So I haven't been around much lately...

[PCIntern]

No it's not illness, it's not family issues, it's not exhaustion from politics.

As a healthcare practitioner I have been besieged by financial issues which have almost crushed me. It is the nature of private practice these days. I will give you a taste:

Forget I'm a dentist and have been practicing for 39 years in my own, progressive, yet highly undercapitalized office. Let's pretend that I'm a grocery store owner. Now my prices have been set, as t hey are in capitalism, by market forces and expenses and competition. So one day I'm stocking shelves and a couple well-dressed fellows come to my aisle and ask, "Are you the owner?" I reply "Yes I am..."

And they say, this is how it is going to be from now on: your prices will be determined by us and be roughly 60% at best of your prices now. You will not be paid when the customer leaves the store but perhaps three to six weeks later if we approve the sale. We reserve the right to review all sales and may, if we decide that you sold food inappropriately to someone, to demand our money back in full, although the customer will be entitled to the food he or she received. Such is the dental insurance industry - it is formidable and calling the shots for the most part

I am not asking for your sympathy: I only wish to tell you that I have been facing catastrophe which I looked right in the eyes and began doing battle in every way imaginable within the law.And I believe that I have turned the corner but am still a mite unsure. Time will tell. I should have been a high school teacher...I was very good at that and I would have a pension and summers off. What a schmuck I am. Oh well....

Oh and one more thing: keep your eyes on your practitioner that he or she is not trying to sell you some high end unnecessary items or services. It's getting more prevalent as people are getting more desperate. Good luck to us all...

Oh yes...and that creepy S.O.B is still the titular President. I am definitely gonna be sick...

[walkingman]

1. I've had a great dentist for the last 20 years but that was not always the case. I do feel

my dentist takes advantage of our relationship financially sometimes but I don't complain simply because I know that I can depend on him when I need him. All in all good trustworthy dentists, like physicians , are hard to find these days - maybe it's always been that way?

It seems that medicine has turned to a "corporate model" where you go to groups of doctors instead of individuals simply to spread the overhead and responsibilities. I was telling my Opthamologists the other day how much I appreciated her private practice and she commented "Well, it's not easy - especially for someone just getting out of school - like it was for me. She has been in practice for 37 years.

[nolabear]

2. I retired from my psychotherapy practice a couple of years ago. I feel ya.

The insurance challenges, the unbillable hours, the Continuing Ed costs, the self funded advertising, the volunteer hours...I loved it but I don’t know how I’d have made it alone.

Hang in.

[Vinca]

3. Sorry to hear it. We've never had dental insurance so I guess we've always been

dream patients. Cash on the barrelhead. It's never been a problem and a good dentist is worth every penny. Funny you should mention cross selling though. My husband changed dentists a couple of years back and every time he goes to the new practice they try to sell him something. The last pitch was for $23,000 worth of cosmetic dentistry. I'm not sure whether my husband laughed out loud while he was in the chair, but at 72 years of age it wasn't anything he was interested in. He has perfectly fine teeth and all that cosmetic dentistry does is make them look like dentures. LOL. Chin up. If you were a high school teacher you'd be subjected to rap music.

[PCIntern]

4. I'm in Center City Philly

We have a little rap going on here

[erronis]

5. Many practitioners throughout the healtcare industry are looking for ways to stop paying insurance

markups and extortion.

It doesn't matter if it is internists, cardio, gastro-enterologists, FP, DDS, DOs. They all hate the controls that the insurance companies levy on top of the normal professional standards.

Just like going to the pharmacy and asking "How much would this prescription cost me if I weren't going through insurance?" (and the answer can be 20-80% lower) - every practitioner I've know would rather I pay directly rather than subject themselves to the haggling and delayed payments.

Medicare is not as big a deal as having to work with 10-30 separate insurers with their own paperwork variations.

Sorry to hear about your frustrations! I'm just a partially-educated Joe but I think I understand your pain.

[PCIntern]

6. Thanks

Unfortunately ultimately the patients suffer from this.

