I feel like insurance companies should be required to be non-profit but that could just be me.
Dental Insurance not keeping up with $$
- Thread starter ZZman
- Start date
my issue is i have a great dentist who only will recognize/use the pricing schedule of the DELTA Premier version insurance any other insurances schedule including the other plans DELTA has he will not abide by the price schedule which always means more out of pocket expenses when i leave his office, even after a routine cleaning/examination i still got to fork out another $103 to cover the cost difference on that and mostly all other procedures which can really add up. im going to purchase my own DELTA Plan III which shows my Dentist and his associate as on their In-Network group but also states he only recognizes the Premier version of price schedule (sucks)
Delta Dental was a non-profit started and managed by dentists for years. A few years ago they started a "new" DD that was for profit. All the old plans are being allowed to fade away and the "new" 30% less plans are all part of the new DD.
This is DD's doing. There are 5 billion different DD plans. The "Premier" pays decently but the PPOs are heading towards being close to Medicaid fees. If he takes even ONE PPO, he's in-network with all PPOs including the ones paying less than his overhead. It would be foolish for him to accept these plans. DD does this on purpose to strongarm dentists to being in-network.
The problem is DD's all-or-nothing rules to being in-network.
I for one appreciate what you and other medical professionals have sacrificed, in order to become proficient in your necessary and vital field.
I am happy to pay for that expertise.
Just to give people an idea of the costs to us in dentistry: We have a 3500sqft office with 2 partners, 2 associates dentists, 3 hygienists, 6 font desk people, 2 managers, and the rest are assistants - we have 24 employees not including me and my partner.
Untrained dental assistant - $16/hr
Trained dental assistant - $20-30/hr
Hygienist - $45-60/hr
Managers - $40-50/hr
Dentists - $125/hr + % of collections
Weekly payroll is $30K not including me and my partner. These numbers do not include benefits which is worth another $6-7/hr.
Payroll - $100K/mo
Rent + office insurance + utlilites - $15k/mo
Dental supplies - $15-20K/mo
Accounting - $1K/mo
IT - $850/mo
Office Software support - $700/mo
Health Insurance - $10k/mo
401k match - $5K/mo
Lab fees $10-20K per month
Another $5-10K in misc stuff
Up until recently, the practice loan was $17K/mo
Needed 25 new computers + a new server plus migration and setup (they were 8 years old and did not support the new version of our office software) last year - write a check for $50K
Panorex machine went down and because it's 10 years old they no longer make parts - write a check for $70K
Kid bites down on a digital x-ray sensor - they're $10K per sensor
We were shut down for nearly 3 months by the state due to CV-19 and operated at ~50% volume for all of 2020. Even now we are at about 80% due to the continued need for social distancing in health care (state mandate). We did not lay anyone off but we will be digging out of this hole for a while and much of any reserves we had are gone and my income for 2020 was half of what it was for 2019. This is a profession where you have to make hay when the weather's good because pandemics were never part of my business plan. Disability is also very high in dentistry. It may look like a cushy gig but there is always a lot of uncertainty.
After all of this, my partner and I pay ourselves...
Untrained dental assistant - $16/hr
Trained dental assistant - $20-30/hr
Hygienist - $45-60/hr
Managers - $40-50/hr
Dentists - $125/hr + % of collections
Weekly payroll is $30K not including me and my partner. These numbers do not include benefits which is worth another $6-7/hr.
Payroll - $100K/mo
Rent + office insurance + utlilites - $15k/mo
Dental supplies - $15-20K/mo
Accounting - $1K/mo
IT - $850/mo
Office Software support - $700/mo
Health Insurance - $10k/mo
401k match - $5K/mo
Lab fees $10-20K per month
Another $5-10K in misc stuff
Up until recently, the practice loan was $17K/mo
Needed 25 new computers + a new server plus migration and setup (they were 8 years old and did not support the new version of our office software) last year - write a check for $50K
Panorex machine went down and because it's 10 years old they no longer make parts - write a check for $70K
Kid bites down on a digital x-ray sensor - they're $10K per sensor
We were shut down for nearly 3 months by the state due to CV-19 and operated at ~50% volume for all of 2020. Even now we are at about 80% due to the continued need for social distancing in health care (state mandate). We did not lay anyone off but we will be digging out of this hole for a while and much of any reserves we had are gone and my income for 2020 was half of what it was for 2019. This is a profession where you have to make hay when the weather's good because pandemics were never part of my business plan. Disability is also very high in dentistry. It may look like a cushy gig but there is always a lot of uncertainty.
