurance company which means that he accepts what ever fee this insurance company tell him he can charge for his service- no matter how ridiculously low.

                                                  For this appointment the doctors fee is $158

                                                                  the insurance company paid $28.08

                                                                                                   I paid $  3.12

                                                                  the doctor had to write off   $126.80

   _____________________________________________________________________
          The insurance company set the fee for the MD's service at            $31.20


Anyone who doesn't have insurance would have to pay the $158 fee, so as a patient I am torn between being happy that I only have to pay $3 and annoyed that I have to wait in the waiting room forever because the doctor has to see 5 patients at a time to turn a profit because he is only getting paid 20% of his fee in most cases. Because I like this doctor I also hope that he is able to remain in business by only getting paid a fraction of what is owed to him.

As a dental practice that wants to provide our patients with great service we decided that allowing insurance to dictate our fees and essentially determine how we would need to book our schedules would not allow us to provide the kind of treatment we wanted to.



1 comment:

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