Roll the Bones – Tell Insurance Companies to FOAD

claim denied

The following is from a thread on Dentaltown.  It has been suggested that dentists should file a class action lawsuit against dental insurance companies for “coercing them into accepting low fees or reimbursement.”  In the thread, several dentists share their stories about feeling they have no choice but to go along with the insurance companies ever-changing rules and ever-decreasing fee schedules.

Here is one post.  It is followed by my response.

Quote: (A Dentaltown writer)

I would like to go OON with Delta eventually.  But they’re huge here as the Univ of MO is almost all Delta.  Delta will not assign benefits to providers… forcing OON providers to adopt financial measures that would be disastrous to a typical insurance driven practice.  Thus… I feel coerced to stay in network and accept their rates.

Many of you know that I’m not a “participating provider.”  But, I hope you’ll indulge my comments nonetheless…

I’m reading these stories aloud to my wife (who has ZERO knowledge of dental practice other than just osmosis through me… she doesn’t work in my practice in any capacity).

My wife’s comment sums it up well… “These dentists are like a woman who is being physically beaten at home.  The only way to stop the beating is for her to LEAVE.  If she stays, she will continue to get beaten.  Leaving may be difficult.  But, it is the ONLY way to stop the beating.”

Even though I have never participated in any insurance plan by contract, I check into these threads to see what’s going on in my profession.  And, while I have STRUGGLED MIGHTILY to build my truly FFS private care practice, I have often pondered whether I’ve been an idiot.  I see many insurance-based practices making money hand-over-fist.  I sometimes think, “I’m an idiot.”

Elder Couple with Bills

“What do you mean we have to pay???  We have dental insurance!”

But, then I read and hear about what insurance-based practices have to deal with.  They tell me, “You have to PLAY THE GAME.”  OK… but, the INSCO makes the RULES.  And, I dare say they are smarter business-people than dentists.  Once the inscos figure out the GAMES the DENTISTS are playing to “work the system,” the inscos CHANGE THE RULES.  And, in some cases… pull the rug out from under the dentist.

The inscos know that many of these dentists’ practices have become DEPENDENT on the plans, as a majority of their patients are on the plans.  On Dentaltown, I’m seeing guys report 60 – 80% of their practices based on contractual participation in plans.  So, they feel they are STUCK.  And, the inscos KNOW IT.


I personally believe pursuit of a class action suit is pissing up a rope.  Shit… you don’t even have the support of your own ADA!  Rather, I believe that you should be moving to “PLAN B.”  That is to transition or even revolutionize your practices…. to private care.  It’s NOT easy!  For a woman to leave an abusive spouse isn’t easy.  But, it must be done.

Attracting patients to your practice JUST TO SEE YOU can be a tall order.  But, I’ve long contended that patients who come to a practice because it’s “on the plan,” will leave the practice for the very same reason (you’re not on the plan anymore).  So, to be a private care dentist, it means you have to get folks in the door ENTIRELY on your own merit.  Scary stuff for some guys.  So, how do you do that?  Hell… I wish I knew the entire magic formula.  But, I know SOME of it.

Getting patients to CHOOSE you over all the other dentists based ENTIRELY on MERIT means you have to have something… many things, actually… that the other dentists don’t have (at least in the perception of the patient).  Those things may include (but not limited to):

  • Spending TIME with patients.  REAL time… talking… answering questions…. LISTENING.
  • Learning new skills and providing elective or enhanced treatments at a very high level (perception counts here, too).  Think “niche.”  What niche services can you offer?  Six Month Smiles?  Implants?  Sleep apnea?  Sedation?  Cosmetic smile makeovers?  Full mouth rehabs?  Do all your own endo?  And so on and so forth.
  • Red carpet service.
  • Attentive staff.  And, a STABLE staff presence… staff turnover is a turn-off.
  • Follow-up.

None of this is easy.  None of it is cheap.  And, it will take TIME to implement.  While I have taken the tougher road, I will say that I am thankful to not deal with the insco bullshit described here and on so many other Dentaltown threads.  I am the captain of my ship.  My success or failure rests entirely upon MY shoulders.  If my ship is on the wrong course, I have the power to correct it… without having to consider third party interferences or contracts.  It’s all me.

I understand that for some, this is a very frightening proposition.  But, then again… you complain about your “masters” (the inscos).  It is up to you to decide FOR YOURSELF.  What is your destiny?  Who do you WANT to be in charge of your destiny? 

Or are you going to hope that a lawyer is going to soften the blows of your daily beatings?

Also consider the TIME FRAME of most class action lawsuits.  How much time do you have?  What will you do in the meantime?  Plan B… that’s what.

I’ll wrap this up with some lyrics by the best band ever (Rush):

We go out in the world and take our chances
Fate is just the weight of circumstances
That’s the way that lady luck dances
Roll the bones

Why are we here?
Because we’re here
Roll the bones
Why does it happen?
Because it happens
Roll the bones

So get out there and rock,
And roll the bones.
Get busy!