After all of this, my partner and I pay ourselves...
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I’ll keep you posted with short updates. My main question is..are these costs in line with what you,as a pro, would charge? Extraction $350..epico $3000, 3 tooth bridge to wrap things up..$2800. I have the $$, are these charges exorbitant or in line? I have no problem with paying for professional services. Nor to I have an axe to grind with dentistry. Just wondering if these charges are in the ballpark.
Those costs seem reasonable to me.
This.
Most people look at someone driving a fancy car and automatically assume he or she is a rip off. When in reality the cost to start this is high and many not making it to the end. What is a fancy E class these days? just a car that everyone can afford at least around my area, they blend in and nobody notice them already.
Most general practitioners also don't make much money and the real money in medical is in the lawsuits and surgeries. Cancer medicines can be a ripoff but without the incentives to rip off you also don't get some of the newer innovative drugs (because government won't sponsor drug researches and the chances of failure is high).
A lot of people I know did the calculation, and end up going into software engineering instead.
Non profit doesn't means they give things to you for free, the management can still run them as a rip off.
Look at PAMF, Blue Cross Blue Shield, Kaiser Permanente, they supposedly or at one time used to be non profit, but they still charge a lot.
They pay out a lot too. I think by law, they're now supposed to pay out 80% of premiums otherwise you get a refund. In bad years, they can pay out more than that and some go out of business. Medicare pays about 2-5% on administrative costs although that may be misleading because they spend a lot more money per patient.
~13yrs ago, with insurance I paid about $2K for the 3 crowns and just under a grand for the apico.
Now that we stay in network, we just paid about $350 for a new crown for the bride.
I pay about $40 a month for my Aetna premium plan for a family of 6. I was wrong with my statement above in that it is indeed capped at $1500 per person, per year w/ no lifetime cap. Routine cleanings and x-rays usually work out to $50 out of pocket.
My BCBS high deductible medical is another story. LOL
That’s what I need to know. I can come in this afternoon
Ok. This is great. A thread where many have traveled and few have reported back. I assure you I will report at every juncture and keep you abreast. To infinity…and beyond!
Have yet to see a dental policy that is worth the paper it is printed on. Poor coverage for 99% of them.
Come on over to the Corporate Jet world, where individual replacement items cost $50K-$90K, replacement avionics $100K-$250K for routine stuff and $1M for EVS related equipment. Engines are $12M each, Overhauls $5M each, heck, we don't even bother to get approval for invoices under $50K. Annual budget $6.9M, fire the entire crew and we are still north of $6.5M with nobody to fly the thing.
Unfortunately, our pay is not high enough to afford "premier" dentists. BTW, my dentist does unnecessary work. Got me twice with that one. He's fired once I get him to re-do the $2K crown that is a food trap due to poor quality work
There's a huge difference - people expect their corporate jets to cost a lot of money but for some reason, dental fees are considered exorbitant. Almost every day someone calls us and asks to come in for an evaluation for pain or something looks weird or feels weird. We schedule them promptly, adjust the day if needed, and we get them in. Many times there is something I can do immediately but sometimes they need a referral. The room is booked for 45 mins. At least a couple of times per month someone who received an x-ray, exam, and referral complains about the $85 exam fee because "The girl came in and took an x-ray and dentist was only in the room for 5 mins".
That $85 is what it cost me to set up and disinfect the room - it covers the cost and I made zero or very little. The real truth is if that person wasn't in my chair, someone else could've been, and that chair could've produced $500-1000 in that time. That person complaining probably thinks my time is worth $35 and at that point I'm paying them to come in...not a great business decision if you want to be open in a year. I'm happy to get someone in pain in ASAP but it's always annoying when they complain (even though they were told the cost over the phone) and no one understands how much time can go into figuring out where and how to get these people in for the evaluation, not to mention turnover the room, sterilization, equipment wear and tear, etc, etc.
