Although we accept most PPO Dental Insurance and help you get most out of your benefits, we are not on any PPO/HMO/DMO list. We’ve been asked “Why Aren’t You on The List My Company Says Are Preferred Providers?” occasionally when a patient’s company switches to an HMO/PPO plan. I could give you a wishy-washy, sugar coated answer like some dentist do. But I think my patients deserve the real answer.
Three or four insurance companies solicit every dentist each month to join their plan. Contrary to popular belief there is no quality control or screening process even though it sounds like you will be joining an elite family of dentists. The “elite” are simply whoever signs up. “Preferred Provider” is an insurance industry term, it has nothing to do with a dentists skills, knowledge or experience.
THE FREE LUNCH
The promotional material we get from these multi billion dollar insurance companies is very appealing. It appears everyone wins in this deal: the patients now get FREE or greatly reduced) cleanings, x-rays, exams and perhaps even fillings. Even the major treatment is much cheaper. They’re ecstatic! Your employer has much cheaper dental insurance premiums to pay each month they’re ecstatic! If you have been following the profits of the HMO/PPO industry, you know they are making money hand over fist. The insurance executives are the most highly paid in the business world. So we know they are ecstatic too.
This must be the mystical free lunch at last. Who could lose? Unfortunately someone has to absorb the cost of all this free or cheap treatment. You guessed it, it’s the HMO/PPO dentist.
Now, You ask, “Why would anyone work harder for less money?”
Well my friends, that’s the $64 question. Let’s look at why anyone would do this. The insurance industry dazzles dentists with promises of wealth, endless patients and busy practices. Then they add, “Oh did we forgot to mention that you have to give away many services for free and cut the rest of your fees 30-40%? But don’t worry about that,” they point out, “because you will have two to four times as many patients to try and see in order to make up for the lost revenue. You’ll just have to work faster.”
Ok, so that’s the dentist complaint. What about you, the patient. How does all this affect you? Here’s how; Understand that an HMO/PPO dentist is paid 6-10 dollars per month per family or patient whether or not that patient ever shows up in your office. Now if that patient does want to come in and get there teeth cleaned or a filling done (which the dentist is by contract required to do for FREE) do you think that dentist (or anyone else in the practice) actually wants that patient to come in? Of course not. He doesn’t make any money when the patient comes in. Does it make any sense to pay someone not to perform their craft or practice to their profession?
Now do you see why it might be difficult for you to be seen for a routine visit or in an emergency in one of these practices? The biggest complaints from patients about HMO/PPO practices are they can’t get an appointment and they never see the same dentist twice. Is there any mystery now as to why?
TOO MANY CUT CORNERS
In my opinion, to be an HMO/PPO dentist I would have to sacrifice quality, service and the personal attention we give to our patients. In short we would have to give up our ethical and clinical standards. I won’t do that and it’s an easy choice to make. I won’t practice on roller skates, sacrificing quality for the sake of quantity. As an HMO practice we would have to use cheap labs, cheap materials, work faster and cut corners. Some of the corner cutting would come in the area of sterilization, by not providing as many disposables as we now do. My patients are too important for us to do that to them. The medical profession has all but lost the war to the insurance industry. The story has been well documented in a recent TIME magazine cover story. The dental profession still offers you the freedom to choose your own dentist and level of care. And as long as that continues, I will endeavor to provide you with the best dentistry has to offer. You deserve nothing less.
Dr. Ushma Patel, D.M.D.
Center for Advanced Dentistry