Misery of a PPO dentist

Misery of a PPO dentist

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Misery of a PPO dentist Teeth27 Official Townie Posts: 4467 Member Since: 09/30/04 Location: Montana Followers: 10

I thought I read a statistic Howard posted saying 82% of dentists are PPO dentists.

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Misery of a PPO dentist teethdood Official Townie Posts: 400 Last Post: 09/30/16 Member Since: 12/29/05 Location: CA

My RDA spoke with another RDA at a wedding reception. The friend RDA used to work for a local dentist. She left due to his refusal to increase her pay. Now she's working as a Cigna claims agent lording over all these dentists including her former boss. Her own words

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rundoc

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Quote: (Tooth Carpenter)

I am in network with many PPO. Recently I am getting claim denials,late payments etc a lot.I feel like PPO is my business partner who did not invest in my practice, did not go to school of 8 years or more and take fourty percent of my income and remotely controls my office. They make all the clinical judgements and I work for them. I make a little profit of the 60 percent they leave for me after I pay all my overheads.

They make recommendations regarding downgrades, missing tooth and what type of material to use. They also tell the patient that some of those procedures were not medically necessary.

Pretty good summation of the state of our profession right there.

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Teeth27

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I'm out of network and I can't stand the bs they put me Thru. I have to estimate super high because they can be unpredictable. I really don't like it when I verify and then they ask for money back. I tell them to shove it. They simply just withhold it from the next insurance check.. but your post makes me glad I'm not in network.. at least not yet hope I can hold out.

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AB

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You are correct. Our PPO business partner is also changing the rules. I'm in Virginia and we are in network with quite a few ins co's. We've noticed lately they arbitrarily change the way they are processing claims - requiring pa's for anterior fills, downgrading multi-surface ant fills to single surface, not paying on build ups for endo treated teeth, denying payment for SRP, the list goes on. As a provider it pisses me off.

If I were a patient I would be pissed too that my ins co isn't paying for these things - pt's pay their premiums, but don't get the benefits they are promised. But pt's usually don't see it that way. They get mad at us b/c they think we should have told them their ins co will not pay. It really does seem criminal to me.

My best suggestion is to try and renegotiate your fee schedules - some will do it, some will not, but it's worth a try. The worst they can do is "deny" you :) We also have an in-office benefit plan that a number of our patients use - this helps a lot.

Another thing that may help is to focus on the fact you probably make more money than a lot of your friends and have more control over your schedule, and thus your life. I work 4 days a week - I don't have many friends who get a 3 day weekend every week. I also enjoy not sweating paying a few extra bucks for a nice dinner, or a nicer car. I'm not wealthy by any means, but better off than many.

Hang in there,

Tony

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Tooth Carpenter

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How many here are running a pure FFS office meaning collect all upfront and send the assignment of benefit to the patient ?

I guess assignment of benefits to the office is an easier way to run a FFS office than the traditional approach. What is the downside of this approach ? Estimation issues ?

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pEru Vn

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TC......this is not the good ole days.....but i tell you what if the feds and medicare get their fingers around delta... it will be. all ways are tough

FFS PPO mixed HMO you name it. delivery configuration makes no difference...... it is because there are too many dentists. all ways are tough......choose boy...... don't like their bs, withdraw from their net. don't like 8 NPs a month as FFS join their net. i guess it comes down to how strong your desire for independence is.

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USA Golfer

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Mark for later. I'm 90% PPO.

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mouthjanitor

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Quote: (Tooth Carpenter)

Quote: (Teeth27)

I thought I read a statistic Howard posted saying 82% of dentists are PPO dentists.

82% in network?. That's a lot

It's the public voting with their wallets and the profession reacting.

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pEru Vn

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got no problem with that if it is market forces

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pEru Vn

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got no problem with that if it is market forces at work....but it is not....our not so benevolent .gov is rigging it against us small ops.+

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cwru87

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The practice I bought is 70 percent PPO with the majority of patients being MetLife.