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Thanks for that. It's not clear to most people what goes on behind the scenes. My next tooth is going to be made from JB weld.
[just a little joke,of course. I had a friend who did that and I found it funny]
JHZR2
Staff member
I didn’t say rip-off. So don’t make assumptions.
And your angle that an e class in your area is something everyone can have is so distanced from anything remotely reality in the USA, where the median household salary is less than the MSRP of the base model, that it’s just about irrelevant.
It’s great that the costs of setting up a dental business were laid out. Outside of the exorbitant schooling, which as I understand are arbitrarily kept high through arbitrarily low enrollment and attempts to prevent more medical/dental schools from being created…. Outside of that it looks like most any other business where someone has to take a risk, apply capital, and expects an outcome.
Sure, you can’t start a medical practice on a card table in a living room, or out of a garage. Ok, so it has a higher barrier to entry. That’s how it works.
And for the record, I’m not against dentists or anyone else with training making money. Far from it. I have a terminal degree in an academically challenging technical area that I’d put up in complexity to anything in the medical field. I work in an area with extremely high costs of entry.
Perhaps that’s why I’m jaded to the whole thing. Medical isn’t the only hard thing that takes a lot of training and complex understanding, and that has high barriers to entry. The reality is that for whatever reason, the system is broken, people aren’t earning more, insurance isn’t increasing benefits, nor costing less. Effectively the liability of healthcare will destroy most of the rest of the economy. Thus it has to be fixed or it will be fixed. No need to make political commentary, let’s just call a spade a spade. The vast, vast majority of Americans are one major medical event away from bankruptcy, even with what is considered good insurance.
So people can go off making the I deserve claim, people can go off in a bubble that’s not indicative of the rest of the country and make claims about status symbol cars. Lots of things can be said, but at the end of the day the system is collapsing all around…
Frankly, if with megabuck technology, these medical tourism locations can do things for a fraction of the cost, we should look hard at why. Is it the overhead? Salaries? Bonuses? Insurance?
For some reason most every other industry in existence is supposed to figure out how to cut costs and increase efficiencies, but when it comes to medical costs and conpensation it becomes “I deserve”?!?
JHZR2
Staff member
Corporate jets with millions of dollars worth of complex systems that affect life, limb, and public safety is a pretty vast difference from a medical practice. Stuff costs money. Ok. That’s why most folks don’t have a corporate jet.
Expectations far on the other end are annoying too. Someone making a fuss after being told a price and being promptly provided a service is horrible. It’s nature of the beast I guess for anything public-facing, but it’s not fair.
But the interesting thing you mentioned was the cost to do a variety of setup steps. Ok so you think it costs $85. I suspect that if I came in tomorrow, you would charge me/my insurance $250 for it, in expectation of them coming back and saying that they’ll pay $70.
What’s not clear to me, and one of the most frustrating things to me as I use an HSA/HDHP, and thus pay much more out of pocket and are more in tune with costs…. Is why anyone can’t get a straight up price, straight up, to make decisions and compete on. It’s not an easy process. There’s lots of ambiguity. The scale sliding so broadly for a service is insanity.
My pregnant wife went for some tests. Her OB said they would be around $250 each. The test company billed somewhere on the order of $3500 each, and insurance denied it as necessary (I pay it myself kind you with an hdhp). My wife called and asked about this, and indicated the cost that the OB stated. The test company quickly replied that if that’s what they said, they would rebook at $249 each, which we paid.
Obviously the test company can’t stay in business on such “goodwill”, thus it’s all just opportunistic billing. I recall seeing similar for the last day in the maternity ward with my first. Somehow the hospital thought that day was worth $69k though it was just the one extra day allowed after a c-section. It was denied abs insurance somehow “magically” made it go away.
Have tons more of these stories, and we’re healthy and rarely need to go to a doctor. So it’s just wild to me to have any confidence in the reality of any pricing for anything.
