Content Dam Diq Online Articles 2016 03 Take Action 1

Op/Ed: Dentists, we’ve done this to ourselves, and we can change things

March 7, 2016
This dentist shares his opinion regarding dental insurance. If his peers have checked the box that they've accepted certain insurance coverage, yet do not feel they're being reimbursed sufficiently, they've brought on the problem themselves. It's time to take action.

This article first appeared in DE's Expert Tips & Tricks. To receive enlightening and helpful practice management articles in this e-newsletter twice a month, visit

One of the great things about private practice dentistry is that dentists get to choose where we want to live. But why is it getting tougher to make it where we choose to practice? We constantly hear, “There are too many dentists in XYZville” or, “It’s too saturated with dentists to open a practice there.” Some are afraid that new dental schools will take good patients from our practices.

In my experience there’s one reason we feel the squeeze, and feel we’re continually paid less for our services because our insurance reimbursements are getting lower each year. This is especially true when we factor in cost of living increases, inflation, and increasing wages for our employees. Even if a plan pays the same amount on a treatment year after year, we are effectively making less from it.

As the saying goes, there are three types of people—those who make things happen, those who watch things happen, and those who wonder what happened. It’s easy to complain that insurance companies are ripping us off, or that patients don’t want to pay full price for a filling. It’s easy to blame the economy or the government. We can say, “Oh, that’s how it is,” and say people are cheap.

But why does this really happen? Because we allow it to.

When we accept a fee schedule and plan agreement from a dental insurance carrier, we’re in essence telling patients and the insurance company that we can offer a quality service, be profitable, and grow our practice at the given allowable rate. Further, we complain that we aren’t getting paid fairly, we can’t offer certain procedures properly, and that XYZ insurance company is making too much money.

We perpetuate the problem when we tell patients a certain dental procedure is way too expensive or that it costs a lot of money. Our friends in medicine recommend the best care because most of their patients see their extensive procedures and surgeries covered, something we rarely see with dental insurance. We need to offer the same high quality care, regardless of benefits, and then review alternative options when patients decline or don’t have the budget for treatment.

Dental practices continue to undercharge for services: What you can do to change that
Primary and secondary dental insurance woes

I’m not suggesting we abandon insurance. If you’re happy with what a plan pays and allows, then stick with it. But if you’re not, make a call or write a letter and demand to be paid what you’re worth, and renegotiate, because you go above and beyond in the materials, time, and quality of care you provide patients. If that doesn’t work, drop the plan and let your patients know why. Let’s face it, the public thinks we are all millionaires making too much money anyway, so why not collect what we’ve earned?

In 1994, the average fee for a PFM crown in the U.S. was under $500. I receive packets in the mail with offers from plans all the time asking me to charge the same fee for a crown today. What was the hard cost to produce a crown in 1994 compared to today? We need to send a message collectively that fees need to be fair to patients, insurance companies, and providers. Many fee schedules are very lopsided and we lose when we accept them as is.

New dental schools are a great community resource. They’re a place to refer patients who can’t afford much treatment or who don’t keep appointments, and they’re a source of new jobs. In order to succeed today, we have to focus on patient-centered services and creative thinking, not on only what insurance will allow. Thius is very limited and inside the box thinking that restricts practice growth and patient satisfaction.

I recently listened to a podcast by a successful marketing entrepreneur(1) who stated, “We don’t have a resource problem, we have a distribution problem.” We have plenty of patients (over 30% of our nation’s population hasn’t seen a dentist in 12 or more months since the recent economic downturn), but we need to improve the way we approach care.

As medical costs go up we can only expect to see dental insurance reimbursements go down. How low are you willing to go? As Julia Pimsleur(2) wrote it in a recent article, we all have to overcome obstacles in our business, or our “Panama Canal,” to break through to something better. It’s up to us to better reinforce value, negotiate fair terms with plans, and convey the importance of oral care to our patients.

Tyler Williams, DDS, is a general dentist practicing in Murray, Utah. He is an active member of the AGD with a strong interest in practice leadership and development, as well as general, implant, and sleep dentistry.