It's like a Cancer. It keeps growing. Patients leave good dentists because they are no longer in network.

Last new patient was convinced his PPO would pay for whitening, adult ortho and then was shocked his fillings were not covered at 100 percent.

My goal is to drop a PPO every year.

Most established practices are in network with 3 PPOs.

If it's. Numbers game and your overhead is 70 percent how does it help if met life cuts your fee by 40 percent. MetLife does not negotiate.

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Tooth Carpenter

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Key question is how to attract those 50 more percent of patients who don't have dental insurance.

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pEru Vn

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TC you can pay consultants...marketers...etc.... but the only thing that will bring that group is their perceived need. radio print internet try to persuade them of the value of your service. that group is not buying unless they are in pain or damage a front sexy six tooth that makes them look like a hillbilly...sometimes not even then. got better things to do than try to recruit and convert them.

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dds262

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I am 85% FFS and 15% Delta Premier........and it is HARD to stay that way........

Hoping to stay that way until I retire or until I can work 3 days per week.

I run a lean office and live below my means.....basic dentistry and able to still refer out to specialists for things I don't want to do.

Having a great team has been key......long term employees that are treated well and that the patient sees every time they come goes a long way.

I hired a consultant this year(after being in business for 15 years) and it has been a great tune up and has been paying for itself and increasing the bottom line.

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regularguy

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Quote: (pEru Vn)

TC you can pay consultants...marketers...etc.... but the only thing that will bring that group is their perceived need. radio print internet try to persuade them of the value of your service. that group is not buying unless they are in pain or damage a front sexy six tooth that makes them look like a hillbilly...sometimes not even then. got better things to do than try to recruit and convert them.

Agreed. Very tough to get those that don't have insurance. If it doesn't hurt and does not look bad, they do not come in much. Even with those FFS pts, we have to push an in house dental savings plan (20% off standard fees) in order to get them to do any work. I can't blame them much. I am in a low to middle class city. Those without insurance do not have a few thousand extra dollars to spend on dentistry.

1.The biggest problem we have is we have to fight to get our share of the PPO pts. We have a lot of dentists in our town due to the big clinics in town. They have the corner location, in house specialists, and a big advertising budget. You may say, "They will leave the big clinics due to poor treatment and come to you because you have a good reputation." Not so. Some may after they have all their work done. I don't have the big advertising budget to get many of these pts. in. When I do get in unhappy pts. from a clinic, I ask them why they went there. They usually say it is because they saw the big office on the corner. I can't compete with that.

2. Another big problem when we do get PPO pts in, a lot of them are just too afraid or lazy to have any work done. On many of these new PPO pts I diagnose a lot of work, but because they don't want to come it, they don't do the work and they lose thousands of dollars in benefits. Very frustrating. I often see pts come in with teeth rotten to the gumline with great insurance. Don't they know I have to pay my bills and feed my family?

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mikebarrdds

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Interesting thread with some interesting insights. Following....

Michael I. Barr, DDS

DISCLAIMER: Anything I've ever written or write in the future is my opinion, and my opinion only. Read, ponder, repeat, or implement anything I've said at your own risk. Before doing so, consider consulting with: an attorney, the President, your BFF, the ghost of G.V. Black, your dog, or simply reconsider while contemplating your navel and sipping on a margarita. That is all.

A Bitewing Teeth Party Extremist clinging to his occlusion and gums. Don't drool on me!

The Dental Warrior® - Blog for Dentists on the Battlefield of Private Practice (and more)!

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ahinks21

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It's threads like this as a newer grad that scare the crap out of me about my choice of dentistry. I'm two years out of school and struggling to get by, and constantly wonder what to do long term.

Continue to be an associate in private practice, go buy my own practice only to deal with the problems that many of the docs in this thread deal with, join the corporate/dso/ group practice model as it seems that's the future of dentistry or try to get out all together.