[dixiegrrrrl]

23. You are correct about the pharmacy bit

Our local pharmacy charges about 1/3 less cash price for basic meds than Wal/Mart-Wal-greens here in town.Don't know about the insurance prices.
And we have only those 3 to choose from, Wal-greens bought out our Rite-aid and 2 other local pharmacies.
and has the highest prices for prescriptions.
wal-Mart is slightly lower but it is a nightmare to shop there for anything.

[csziggy]

7. Stuff like this is why I hate insurance as a business

I have dental insurance but it doesn't cover much above our regular cleanings. Just those alone are all that are keeping me from canceling it. Fillings, crowns, dental implants, extractions, or anything more complicated are pretty much not covered by the insurance.

My dentist office loves me because I pay whatever they tell me as I am leaving the office after a procedure. But I love them because they give me excellent dental care and help me keep my crappy teeth as long as possible. In the last year I have had an extraction, two dental implants, sectioned a bridge, two crowns, a root canal, and I am currently waiting on the second implant to heal so I can get a crown on it and a crown on a front tooth that keeps falling apart.

Every step of the way my dentist discusses with me the options and is willing to work with me to reduce costs if I need to. Since I can pay now, he sends me to the best local practioners and they are the same - discuss the procedure and alternatives, go over the costs, and make sure I understand everything.

With all that education - plus the research I do on my own online - I feel comfortable with what work has been done and the costs associated with it.

Good luck with your fight - the business does not need to lose a dedicated professional!

[BadgerKid]

19. Insurance is quite the racket

Insurance companies don't announce it when they have better paying fee schedules. I guess it's no wonder that more expensive services are offered by more clinics these days. Patients need to figure out if they're being pressured or not. Some offices/doctors just won't pressure their patients.

[csziggy]

20. Yeah, you're betting the insurance company that bad things will happen

If the do, you could come out ahead. If bad things don't happen, the insurance company wins by taking your money and giving you nothing back.

Most of the work my dentist has done is because I brought problems to his attention. I have lousy teeth so I am used to dental problems - but he is by far the best dentist I have had in my lifetime.

[enough]

8. What a completely fucked up medical/dental system we have.

First, dentistry should be seen as an integral branch of medicine, which it is.

Second, the system almost forces dentists to try to convince customers to buy into very expensive procedures, while the patient has no idea whether it’s necessary or not.

We have had a very good dentist for 25 years, out here in suburban Chester County. He’s a always been into current technology,etc., and three generations of our family have had good, longlasting, and expensive treatments and repairs to our teeth. We’ve always been happy with the work. But lately I feel as if he’s not looking me in the eye, he and his office are trying to make it hard to remember what has already been paid and what the future payments will be. The costs are becoming astronomical, to the point where I seriously consider not doing it. I am not talking about cosmetic dentistry. We’ve never had dental insurance (self employed) and always self pay immediately.

Your post is making me think that our dentist may also be going through the same kind of situation that you are describing in your practice. It’s hard to see how dentists are going to survive in context of our current system.

I wish you well, PCIntern.

[hunter]

42. "First, dentistry should be seen as an integral branch of medicine, which it is."

This is so true.

Chronic inflammation and pain are a bad thing wherever they occur.

Quality of life issues are the same in dentistry as many other medical issues.

[leftieNanner]

9. We dropped our dental insurance

because it just doesn't pencil out any more. They no longer cover cleanings fully and only a small portion of other procedures. So I write a check to my dentist whenever we have any treatment, and get a 10% discount.

I'm so sorry that you are having to deal with this. For-profit health insurance companies are vultures.

[csziggy]

10. Oh - forgot to mention an alternative to outside insurance

Our dentists' office offers sort of a self insurance plan for many of their patients. The patients still make monthly payments, get free cleanings, and significant (20-50%) discounts on other procedures. I've discussed it with my dentist but since so much of what I need is done by outside experts we pretty much decided it was not worth it to me. I go to an oral surgeon for extractions and the dental implants and an endodontist for root canals - neither of which would be covered by my dentist's in-house dental care program.