So, is it time to turn the tables and tell the insurance companies to “FOAD?”  Comment below!

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7 Responses to Roll the Bones – Tell Insurance Companies to FOAD

  1. I am presenting today with a similar thought Mike! Understanding your costs and running your clinic like a business. If someone else is telling you what you need to ‘retail’ your service for, then you need to make adjustments to the services you provide. In order to maintain profitability you either cut your time or material costs….or both.

    None of these options are good to patients.

    Insurance and fee guides make all dentists look equal. We all know that skills of any trade can vary, but more importantly in dentistry and health care! What a lot of people don’t think of is that material and technique DO MATTER in providing a higher level of care, especially in dentistry. Patient education and treatment options should matter, and I believe that insurance driven practices are only ever looking at ways to remaining profitable….which would mean – less expensive materials, less expensive techniques, less treatment options and less time with patient care.

    The basis of my TIMEfactors formula is to teach the cost of a procedure and then price it accordingly….like any other business would do!



    • The Dental Warrior says:

      Thanks for your thoughtful comments, Warren!

      Ultimately, it comes down to a dentist’s tolerance (and its limits) of agreeing to letting a third party (who has NO SKIN in the game) dictate fees in exchange for a form of marketing and sending patients to his / her practice.

      To me it’s not even a matter of the cost of doing business or the higher costs of quality treatment. It’s more a matter of PRINCIPLE.

      But, yes… as the inscos continue to lower reimbursement, there does come a point of fiscal impossibility. At some point, the profit margins become so thin (or even negative) that the participating dentist is placed between a rock and a hard place. According to the threads on DT, that point has arrived. The fees are so low, the dentist has run out of ways to economize (time, technique, materials). Yet, the dentists’ practices have become dependent on the “insured” patient population. They are afraid of losing 60+% of their patient base. But, they can’t continue to see them at those fees, either. What to do?

  2. Waneta Chenault says:

    Yes, it IS a struggle to start out brand-new: you wouldn’t believe all the hardships/stress I’ve endured since 1999! I did join Delta Dental Premier only, and filed insurance for my patients, but I’m about to kick Delta to the curb, then have my “boutique” practice where the patients pay up-front for the type of care we provide so that they can see how “yanked around” insurance companies will do the same (to a lesser extent) to them. Even with a severely compromised clinical crown where there’s no way to achieve adequate resistance/retention form, along with my narrative as to why the tooth needs a BU, AND electronically send our x-rays AND photos of the tooth before and after decay removal, they still “play that game with me”, who’s uber prepared! I’m tired of being a “worker bee” for the insurance companies….I always tell my patients “follow the trail”….your insurance company is not in business so that you get the best, most comfortable care that you deserve, they are in it to make money, whereas I just want to live comfortably and provide for my family, hopefully take my mom to visit her homeland (not right now), South Korea someday, and our two daughters to Disney World. Sure, I’d like to own a Dodge Viper, but I simply can’t afford one. I’ve refused to cut any corners and always do my best, no matter if I lose money seeing a Delta Dental Premier patient, they still get the same treatment as those who are constantly “throwing” $10-20K checks at me to prepay for lots of work. I can lay my head down at night with a completey clear conscience. I happen to used to have a Delta Dental representative as a patient, and when I started asking her some hard, open-ended questions about what I’ve been hearing (from DentalTown), she gave me the runaround and couldn’t even look me in the eye….completely avoided my questions. Happy to say, she has since switched to another Delta Dental provider, as I was going to drop this insurance PPO ASAP! Woot-woot!!!!!

  3. Ritu says:

    As a fellow FFS practice owner (who thankfully deals with only some insco crap as an “outsider”), I echo your sentiments.

    And would you believe it, patients actually LIKE getting attention, having their voice heard, not being oversold/over treated and getting A class service without being shuffled like a number? Who’d a thunk?

    Keep on, Warrior friend.


  4. I am a private care dentist. The 10% of patients(my estimate) who choose a private care office really want and enjoy thoughtful gentle dental care that I enjoy providing. Dentistry has been in my family since 1954 when I was born in Montgomery Hospital that is no longer in existence. Many of my patients are worried that my practice may not be able to go on into the future. These folks want me to remain as their family dentist.
    The “insco crap” is starting to hit the fan. I notice each year it’s gets more difficult to get cooperation from the major insures. They do the “boiling the Frog” thing with the out-of -network offices also. I won’t bore you with the horror stories but I have written to my state representative in Pennsylvania to see if she can help a small office that provides care for many families in her district. You’ll need to stay tuned for “the rest of the story.” Hopefully there is a happy story to tell someday.

    • The Dental Warrior says:

      Thanks for your comment, Thomas. The “corporatization” of dentistry is turning it into a two-tier system. I’m happy being the top tier, even if it serves a minority of patients.

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