Paid for Life: On Negotiating Dental Care Contracts

Dentists are some of the most visited medical professionals in the world; everybody needs dental care, and a lot of people visit their dentists in order to maintain their teeth. Most people assume that dentists have it easy with their income due to having so many patients to attend to. The truth is: it can be difficult for dentists to get paid completely for their services, particularly if they’re a member of an HMO.

An insured patient doesn’t need to pay the dentist if his insurance company has a payer contract with the dental office. Essentially, it’ll be the insurance company that pays for the treatment, though things don’t always work out as planned. Sometimes, the insurance company won’t cover certain treatments, or won’t even complete the payments.

Dentists have every right to fight for their proper pay; as trained and skilled medical professionals, they deserve to be compensated for their delicate services. If a dentist finds that he wasn’t paid correctly by the insurance company for his expertise, then he’s free to negotiate a compromise. Negotiating can be a grueling and time-consuming process, but it’s necessary so that dentists can protect their revenue. It’s a good thing that there are consultants around who can help dentists properly settle matters with insurance companies.

Reaping the Rewards of PPO Insurance

Dentists constantly remind their patients to keep brushing and flossing daily to have stronger teeth and brighter smiles. However, as far as dental care costs are concerned, savings can be considered another reason. Preventive care under preferred provider organization (PPO) insurance may cost 80 percent lower at preferred dentists. In fact, some insurance companies may shoulder the checkup fully, which will surely be a heavy burden off the policyholder’s back.

PPO plans are among the fastest growing healthcare plans in the market today due in no small part to their simplicity. As dental care is predominantly preventive in nature, patients pay less for a preferred service provider. Dentists, on the other hand, receive most of the premium as reimbursement, tied to a specific fee schedule as per the agreement with the company. He simply needs to furnish proof that the policyholder indeed had his mouth checked at the dentist’s office.

Dentists are welcome to negotiate the fee schedule depending on the nature of their situation. Then again, the fact that more patients may go to a preferred dentist under a PPO plan can generate tons of direct profit. Under PPO, a patient can choose or not choose to go to a preferred dentist, but the cost of a non-preferred provider’s services will be substantially higher. More patients translates to more profit, so in the end, the dentist enjoys as many benefits as his patients.

A Good Reason to Raise Dental Fees

Any business on the brink of a deficit generally has two choices: cut costs or raise fees. As far as the cons are concerned, businesses are choosing between affecting quality and losing the trust of clients. That’s less of a concern for dentists, as a drop in quality service will, more or less, scare clients away. As the shepherds of teeth and gums, dentists can’t afford selling their state-of-the-art equipment to save on overhead costs.

 

They can try to cut costs on other areas, but most of the time they’ll need to raise their service fees to stabilize their finances. For any business, profit is the prize; after all, being unable to generate profit defeats the purpose of doing business. For years, dental fees haven’t been in sync with the rising costs of running a dental office. This places the dentist at the receiving end of negative revenue, which gets worse the longer it persists.

 

However, dentists must justify their reason for raising dental fees. Raising fees for the sole purpose of profit is less appealing to clients than raising fees for profit and keeping quality service alive. He’ll have to explain it to clients and insurance firms, convincing them that raising his dental fees will truly be for the best.

Why Dentists Should Negotiate for Better Rates

Before a dentist can provide exceptional oral health care, he or she must first earn a course in general dentistry, after which one can pursue further studies to pursue a specialization. This will require aspiring dentists to complete a graduate training program and a period of residency that will enable them to develop the necessary expertise in such fields as periodontics, pediatric dentistry, oral and maxillofacial surgery, and others. It takes a lot of blood, sweat, and tears before one can become a certified practitioner of any dental specialty.

However, this fact is often overlooked by many dental insurance providers. When it comes to money matters such as settling reimbursement rates, some dentists are inclined to think that insurance companies have the upper hand. While there may be some truth to this assumption, it certainly does not mean that dentists should allow themselves to get shortchanged when claiming what is due unto them.

Dentists, more than anyone else, know full well the value of their skills and the money required to run a dental practice. When building a stronger argument for claiming much higher reimbursement rates than what they are being offered, dentists need to gather as much information as possible so they can successfully prove their point. Luckily, dentists can turn to reputable companies who can negotiate for higher reimbursement rates from insurance companies.

The Direct Reimbursement Dental Plan Explained

A comprehensive dental plan is one of the many benefits employers can give their employees. Among the various types of dental plans available, Direct Reimbursement is gaining popularity the quickest. More and more companies are opting for this dental plan because of its distinct advantages.

While conventional plans usually cover specific treatments, a direct reimbursement plan reimburses patients a predetermined percentage of the total dollar amount spent on specific treatments. Instead of paying a monthly premium according to the pooled experience of the plan provider, an employer only pays treatment costs based on the employees’ experiences. This makes the entire process simpler and far more manageable.

Like the Usual, Customary, and Reasonable (UCR) dental plan, Direct Reimbursement allows patients to go to the dentists of their choice. In Direct Reimbursement, patients seek dental treatments from the dentists they want, pay full price for the treatments, and obtain reimbursement from their employers based on predetermined values. Normally, there is an annual limit of around $500 to $2000.

A direct reimbursement plan is the dental plan of choice for most employers because it’s cost-effective. In fact, it is strongly supported by the American Dental Association. Both employers and employees benefit from Direct Reimbursement’s cost containment features.