[Blue_true]

11. My dental office sells things like professional teeth whitening and

something that fights disease formation nay the base of teeth. The treatment is done automatically for people that have deep pockets. The whitening is offered, but not pushed. Overall I like their service.

Many people think that anyone that owns a business has it made, they don't realize how difficult it is for small and medium sized businesses. While you are a highly trained professional, you are also a business person who has to meet payroll, pay several types of insurance if you rent your office, pay utilities and keep track of things required by regulations. If you are like me, you are the first to arrive and the last to leave of the people that worked most of the day with you.

Because you are a very highly trained professional, your options are somewhat limited at this point. You can maybe still go into teaching by working with a college to teach dentistry, I don't know what that involves, you may only be able to train certain students given your level of certification. Or, because you understand the knocks and bruises of running a business, maybe you can teach a business course at the nearest university or Junior College. Just some ideas.

There have been times when I regretted going into engineering instead of a quantitative business field like Finance. I regretted owning my first business that failed after a struggle to keep it afloat. But I set my sights on another horizon and moved toward it, I don't know whether that will work for you, but from my experience, I only found out once I took the chance.

I wish you the best of luck. I know what owning a business that is in a rough patch is like, it is emotionally and physically draining, and it seems that everyone is waiting to pick your bones after the business fails. Keep fighting and keep thinking of innovative ways to get your business where you want it.

One last idea, have you talked to newly minted dentists about practicing in your office? It seems that would help them in that they can avoid renting or buying expensive equipment and it helps you if they share your office expenses.

[Pepsidog]

12. Getting ready to sue my dentist. Went to get a tooth pulled now looking at $52,000 in implants.

I had to go to another dentist to get my tooth pulled. 3 years later I am interviewing new dentists who want over $52k for implants. It’s immoral and they are no better than car salesman. Hard sales tactics. I’m looking at overseas dentists.

[csziggy]

22. $52K for implants? How many?

My total cost for my tooth for an extraction, implant, and the crown was just under $5000. The only complication was that the bridge on the other side cracked - after 25 years the bridge that was put in when I was in my mid-40s when the baby pre-molar with no adult tooth finally gave up the ghost.

Once I got the crown on the implant, my dentist sectioned the old bridge, replaced the cracked part with an in-office made crown, and sent me back to the oral surgeon for another implant where the baby pre-molar was (my idea since I do NOT want another bridge there). This implant will cost less since there was no extraction involved.

[Pepsidog]

25. $52k for complete upper and lower. $28k for just upper set. Never had a cavity until 45 yo. Cracked

a front tooth when I was 7 years old and finally had to have it removed at 50 years old. I don’t know how to explain what happened other than to say that the dentist saw that I was a trial attorney and assumed I would be willing to pay. After spending 4 hours in the chair, I came out with a mouthful of provisional teeth on top and bottom. There was no discussion of this and I think he did it for cosmetic reasons. After spending $12K and got 3 just implants, no crowns, just the implants he said We should just pull all the top and put 5 more implants in at a cost of another $35k. At that point I said give me my file and I am seeking other opinions. One said that he would have to remove the 3 implants as they are of no use. I don’t know if he is correct or not. I’m going to Univ. of Penn Dental School to get another opinion and possible treatment where my friend paid $2k for a compltete impant. It’s a total scam taking advantage of people. I’m in NJ so it’s an expensive area but that’s a little crazy. I have received prices of $14,000 for same procedure in Cista Rica.

[csziggy]

26. Yeah if they did not discuss it with you ahead of time, that's a scam

Any of my work has been thoroughly discussed with me well before the procedures - costs, alternatives, and what is involved.

I've had lousy teeth since I was a kid - lots of cavities and three baby pre-molars with no adult teeth to take their place. My childhood dentist was a nightmare - didn't believe in using pain killer even when he pulled my wisdom teeth. But the dentists I have picked as an adult have been great.

