Before joining any PPO read this article by Sandi Hudson in Dental Town "Welcome to the new world of dental insurance. The days of being able to contract only with the insurance company directly are gone. With the exception of Delta, every major insurance company now has some sort of shared network agreement for at least a portion of their networks. Some offices may find third parties a good fit, others are being blindsided by them. One area of the country may find superior fee schedules with a third party while direct contracts may come in higher in others and differ- ent business models within dentistry vary in how useful or harmful a third party administrator could be."
NON-COVERED PROCEDURES LEGISLATION BY STATE
Thursday Troubleshooter: Is there a way for this dentist to avoid PPOs and still survive?
The short answer is NO because dental insurance companies and The Federal government want severe competition that they think will lower the cost and improve care. But as every dentist knows to provide the proper care takes time if a dentist tries to do procedures faster many times that procedure is of lesser quality.
Insured Patients are making the decision to cut their costs for dental care by only seeing PPO dentists. Having just joined 12 PPO's 9 months ago 56% of my 37 new patients in 2014 list their referral from their insurance company website. In the Raleigh, NC area I have seen more patients shopping when other dentists tell them they have need 10-12 restorations and after my exam I find no needed restorations. 5-7 years ago no specialist were on PPO lists now 80% of the specialist in Raleigh are listed on 2-3 PPO's. The problem is oversupply as an example in a 5 miles of my office are there are 8 Endodontists and just 4 weeks ago another Endodontist who had practiced in two other states after his training opened an office. A system is needed to evaluate the need for dental care and the ability of practices in each are to fulfill that need and inform the dental community where to practice. The decay rate is decreasing in the much of the population that starts dental care at a young age and has the education to understand preventing dental decay is a great benefit and the ability to pay for preventative care. The last time a large study was done to evaluate decay rates in the US population was over 10-15 years ago. US dental schools have built larger facilities to train more dentist. Dentist in other states read on government websites that more dentists are needed in areas that have larger populations ie: Wake County NC just past the 1 million population mark. When they look for jobs in these areas there are none. What is needed is first to understand there is a problem and then determine the need and second the ability of practices in the are to meet that need county by county and state by state. The ADA and state associations must be the leaders and problem solvers in this area. The Federal Trade Commission must understand that it is a disservice to the US population to flood an area with dentists some who will do unnecessary treatment for a fee.