Helping Patients Save with Dental Reimbursement

Dental insurance is a great way to attract patients to your office. The cost of dental services can be kept to a minimum because the plan covers part of the cost depending on the nature of the service in question. To get a better picture of what dental insurance can do to patients, say your patient pays a visit to your office for his regular checkup. Normally, regular dental checkups fall under Class I, which is diagnostic and preventive care.

Most dental plans shoulder the cost of regular checkups at no expense to the in-network dentist. In fact, some dentists, thanks to full dental reimbursement, offer free dental checkups to also encourage people to take good care of their teeth. However, the effect of dental insurance is more apparent the more extensive the operation. In another example, say you have a patient scheduled for installation of bridges, which falls under Class III.

The typical coverage for Class III services is fifty-fifty; 50 percent for the plan and 50 percent for the dentist. As long as you honor the patient’s insurance policy, you can make the cost less of a burden for him. Out-of-network dentists have different and more expensive plans, typically a 40-60 split in which the patient shoulders 60 percent of the cost. Experts estimate that patients can save as much as $500 on major restorative care with an in-network dentist.

Getting the Ideal Dental Insurance for You

If you have gums that are red, swollen, and bleed easily when you eat or when you brush your teeth, it’s likely that you have a mild case of periodontal disease. Catching periodontal disease at an early stage is possible if you seek the necessary dental treatment right away. Doing so is easy if you have dental insurance to cover part of the costs of the dental services because you don’t have to worry whether you have enough cash or credit on your card.

A problem can arise if you don’t have dental insurance, so before things get worse, it’s smart to obtain it soon. However, not all dental plans offered under dental insurance are the same, and it’s critical to study all possible options first before you sign up with a company that provides that type of insurance. There are plans where major dental care procedures are covered, such as root canal, and there are plans that only cover diagnostic and preventive services.

Where you seek dental services is also an important part of the terms in dental insurance contracts. The insurance may only allow you to seek dental treatment from a preferred provider organization or PPOs, which means there is a specific list of dentists that accept the dental insurance. There is also the out-of-network option that allows you more flexibility to choose which dental facility to go to.

A Brief Explanation of PPO Dental Insurance

A dental preferred provider organization (PPO) is a type of insurance that enables patients to get the best possible dental care at affordable prices. Companies will negotiate a deal with dentists who will be placed under the companies “preferred providers” or “in network.” If employees of the company want to get the best deal in pricing for dental care they need to look for dentists under the PPO’s network.

According to Dr. Jerry Gordon, in an article for How Stuff Works, dental PPO plans usually cover preventative dental care like routing cleanings, check-ups, x-rays, or flouride treatments (80-100% coverage). If an employee wants basic treatment services like root canal, fillings, or extraction, the coverage might be 80%. Major dental work like crowns, permanent bridgework, or dentures are usually covered at 50%.

Dental PPO plans are not cumulative, so in other words, if an employee doesn’t use it then he or she will lose it. Gordon says that a good number of insurance plans have a deductible of fifty to one hundred and have an annual maximum amount of funds available for dental care; the general yearly maximum is reportedly one thousand dollars. Despite its limitations PPOs does have its advantages but it’s important for patients to understand it clearly so they can make the most out of their plans.

Negotiating to Raise Dental Fees

In this day and age most people are covered by all kinds of insurance to provide for all their needs. This includes cars, homes, various properties, health, retirement, and life insurance among many other things. It’s a practical and convenient way to ensure that you get the services you want when you need them most.

This program can be especially valuable in times of emergencies when you require immediate assistance. Without insurance coverage, it may be difficult to get the services you require from professionals that can address such needs. However, for medical health providers like dentists for example, such arrangements can be complicated and put them at a disadvantage.

This is especially critical for medical professionals who agree to be part of a group of health providers that render their services at a discount. It’s a great advantage to the public for the opportunity to use these services at a much lower cost. On the other hand, professionals like dentists may not be able to get what is rightfully due them.

Fortunately, there are companies that can help dentists negociate in raising dental fees to enable them to make reasonable profits. This requires savvy business acumen and medical practitioners like dentists need the help of these people to keep them afloat particular in times of economic distress, and that’s a valuable assistance that medical professionals need.

Don’t Go Overboard When Negotiating Fees

Dentistry is primarily a service, not a business, and so dentists should therefore value ethics more than making a profit. However, this reminder also goes both ways: a patient shouldn’t feel entitled to discounts or something just because he or she is a “regular customer” for example. A certain middle-ground can be seen only if a certain flexibility comes into play when discussing dental fees.

Much like any service provider, dentists vary in quality which means that if a patient isn’t satisfied with the services rendered, he or she has the right to negotiate the fee (within reason of course). Of course, it would help if the patient had researched the dentist before coming to his or her office. This is because dentists also work with dental labs (for creating dentures, veneers, etc.) which, in turn, vary in quality as well; knowing about the lab would give the patient an idea of what to expect from the dentist.

On the other hand, dentists also feel that it is their duty to serve their patients as best as possible since a bad treatment will definitely look bad on their record. However, even the best tooth procedure will be in vain if the patient doesn’t follow the dentist’s medical recommendations. In such a case, the patient is in the wrong if he or she still wants to negotiate the dental fees.