I kept those baby teeth until I was in my 40s. The bridge that cracked is the first I've had to do anything about. I hate those bridges so as they fail I will replace them with implants. One down, two to go!

[Pepsidog]

29. Good luck.

[Ms. Toad]

35. Change dentists.

There's no way you need a mouthful of implants for cosmetic reasons, nor should your own teeth have been removed and replaced without a full discussion in advance, including the price. I have one implant, and a variety of options were discussed with me about how to fill the gap from the resorbed tooth.

[Hermit-The-Prog]

13. all forms of 'health' insurance are rackets

The health insurance industry does nothing to improve health care. It simply stands between patient and provider and demands a cut from both.

[BlancheSplanchnik]

21. Yep. I hate them.

I remember long ago, the HMO business began here in Rochester. It was hailed as such new step that will benefit patients.... blah blah dee dah.

[PCIntern]

31. I'm a U of R grad...

Or as the residents say: Youuu Uv Arrrrre

[BlancheSplanchnik]

40. Hi! I'm at RIT. And an RIT alumna 😊

Both great schools!

[PCIntern]

47. Yes they are!!

I hear they closed the Inner Loop!

[jmbar2]

14. May I ask your professional opinion...

I recently hit medicare age and have no dental insurance.

Is it worth it to have dental insurance? Seems like with all the waiting times, deductibles and copays that it really doesn't make sense. I am fortunate to have pretty low maintenance teeth at this point.

[PCIntern]

15. Depends:

Having insurance like Delta not only helps pay, but the allowable fees are much lower than list price so it’s not just the reimbursement. If you have dental issues it may well pay to have it.

[jmbar2]

18. Thanks for the input

I enjoyed reading your perspective on things. Good luck to you in your practice.

[SidDithers]

16. Sending good vibes your way...

Hope it works out for you.



Sid

[grantcart]

17. I feel you. Similar challenges in a different service area.

[Generic Brad]

24. We encountered something related within the past week

My wife went in for a routine teeth cleaning and the dentist was pressuring her into replacing her perfectly fine dentures, get a root canal, and cap two teeth that are not having any issues. My wife is incensed with her dentist over this and is refusing to be coerced into what she feels is unnecessary work.

[Hoyt]

27. On the other hand, go to a doctor without insurance and see what they charge you unless you

plead poverty, and they care.

I don’t know your situation, so not aimed at you, but I can read what the average dentist, physician, pharmacist, etc., makes, even when employed by some big corporation. There’s not a lot of room for complaining unless one has devoted their practice to the underserved.

[PCIntern]

28. I expected a post like yours...

I understand your sentiment. Try to do this job is all I can say....there ain’t a high suicide and failure rate for nothing.

[JI7]

33. i have read there is a lot of competition when it comes to dentists because there are so many

i don't think it's as you think it is for all.

it's similar to lawyers . there are certain highly paid ones but that's not the case for most.

[Hoyt]

36. Average pay for dentists is $174K, Median is $151K. Admittedly, it's tough as a solo dentist, but

that's true of most professions nowadays. Again, I don't know the OP's situation and hopefully it's a temporary situation.

But I do know that a lot -- probably substantially more than half -- of dentists and physicians do not take Medicaid patients. That tells me something.

Dentistry rates in the top 2 or 3 jobs in studies like those published in Forbes.


https://money.usnews.com/careers/best-jobs/dentist/salary

[JI7]

38. they probably make people get high cost procedures they don't need

the op doesn't want to do that.

the op has also offered help when people on du have complained about problems and lack of money.

[Hoyt]

39. As I read it, the OP doesn't want insurance companies telling him he charges too much, or that

a crown or something is not needed.

Like I said, go to a physician or dentist without insurance -- but willing to pay out-of-pocket with no utilization or necessity oversight -- and you are headed for a big bill.

While doctors and dentists gripe about insurance, they'd be providing services for chickens, sides of beef, and produce were it not for insurance. Insurance, Medicare, Medicaid have helped most of us -- except those excluded -- and it darn sure has helped medical professionals do well. The golden age of health care for providers like physicians were the early years of Medicare where the government paid about what providers charged and allowed any procedure, even a total hip replacement for patients about to go in a hospice.

