Not "On the List"



Patients sometimes wonder if our office is "on the list" for their insurance company. They are usually referring to a PPO (Preferred Provider Organization) dental insurance plan which encourages them to choose a dentist within the company's "network". In such an arrangement, a participating dentist agrees to an insurance company's reduced fee schedule, presumably in exchange for the referral of new patients to his or her office. In theory, this sounds like a good idea, but it does have its potential problems.

My decision not to be a "participating provider" with most insurance carriers is driven by a number of factors, chief among them that such programs can have the effect of undermining the patient-doctor relationship. Accepting a reduced fee schedule necessitates that the dentist sees an increased number of patients to maintain the financial health of the practice. A necessary consequence is that the dentist must spend less time with each patient. This scenario is not fair to anyone, least of all the patients who are rushed in and out of the office. The fees in my office are a result of a great deal of analysis and foresight, with a cornerstone of fairness to all parties involved. I begin with the premise of caring for each of my patients as I would care for my own family and work forward from there. To this end, I choose only the highest quality materials available. Additionally, I choose a dental lab with the most experience and attention to detail. Most importantly, I allow enough of my time to achieve the level of care I strive to provide.

In my opinion, another ill-effect of PPO dentistry is the manner in which some offices bill the insurance company for procedures. Some (but certainly not all) PPO dentists become "creative" in billing insurance for small adjunctive procedures as a means of increasing revenue to compensate for the reduced fee schedule. In the end, this ultimately costs the patient, whether in fees from the office or an increase in their insurance premiums. Over time, such practices cancel any cost benefit to the patient, which was the rationale for the PPO in the first place!

Truth be told, my patients and I care much more about their total oral health than any insurance company, which is why I am opposed to the dictation of fees and reimbursement. I am concerned that with an omnipresent atmosphere of cost-saving in the insurance industry, service to the policyholders has suffered. If I elected to become a "participating provider", I would be agreeing to a fee schedule that encourages compromises in the quality of treatment I provide or the manner in which I provide it. The pressure to "cut corners" as a cost-saving measure or "adjust" billing practices to facilitate higher insurance payments encourages dentists to lower their standards, and these are compromises I am not willing to make - not for my family and not for anyone else.

Incidentally, most patients with PPO insurance can still choose to see the dentist they prefer, whether the dentist is "in-network" or not. Most find the out-of-pocket cost difference to be a non-issue relative to the value of seeing a dentist they know and trust. Please do not hesitate to contact the office with any further questions.