Vetting a Practice Through Dental Insurance

What’s the deal with dental insurance?

Once a practice establishes interest in you, the next step is for you to vet the practice. How do you do that? You can start by finding out the dental insurance accepted by the practice. This can give a glimpse into the office fee schedule. In a where you are paid a percentage for your work, a fee-for-service practice is going to be optimal.

The fee schedules of fee-for-service practices are generally much higher and set by what the competition charges in the area. These offices are also more likely to be higher-end and equipped with digital technology. Though this may be ideal from a monetary standpoint, it is probably not ideal as a first job. In other words, when patients are paying thousands of dollars out of pocket, mistakes come at a higher cost.

When an office chooses to accept insurance, and the provider agrees to be “in-network” for the insurance, this means they accept the fees that the insurance pays for the procedures. These fees vary; one insurance can reimburse $800 for a #30 crown, another insurance can reimburse $1200. The more “premium” insurances that the office accepts, the better off you’re going to be throughout your associateship if your compensation structure is based on collection.

Preferred Provider Organization (PPO)

Preferred Provider Organization (PPO) is the more “expensive” dental insurance. Many individuals who receive dental insurance through their jobs will have PPO insurance. The fee schedule for PPOs varies by the plan itself and the location. These insurances set their fee schedules based on the average fee schedule of the area.

Dental Health Maintenance Organization (DHMO)

You may want to avoid DHMO offices entirely. DHMO stands for Dental Health Maintenance Organization. Under this model, a dental insurance company pays the office for a set number of patients per month. This is regardless of whether those patients ever show up for treatment. The cost is usually between $3 and $10 per patient.

These are colloquially known as “sit and pray” offices because the owners sit and pray that patients don’t come. When patients do come, the office either gets compensated nothing or low rates. The rates can be $5 for adult prophylaxis or $4 for a two surface anterior composite restoration. The cost of materials is almost always higher than the reimbursement for procedures. Usually if an office is new it might accept this insurance to fill up missing schedule spots.

DHMO plans are widely looked down upon in the industry. When an office takes this type of insurance, it is usually losing money because a dentist has to cut corners to make the model work long-term. This usually means using cheap materials, treatment planning unethically (e.g., crowns where fillings are needed), or doing a rushed, poor job on procedures. This type of office may have to fit 5 procedures into 15 minutes to break even at the end of the day. It is not an ideal scenario for an associate looking to do quality dentistry and learn.

The dental insurance structure of an office can give insight on the operations of that practice. If the most ethical treatment plan per patient costs the office money, the office is not operating without cutting corners.

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