As to the OP, I know he's a good DUer, and being a solo dentist or physician is really tough nowadays.

But, I'm not sure insurers are the problem. Of course, dental insurance is a different animal. Coverage is usually limited and the insurance companies know most people are going to max out the coverage. The only value I've ever found from dental insurance is that I don't have to ask the dentist for a discount over what they'd charge me otherwise. The insurance company has already gotten the discount for me and dentists know they are going to look a xrays to make sure that tooth needed to have a crown.

[orleans]

30. what you said about upselling shit

was what i encountered w/my dentist of 25 or so years

i hadn't gone to see him for several years and when i went back there he had dumped his entire staff and replaced it with a bunch of mostly younger women whose job it is to upsell you on tons of crap. and they do it after you've been there for a couple hours, are exhausted & just want to get the fuck out. i was even told i couldn't have the work done unless i did this and this and this and fucking this first!

and if i pay for half upfront i get a big discount.

so i did. and the next day i thought WTF???

i ended up on the phone for one hour with these bitches who were worse than the aluminum siding salesmen i worked around years ago. (and i can be a major bitch on wheels but apparently they had taken classes for that in order to work at a dentist office! true--a friend of mine worked on the computers for this guy and that was what he was told--classes that included upselling)

it was unbelievable. i got my deposit back and haven't returned.

i also had a doctor who gave up his private practice, he told me b/c he couldn't afford the insurance anymore. he ended up in one of those large corporate medical groups and then finally quit to go work at blue cross. (asshole)

i didn't have insurance for either. the dr. office always seemed to give me a break on that b/c i was uninsured but that dentist? ha!

good luck. i know things are hard for private practice folks.

[JI7]

32. sorry to hear this. i hope things improve. I felt like my dentist was trying to get me to get

expensive work done i didn't need for some time. and i cancelled the appointment i had a little over a year ago. i was going to go back but haven't yet.

[PCIntern]

34. You need to tell him or her

Why you took a hiatus

[Ms. Toad]

37. Charge up front,

Process the insurance as a courtesy to your clients. That's what my dentist does.

Too many teeth destroyed by dentists in a box - so I found one I knew was good - and the price I pay is that they don't accept insurance as direct payment.

(Dentists in a box touched two teeth and destroyed 3. Every bit of work they did had to be replaced within 3 years - one requiring a root canal, a second saved from that fate by my then new dentist.)

[CTyankee]

41. Are old enugh and well off enough to retire?

My PCP did that when he turned 78 and sold his practice to another group (which turned out to be disastrous in terms of the way they treated patients). My PCP wrote his patients a letter, citing his dissatisfaction with the way health care is handled in this country and also the desire to spend more time with his young grandkids. I was distrought. He had been my wonderful PCP and listened to my many complaints with real caring.

so I guess is you are not alone in your disgust and frustration with the way you have been treated. I wish it were better for you but I understand your position.

Take care and good luck.

[bluescribbler]

43. Years ago I had a neighbor who was a psychiatrist.

He refused to take insurance. He insisted on cash or a check at the end of each session. He found that by not having to deal with billing and insurance companies, etc., he could charge a lower rate and still run a profitable practice. In fact, he made more money and his patients spent less out of pocket this way. It was a win for all concerned, (except for the insurance companies, of course).

[Hortensis]

44. Health and dental insurance itself is OBSOLETE,

at least for almost all people. I'm so sorry that that industry hasn't gone the way of horseshoers before this, PCIntern, and no insult by association warranted or intended to farriers.

[saidsimplesimon]

45. Insurance companies spend

a lot of money on lobbyists who paint medical professionals as the "greedy" ones when in fact it is their desire to grab the biggest share of health care dollars.

[LittleGirl]

46. I'm so sorry

I hope everything comes to your favor and you can get past this awfulness.

Hugs.