Last April I ranted… I mean blogged… about the 15% cut in fees by the state of Washington’s Delta Dental plan. In it I said Washington was the beach head of this war. I predicted that other states would follow suit. And, I was right. It was just announced that Idaho’s Delta is doing the same thing… cutting fees by 4 – 13%. Perhaps it’s coincidence that it was a state bordering Washington.
Dentists DO have a choice. But, they have largely been brainwashed just like patients to think that without so-called “dental insurance” that they wouldn’t or couldn’t get dental care. Of course, reality and simple mathematics prove otherwise. But, emotion is a fearsome opponent of logic (math).
The Elephant in the Room
“So often times it happens that we live our lives in chains And we never even know we have the key” – Already Gone by the Eagles
I see dentists to be like the circus elephant. When the elephant is new, they use a giant chain to confine him. There’s no way he can get away. Eventually he stops trying. At that point, the circus can use a small, lightweight chain (much more convenient) to restrict the elephant’s movements. The elephant could EASILY break the chain, but he gave up trying a long time ago. Emotionally, the elephant is convinced he cannot escape. Emotionally, the elephant is defeated. Logic (physics) would prove otherwise. But, emotion is a very powerful force… even more powerful than science. The elephant would be very surprised to find he could PHYSICALLY escape, if only he would MENTALLY clear that hurdle.
Yes… it’s against the law (anti-trust) for dentists to COLLUDE in setting fees or bargaining with insurance companies. But, there’s no law against all the dentists acting INDIVIDUALLY. And, until all the dentists develop a trace of testicular fortitude, this will continue to happen. And, the quality of our care, along with the quality of our professional experience, will continue the downward spiral. Until dentists decide to stand up and tell the inscos to go screw themselves, this will only get worse… and worse.
“If you choose not to decide, you still have made a choice. ” – Freewill by Rush
A long time ago, I decided I would not participate with “insurance” by way of contractual agreements. And, before anyone argues that my geographic area or demographics are different or magically immune… I’ll just say it’s not true. I live and practice in HMO-land down here. Some will justify their position saying, “I have no choice.” Wrong. You do have a choice. I made my choice, and I will gladly tell you it was NOT easy. It still isn’t easy. It’s HARD. I have to get patients that WANT to come to my office, rather than have them funneled to me via a booklet of “participating providers.” First, I’m not a “provider.” I am a dentist… a DOCTOR of Dental Surgery (DDS). It’s no accident the inscos have demeaned our status down to “providers.” It is intentional, no doubt.
But, I do enjoy being the captain of my ship. My autonomy and liberty have no price. And, I certainly won’t give them up for a discount. Yes… I would rather have an empty chair than a deeply discounted patient in the chair. Some see that as “down time” or unprofitable. I see it as opportunity to seek patients who DO care about quality. It’s an opportunity to market myself to those who prefer to choose their dentist on merit rather than a list of “providers” willing to sign a contract with the devil.
They’ll leave you for the same reason they came.
I’ve always felt that patient who would come to me because I’m on a list… would LEAVE me for the same reason (if I leave the list). And, that is the tenuous thread that holds insurance-based dentists hostage, just like the elephant.
It won’t be easy for dentists who have long practiced within the confines of insurance-oriented patients. But, staying on isn’t working, either. And, it will get worse. Will you go down with the ship? It IS sinking.
It started in Washington. Next was Idaho. Do you really think it will stop at the border of your state? You can see the train coming. Will you get out of the way? Will you continue to lick the hands that feed you? Or will you stand up and live on your own terms? What do you stand for? I can’t resist posting a quote I just love:
“I come in peace. I didn’t bring artillery. But I’m pleading with you, with tears in my eyes: If you fuck with me, I’ll kill you all.” – Marine General James Mattis speaking with Iraqi tribal leaders.
Maybe we should each (no collusion) have a “talk” with the Delta “tribal leaders.” 😀 Ooh-RAH!
UPDATE (5/22/12) CEO of WDS says “Dentists just need to work harder… five days a week.”
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Damnit! Right again! Keep up the great work.
You rock. I’d love to see this printed in our state AGD magazine.
Haha… thanks for the compliment. But, I’m pretty sure I’m a bit too “out there” for mainstream dental magazines. That’s why I had to start my own blog! 🙂
Amen!!!! I’ve long gotten out of the insurance “game”. You are right — it isn’t easy and there are times where there is no one in your chair. BUT seeing patients that WANT to be in your chair vs those that are only there because you are on a list is invigorating to say the least. It is so worth it to treatment plan according to patient needs and your practice philosophy rather than doing only what insurance will cover. I salute you with gratitude for speaking on behalf of all dentists who don’t want to be under the thumb of profit oriented insurance companies! Thanks so much for what you are saying
Thanks for your comments, Harry. I agree with you that it’s far more satisfying to have patients who have intentionally chosen me rather than by contractual happenstance.
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PA had just fallen! Delta rep came to my office last week. We are a Premier provider and are not part of their PPO product (Premier is a PPO – I’m just using their terms). Effective immediately – PA Delta Dental will not be renewing any Premier contracts with employers. The product will be phased out over the next year. All employers will be offered a PPO alternative (which has been around a few years. Allowed patients to use Premier providers). The rep gave us the fee schedules for both. The PPO is at least 15% less than the Premier. The PPO has huge incentives for patients to go in-network: Smaller deductibles and none on preventative, Smaller co-pay percentages, etc. This is worse than what happened in WA. 15% cut sucks but the other parts of the puzzle make it a nightmare!
Hi Bob,
Thanks for the update. I expect that as Delta goes across the country, the other inscos will also follow. Once they see Delta “getting away with it,” they’ll jump on it, too.
Nice work, Bob.
I just have to say that in my neck of the woods, the “cut” was 23% because apparently in SE Idaho where I practice, there is an “overutilization” of the insurance so the cut was bigger.
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Delta Dental benefits from nonprofit status yet the CEO’s make tens of millions. It’s allowed Delta to dominate the dental insurance market. They use this dominance to further undermine the dental profession. Delta’s obvious goal is to lower dental fees. How better to do that than flood the market with dentists. To achieve this goal they propagate the myth that there is a shortage of dentists. They also fund the formation of dental schools. Justice has ceased to exist in the realm of the dental profession. The golden rule now applies: He has has the gold makes the rules.