This profession can be lucrative and personally rewarding but sometimes my head spins thinking about everything it requires to be successful.

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hvl305

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Quote: (cwru87)

The practice I bought is 70 percent PPO with the majority of patients being MetLife.

It's like a Cancer. It keeps growing. Patients leave good dentists because they are no longer in network.

Last new patient was convinced his PPO would pay for whitening, adult ortho and then was shocked his fillings were not covered at 100 percent.

My goal is to drop a PPO every year.

Most established practices are in network with 3 PPOs.

If it's. Numbers game and your overhead is 70 percent how does it help if met life cuts your fee by 40 percent. MetLife does not negotiate.

I am a heavy ppo practice as well. Dropping a PPO every year is a good goal. I am looking at the reimbursement rates of all plans now and it narrows down to either UHC or UCC gets my boot this year end. I am not surprised to see that most, if not all, composite fillings are not covered at 100 percent. I would say comp fillings get covered around 60-80 percent for most plans.

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Tooth Carpenter

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Quote: (mikebarrdds)

Interesting thread with some interesting insights. Following....

This the price to pay for signing those dotted lines.

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pEru Vn

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yeah tc...funny you compared them to a real bad business partner but he's more like a service. a silent one running the business side of things...passive patient recruitment and marketing all he does though for his 35% cut. and it's off the top line. what a f ing thief. fire him yesterday....yes. but we don't. we just go on over treating and cheaping out on them. works.

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drlisa1991

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my assoc signed a ppo contract for the FQHC he used to work for about 10 days before he quit there.....unknow to anyone until a few months ago, that ppo contract had been sold like 4 times and he was on a bunch of ppo lists....took 6 months to get it cancelled b/c of the wording in the ppo contract....finally got it figured out and my assoc off the lists he didnt' even know he was on....

the ppo contract had some crazy stipulation that it autorenewd for 3 yr period unless 9 months written and 6 and 3 months verbal notice of cancellation....we didn't even have a copy of a contract signed 20 years ago......

not to mention that is our area those PPO reimbursement fees are at or below that of medicaid....

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frontofficerocks

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We have to remember what the insurance companies are in business for... they are not in it to help our patients. They are in it to make money so as long as let them dictate what that patient gets done, we are never going to be able to fully help our patients.

We also need to recognize what our patients know.... they know their insurance book, they know they don't like drills and needles in their mouth, they know they are supposed to brush twice a day and floss once a day (oh wait... the media dispelled that one... so that is not valid anymore). They don't know what we know. We need to work hard to do everything we can - from the marketing you send out to the first phone call to the case presentation and all the way through the procedure that your team is talking the same language, helping the patient understand the value in keeping their teeth and showing them that spending money in your office makes good sense!

We used to be in network for a ton of plans and now I am glad we are not. My husband worked harder for less. Getting out of network was the best thing we did. I feel that there are many offices that are scared to do it so I wrote a How To - to help others because I think it is so worth it. As long as you have your systems in place and your team trained.... it makes a lot of sense!

http://resources.frontofficerocks.com/outofnetwork

Laura Hatch

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Timmy G

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The whole idea of insurance is based on actuarial data that attempt to predict that more can be taken in then is spent going out. It's not rocket science. It's math. And its why Social Security and Obamacare will ultimately collapse. Because that balance is upside down. Because the people filing the claim (patient) think a couple hundred bucks a year in premium ought to get them a full mouth fix up-- and the people paying out want to limit to the max what they pay out by any means possible. It's an adversarial relationship from the start. That's just reality.

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drfredc

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One of the additional factors in PPO nonsense is how many PPOs also have ties to medical carriers of one sort or another. The one primary exception is Delta Dental.

For many dental PPOs, this means they are collaterally being damaged by their parent company's being sucked into Obamacare's ongoing dealth spiral.

Hence, they feel additional pressure to make profits to help out their parent...

