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Doctor, Is It OK To Cut Back On PPO Participation?
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I was talking to a close friend of mine about my work with dentists and their PPO
challenges, and he said, “Sounds to me like you’re helping dentists jack up fees on
patients. Don’t you have any qualms about doing that?”
Now, I respect my friend, and therefore it was a bit of a shocker to hear him take it
that way. But it made me think, “How do dentists justify leaving PPO participation
and, how do I justify helping them?”
After all, when a Doctor dumps a PPO, the practice won’t be writing off 20%-50%
of their normal treatment charges. Copays will be higher so it will indeed cost
those patients more money. Since most dentists like their patients and are compassionate
people, I can see that the worry about this can be an underlying cause for
why so many dentists take so many discounts for so long.
So, let’s take a minute to get a perspective on what’s been happening with dentists
and their fees over the last 10 years.
Fair reimbursements?
In our area, the Upper Midwest, the average fee for a dental crown in 2007 was
$985. Nowadays, the average fee for a 2740 crown in our area is about $1,300. The
allowed fee for a prominent PPO in our area is about $970. In effect, this means
that the PPO is reimbursing this fee at the 2007 level. And many other PPOs are
paying even less, as little as $680, which would take the fee back to the turn of the
century!
Doctor, how many of your expenses have gone down by 25% in the last 10 years?
Wages, rents, taxes, equipment, instruments and dental supplies sure haven’t! The
general Consumer Price Index between 2007 and 2018 has increased over 20%.
Meanwhile, Mean Dental Income (for G.P.s) has gone from about $210,000 in 2010
to $188,000 in 2016*.
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reimbursement rates from private dental insurance were down in all but four
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30 TPDMAG.COM | SPRING 2019
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