This is a question we are often asked by our patients when their company switches to an HMO/PPO dental plan, and we hope to clear up much confusion by answering it now.
Before I answer, Here is an ad for a dental practice looking to hire a dentist that recently was run in Craigslist for Westchester County.
"High volume Westchester practice looking for a motivated individual to join our team. Experience in insurance and medicaid is helpful. We're looking for two or three weekdays to start. It is a salaried 9-5 position."Now, please ask yourself, what is missing from this ad (and this is the entire ad, I did not edit anything out)?? What about the traits that you would want your dentist to have; you know, things like skill level, experience, continuing education just to name a few...... are you really looking for a "motivated individual" experienced in "insurance and medicaid" working in a "high volume" practice to perform the dentistry on you and your family? The person who responds to this ad is not a bad person; they will simply be facing the reality of working in an INSURANCE driven practice wherby people (ie. you, the patient) and people's real needs become secondary to the business demands of working in a business with little incentive or reward for quality treatment.
So here is what everyone needs to know about the business side of dentistry BEFORE choosing your dental provider.... dentists are often solicited 3-4 times a month by insurance companies to join their "family" of HMO or PPO dentists. Contrary to popular public belief, there is no quality control or screening process to select top dentists in the area. In fact, the insurance companies make no evaluation or assessment of a dentist's clinical skills whatsoever. Basically, the only prerequisites I've ever seen to sign up as a HMO/PPO provider are: 1) do you have a license to be a dentist and 2) do you have a heartbeat (and I'm not sure about the latter.)
SEE ATTACHED CREDENTIALING QUESTIONNAIRE. This is an actual questionnaire that I received asking me to join a certain HMO; Please note the only questions that they ask are whether the dentist has ever been convicted of a crime or had their license taken away. There are no questions whatsoever regarding the dentists level of training, education, areas of focus, etc."
The promotional material provided to you the patient by this multi-billion dollar insurance company is very appealing. It makes it sound like you have just won the lottery , and there really is a free lunch, or so it seems. It appears that everyone wins in this deal: you, the patient, now get FREE (or greatly reduced) cleanings, x rays, exams, and perhaps even fillings. Even the major treatment is cheaper-you are ecstatic! The upper management of your employer has a much cheaper premium to pay each and every month-they are ecstatic! On a recent train trip from New York to Kentucky (don't ask, but I really did it) I couldn't help but to notice that through every city, small and large the largest building in every city had the name of a major insurance company proudly engraved on the top. The insurance company executives are among the most highly paid in the business world-they are more than ecstatic.
So who is the loser here? Everyone seems to be getting more for less, this must be the mystical free lunch at last! Unfortunately, it isn't. There has to be someone absorbing the costs of al this free or cheaper treatment. You may have guessed it already, it's the HMO dentist primarily, and then ultimately you the patient.
Now you might ask "why would anyone want to work harder for less money?"
This is a really great question that we in the profession have asked ourselves. Let's look at why anyone would do this?
The insurance company attempts to dazzle the prospective dentists with the promises of wealth, endless patients, busy practices, happy patients, and then they add,
"Oh, did we forget to mention that you will have to give away many services for FREE and cut the rest of your fees by 30-50%? But don't worry about that," they quickly point out, "because you will have two to four times as many patients to try to see in order to make up for the lost revenue. You'll just have to work a little faster." (No wonder the craigslist ad mentioned above described the practice as "high volume." Should we really be talking about people/patients as volume?? To me, it just seems wrong).
To some dentists, however, the temptation is too great and they sign up only to quickly realize that their soul now belongs to the insurance company. I believe that a automobiles, and bottles of Windex can be made more quickly with no loss in quality (see Toyota, Honda, Nissan , etc. for details). I do not feel that dentistry can be performed the same way.
Understand that as an HMO provider dentist, you are paid $2-8 per month per family or patient whether or not that patient ever shows up in your office! Now if the patient does want to show up and get their teeth cleaned or a filling done (which the dentist is, by contract, often required to do for FREE), do you think that dentist actually wants that patient to come in?
This is the game the HMO provider has to play with you, the patient, in order to stay in business. Now you see why it might be difficult for you to be seen for a routine visit or in an emergency. The biggest complaints from patients in and HMO practice is that they cannot get an appointment or they never see the same dentist twice. Is it any mystery now why that is the case?
In my opinion, and in my case (see "What makes you different from any other dental practice I can visit" below) to be an HMO provider, I would be forced to sacrifice quality, service, and the personal attention we give to our patients. In short, we would be forced to compromise the standards I have set for my office. I could not nor would ever do that; as I stated earlier, my dad instilled in me a sense of pride about being a dentist. This upbringing is something that I will never compromise upon. As an HMO dental provider we would have to use cheap labs, cheaper materials, work faster, and cut corners. Many corners would have to be cut that you would not be aware of, but would likely compromise the type of treatment offered (or not offered), and/or the expected longevity of treatment.
Several years ago one of my friends was in an HMO medical plan and had lower back spasms. She went to her designated orthopedist and after a brief examination, was given some muscle relaxants. After several days, her condition was no better and she tried to get another appointment. She was told that she must have no pain tolerance and would have to get used to it (emphasis mine). I told her "you just don't understand the HMO insurance game." This same scenario was reported on 60 minutes a few years ago in a story involving HMO psychiatric medicine.
The medical profession has all but lost the war to the insurance industry. The story has been well documented, including making the cover of Time Magazine. The dental profession still has, by and large, the freedom of choice. As long as that continues, I will endeavor to provide my patients with the best that dentistry has to offer.