As for Delta Dental, what I've heard mumbled here and there is Delta maybe scheming on a strategy to save up so they can maybe buy up some struggling medical carrier's carcass. Then they might scheme their way into processing dental and medical Medicaid claims where there is little to no risk...

What seems to be missed in a lot of what is going on in dental and medical carrier activity is the carriers, not grubermint, are processing Medicaid claims. That part of their carrier business is generally doing fine as the taxpayer pays the claims and they get paid for processing the claims by the taxpayers.

Another overlooked aspect of carrier activity is how carriers are all fine and dandy lobbying politicians for more Medicaid expansion for the increased claims they can process. It's like a taxpayer paid lobbying effort all the way to single payer... Just where do you think that Jeb Bush and Kasich got all their bucks to run for President?

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Tooth Carpenter

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Quote: (pEru Vn)

yeah tc...funny you compared them to a real bad business partner but he's more like a service. a silent one running the business side of things...passive patient recruitment and marketing all he does though for his 35% cut. and it's off the top line. what a f ing thief. fire him yesterday....yes. but we don't. we just go on over treating and cheaping out on them. works.

since most of us are in network, even those recruitment will not work anymore.

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drwillie

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I think I"m going to read chunks of this thread at my next team meeting.

Last time I had my part-time hygienist, (whom I love dearly) ask why I didn't just sign up for a few "Plans" since things are a little slow. In her mind that fixed the situation very quickly as she get paid the same no matter what.

WW

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drwillie

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Quote: (frontofficerocks)

We have to remember what the insurance companies are in business for... they are not in it to help our patients. They are in it to make money so as long as let them dictate what that patient gets done, we are never going to be able to fully help our patients.

We also need to recognize what our patients know.... they know their insurance book, they know they don't like drills and needles in their mouth, they know they are supposed to brush twice a day and floss once a day (oh wait... the media dispelled that one... so that is not valid anymore). They don't know what we know. We need to work hard to do everything we can - from the marketing you send out to the first phone call to the case presentation and all the way through the procedure that your team is talking the same language, helping the patient understand the value in keeping their teeth and showing them that spending money in your office makes good sense!

We used to be in network for a ton of plans and now I am glad we are not. My husband worked harder for less. Getting out of network was the best thing we did. I feel that there are many offices that are scared to do it so I wrote a How To - to help others because I think it is so worth it. As long as you have your systems in place and your team trained.... it makes a lot of sense!

http://resources.frontofficerocks.com/outofnetwork

Laura:

That link is dead. Would you mind reposting it as I'm sure it's got GREAT information.

WW

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pEru Vn

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yes TC...in our metro suburban socal it is 14 of 15 docs in network.....then the inscos got you where they want. they will adjust the fees where they keep you alive ......they don't want to kill you....they need you ....but it won't be a vibrant life..... and the weak will die....very comparable to drug dealers.

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Richard1234

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Insurance INDUSTRY = Cartel

They are not subject to collusion laws, can pretty much screw us as hard as they want.

Last time my office dropped a PPO (Cigna) 95% of the patients left. We tried all the techniques discuseed here about retaining patients, out of network stuff, yadda yadda...but at the end of the day my patient population is one paycheck away from financial ruin. It's a fact. So that prophy which used to cost them a $25 copay and now costs them $50 was too much to stomach. It sucks...really an extra $25 was enough to cause their entire family to uproot and go to the next newbie dentist down the road. Oh sure, a few will trickle back, but with lots of bitching and moaning about how "expensive" we are.

It is what it is.....most of us are noting more than a commodity which the consumer will seek out the lowest price on. I'm trying to change things in small ways where I live and in my little sphere, but the going is tough. Heck, one of my best friends missed an entire year with no recall, prophy, BWX...when I finally asked him why he hadn't been in...his answer was telling. "Dude, my new job didn't have dental until I'd been there a year"................there it is. If insurance is NOT available to him, he ain't coming in. Trying to convince patients that they don't NEED insurance to be seen is like trying to have a conversation with an English speaking person while I"m talking mandarin.

