DOES USING “PREFERRED PROVIDER” DENTISTS REALLY SAVE MONEY?
We have seen the same thing happen over and over again. A patient in our practice decides to change dentists because we are not on the insurance company list of “preferred providers.” In very convincing literature, the company promises savings of at least 20% off the copayment, and many times waive the yearly dental deductible. All this, if only the patient will switch to a dentist on the insurance plan’s list of “preferred providers.” Patients may have to drive farther to find one of these dentists, but they are convinced the savings are worth it.
We cheerfully duplicate their dental records for free, wish them well, and tell the family goodbye.
Most of the time, the family returns a year or two later, begging to be taken back as patients. (They actually don’t have to beg, we happily welcome them back! And we resist saying, “We told you so!”)
What went wrong, and why do such patients nearly always return to our practice?
Often it is hinted in insurance mailings that dentists on the “preferred” list are hand-selected and in some way superior, as well as being less expensive. In reality, all any dentist has to do to be a “preferred provider” is to have a valid dental license and malpractice insurance, sign a long one-sided contract favorable to the insurance company, and charge fees on average 20% less than usual.
You might think that dentists would be happy to make 20% less just to have many more patients, but it as not as simple as that. Many offices have overhead of 70%, so a 20% reduction in fees means giving up 2/3 of their profit. Such an office will have to see three times as many patients for the dentist to make the same profit. Not many dentists can suddenly start working three times as fast. More often, they have to spend less time with each patient, by taking shortcuts. And many times these shortcuts decrease the quality of care.
But most of the time, patients ended up paying much more out of pocket than they did at our office. I will explain why in a moment.
We believe the informed patient makes the best decision. Armed with the facts, you may indeed be the rare person able to obtain satisfaction in the care of a “preferred provider” dentist. In our experience, the only patients who usually save money this way are patients who almost never need any treatment except for routine cleanings. If you are not one of these patients, here are some of the ways patients are actually forced to spend MORE money in the offices of “preferred providers.” Let the buyer beware!
· The number one complaint we hear is that is often very difficult to get an appointment quickly, even when it is for an emergency.
· You will probably be charged many services like laughing gas and testing nerve vitality, which are free at our office. Often these are not covered by insurance.
· Your children may be unnecessarily referred to specialists, whose fee schedules are higher than ours.
· The “preferred” general dentists often refer most treatment like root canals, gum surgery, wisdom tooth extractions, and orthodontics to specialists instead of doing the procedures themselves. These specialists’ fees are much higher than mine. Often the patients return to me instead of a specialist to have the treatment done!
· More complicated and expensive treatment is planned for patients. Crowns are done where I would do fillings. More expensive all-porcelain crowns are done on molars, where I would do a more durable (and less expensive) metal crown.
· Fillings may be redone unnecessarily, for alleged esthetic reasons. Even if not redone for that reason, a study in 2002* found that patients have fillings replaced more often when they are treated during their lives by more dentists.
· Treatment is stretched into more visits, so there will be more billings. I might finish a deep root cleaning in two appointments and bill for only two, where a “preferred” dentist might take four appointments to do the same thing, and bill for four treatments.
· Preferred provider dentists often take shortcuts in the fabrication of prosthetics, and use less quality-oriented labs.
· They often “hard sell” non-covered esthetic treatments, whose prices are not limited by the insurance fee schedule. Often the same cosmetic result could be obtained at less cost by orthodontics and bleaching in our office.
· “Preferred” dentists often make compromises in doing fillings, such as hardly ever using rubber dams to control moisture contamination.
· Many patients of “preferred provider” offices have reported a difficult time getting credit balances refunded to them.
· Because of the need to see so many more patients, “preferred providers” are less likely to be on time for your appointment.
It is not our intention to discourage you from leaving our practice to try a “preferred provider.” But if you do, please be cautious about the above. Seek a second opinion if in doubt about the wisdom of any treatment recommended to you, especially if it is expensive and not covered by insurance.
Kim Henry, D.M.D., November 26, 2005
* Bogacki RE, Hunt RJ, del Aguila M & smith, WR (2002) Survival analysis of posterior restorations using an insurance claims database. Operative Dentistry 27(5) 488-492
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