I had a patient come in today for a routine dental cleaning. We have been seeing this patient for years. I would recognize him by name if I saw him in the grocery store. Anyway, as he sits in the chair he tells us he has new insurance and hands us a Cigna card. No problem. I give the card to Cristina and she attempts to verify his new insurance (it takes over an hour to get through!) No xrays needed this time, so we jump right into the exam. I remind him of a couple of fillings that are needed (1 new, 1 replacement) and we proceed to clean his teeth. Cristina tells me "no adult fluoride" for this insurance company. Too bad, he could have used it. We like to use the new high-tech "sticky" fluoride that hangs around all day long, and we floss the fluoride in between the teeth for even more effectiveness.
LUNCHTIME! As I'm microwaving my steak sandwich, Cristina tells me the bad new: Our patient now has an HMO and has to see a certain clinic to get any benefits. We call our patient and let him know about our online coupon, as he now considers himself to be "uninsured". We don't normally accept our coupons after the work has been done, but he had no idea his boss put him on one of those plans.
We have been seeing more and more patients being put on these HMOs. In an effort to keep profits from dipping during this eternal recession, companies are cutting benefits left and right. Spouses and families are being dropped from the list of covered individuals, or patients are being scuttled onto the exchanges. Many of the plans avail in the aftermarket are HMOs. The available PPOs all seem to have lengthy waiting periods and minimal coverage for the services you need.
An HMO is a plan where a clinic receives a small check (maybe $10) every month that you are signed up with them. Its not a lot. In return, they provide many of their services like exams and cleanings for free. The problem is that the longer the clinic can avoid seeing the patient, the more money they make. If they only see the patient once a year, then the clinic can honestly say they made $120 on that cleaning. If they see a patient twice a year, that production drops to $60. When a clinic in Austin, TX pays $35-40/hour (plus taxes. plus overhead) for a dental hygienist, you can see why the less the clinic sees patients, the more money they make. Preventive dentistry is a loser for these clinics. I have a real moral problem with a business model like this, and have refused to sign up with these plans.
If you've been dropped or switched to an HMO, don't panic. There are other offices out there like Austin Smile Center that are trying to catch this dental market with online coupons and cash offers. Instead of paying $50 a month for a PPO dental plan, ask your bank if they can create a separate account for you and have that $50 transferred once a month. That account would be there for up to $600 in dental work a year. That would pay for a couple of cleanings and maybe 50% of a filling or two. Most PPOs only offer $1000 in annual benefits anyway, which is really only $400 in benefits after you subtract your monthly payments. This is assuming that the waiting periods allow you to use all your benefits. These insurance companies do not exist to be philanthropic. Their mission is to make as much money for their stockholders as possible.
Its like being happy that you won $1 on a $2 lottery ticket! It doesn't make sense.
To help our our non-insured patients, Austin Smile Center offers an online coupon for 25% off your dental work (except for dental implants and Invisalign). We even offer coupons for $99 routine teeth cleanings and exams, new or existing patients. Our credit card company charge us 4% for credit cards, so we still offer 5% cash discounts. I would rather give the patients the money than the banks.
BEWARE: some offices will offer a low initial fee for an exam and cleaning, then try to stick it to you for any other dental work you may need. They may even employ high pressure sales tactics to get you to commit to the treatment or use your credit to prepay for your treatment. I don't feel this is a good way to develop a long-lasting doctor-patient relationship. Austin Smile Center prefers to give you a good service at a good price, all day, everyday. If you're in the Austin area, look us up. If you're not, then hopefully there will be some progressive dentists in your area that can help. Click HERE if you would like to see our current coupons.
thanks
Greg Watson, DDS
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