I dunno....it's weird.

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pEru Vn

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yeah these retirees, mostly teachers civil servants that drop their coverage....i tell them just send in the $70 per month delta was charging you on your salary and we will keep it on credit til you need it. better than insurance. we will collect up to $1500.00 then stop.... keep it on credit to insure yourself.....they say yeaaah good idea. then they don't do it.

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Richard1234

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and then show up 5 years later with raging out of control periodontitis which triggers my referral to perio for 4K worth of surgery or exts/dentures for 4K worth of treatment to me. It could have been so easy for them to just come in every 4 months for the pro/maint visit. It's not rocket science, but people by and large have been indoctrinated and brain-washed into believing that IF there is no dental insurance, then they can't or won't go to the dentist. It's INSANE

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pEru Vn

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narcos.........feel sorry for the young docs

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drwillie

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Maybe this is good thread to ask this question:

I've heard people brag on their production numbers here and there, saying they produced, for example. (real numbers from another thread, to the best of my recall) 1.8 million dollars, was very proud of that, then in the next sentence or two says they only collected 1.2 million as they had 600K in write-offs.

Soooooooo…

Did they really produce 1.8M, or did they produce 1.2M at sharply reduced fees.

I'm so tired of the [retracted] that the PPO thing causes.

WW

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cwru87

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Really you need to look at collections. A PPO practice can easily write off 30 or 40 percent. Really it's not what you make, it's what you keep.

I noticed subbing that the overhead could be kept much lower with multiple dentists and a larger practice if it was carefully monitored.

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Timmy G

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Quote: (cwru87)

Really you need to look at collections. A PPO practice can easily write off 30 or 40 percent. Really it's not what you make, it's what you keep.

I noticed subbing that the overhead could be kept much lower with multiple dentists and a larger practice if it was carefully monitored.

It is what you keep, not what you "produce" but the inverse of that is that an empty chair is always zero. There's a balance, a line to walk, at least for me to stay away from stupid going in either direction.

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Richard1234

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Quote: (Timmy G)

Quote: (cwru87)

Really you need to look at collections. A PPO practice can easily write off 30 or 40 percent. Really it's not what you make, it's what you keep.

I noticed subbing that the overhead could be kept much lower with multiple dentists and a larger practice if it was carefully monitored.

It is what you keep, not what you "produce" but the inverse of that is that an empty chair is always zero. There's a balance, a line to walk, at least for me to stay away from stupid going in either direction.

I'll disagree...slightly..."An empty chair is always zero"...........true............unless...........it's a medicaid patient, then an empty chair is better than a chair costing me 30% with a medicaid patient in it.

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JannHRH

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Quote: (drwillie)

Maybe this is good thread to ask this question:

I've heard people brag on their production numbers here and there, saying they produced, for example. (real numbers from another thread, to the best of my recall) 1.8 million dollars, was very proud of that, then in the next sentence or two says they only collected 1.2 million as they had 600K in write-offs.

Soooooooo…

Did they really produce 1.8M, or did they produce 1.2M at sharply reduced fees.

I'm so tired of the Mind Fuck that the PPO thing causes.

WW

If you can't collect it, then its just 'ghost' earnings... .that is why collections is the big ticket item for me.... because, even if you produce 1.8 and then write off that $600K, there is bound to be another $25/50K that is noncollectable.... so in reality, they would need to run the numbers there....not from the imaginary $1.8M...

So, Dr. Will.....Don't let them mind fuck you.... depending on overhead, their personal financial rewards may actually be the same or less than yours.... and truly if you are living pretty well, who cares?.. the more you produce the more headaches... I have worked in a office that produced $1.5M and one that produced about $850K...both dentists took home about the same salary.... one worked longer and harder than the other.... and it wasn't the lower producer... just saying....

Our PPO involvement is about 30% and we are hoping to eliminate it at some point.... We work very hard on referrals from our non-benefited patients...have had good results with that... I'd say less than a third of our new patients are involved in a dental benefit plan.... that's a good thing ; )

Jann

Report AbuseRevisions: 0Posted: 10/5/2016 10:38:56 AMPost: 44 of 47

Misery of a PPO dentist

k5thbeatle

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Quote: (Richard1234)

and then show up 5 years later with raging out of control periodontitis which triggers my referral to perio for 4K worth of surgery or exts/dentures for 4K worth of treatment to me. It could have been so easy for them to just come in every 4 months for the pro/maint visit. It's not rocket science, but people by and large have been indoctrinated and brain-washed into believing that IF there is no dental insurance, then they can't or won't go to the dentist. It's INSANE

Ah yes, what I call the good old "insurance mentality" that people have and seem to be more indoctrinated with nowadays.

Just saw a guy that I knew and was friends with as a kid (I'm still friends with his brother) that hadn't been to the dentist in 8 years. Moderate perio and lots of broken old restorations with recurrent decay. "Do you mind if I ask why you didn't see a dentist in all those years?" "Didn't have dental insurance." Yet I know for a fact this guy has been pulling down a 6 figure income all that time and then some, but he didn't have dental insurance.

If a person breaks an arm or has some medical sign that something is wrong they run to the doctor as fast as they can regardless of insurance or what insurance pays. But with teeth it's different? They'll delay and stall unless they have insurance. In their minds insurance is necessary even if you were to point out that by waiting the simple filling that would have cost them a couple hundred bucks a couple years ago will now cost them 3 times as much now even with their glorious insurance because a rct and crown is needed.

"Not to mince words, Mr. Epstein, but we don’t like your boys’ sound. Groups are out; four-piece groups with guitars particularly are finished…The Beatles have no future in show business.”

-- Decca Records Executive, 1962

Report AbuseRevisions: 1Posted: 10/5/2016 10:43:57 AMPost: 45 of 47

Misery of a PPO dentist

Timmy G

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Quote: (Richard1234)

Quote: (Timmy G)

Quote: (cwru87)

Really you need to look at collections. A PPO practice can easily write off 30 or 40 percent. Really it's not what you make, it's what you keep.

I noticed subbing that the overhead could be kept much lower with multiple dentists and a larger practice if it was carefully monitored.

It is what you keep, not what you "produce" but the inverse of that is that an empty chair is always zero. There's a balance, a line to walk, at least for me to stay away from stupid going in either direction.

I'll disagree...slightly..."An empty chair is always zero"...........true............unless...........it's a medicaid patient, then an empty chair is better than a chair costing me 30% with a medicaid patient in it.

That's what I mean by not going stupid in either direction. That's obviously not doable. And if that's truly the choice then better to just close shop.

Tim Goodheart DDS, MBA, FAGD

Raytown, MO

"Today, there are too many words, with too little meaning, coming at us too fast." Dan Roam

"Training employees is expensive; dumb, untrained employees are more expensive". Larry Winget

"Customers attach value to a product in proportion to its perceived ability to help solve their problems or meet their needs. All else is derivative." Theodore Levitt 1980

Report AbuseRevisions: 0Posted: 10/5/2016 11:14:53 AMPost: 46 of 47

Misery of a PPO dentist

USA Golfer

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Quote: (Timmy G)

That's what I mean by not going [full] stupid in either direction. That's obviously not doable. And if that's truly the choice then better to just close shop.

Robert Downey Jr. taught America that in Tropic Thunder

Owner/Operator of the Wurld Renouned T. Ricky's House of Schmaschmalgams

Everyone has a plan 'till they get punched in the mouth.

-Mike Tyson

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Report AbuseRevisions: 0Posted: 10/5/2016 11:59:33 AMPost: 47 of 47