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Why dentists charge differently for different patients for the same procedure?
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Mark A
medicine forum Guru Wannabe


Joined: 30 Apr 2005
Posts: 226

PostPosted: Wed Mar 22, 2006 4:04 am    Post subject: Re: Why dentists charge differently for different patients for the same procedure? Reply with quote

"Pump" <vpumpkin@gmail.com> wrote in message
news:1142991086.534460.232160@j33g2000cwa.googlegroups.com...
Quote:

Hello friends,

I have a problem with dentists. I do not have any insurance and I have
to pay cash up front for the work they do. That is fine and
understandable. For fillings for my son they charged $220. If I had
insurance, they are happy to accept only $70 and they do not mind. I
tell them I will pay $70 or even double $140 and they do not want to
accept. They want $220. So for the same procedure they agree their
charges are more if you do not have any insurance. Is it fair? It is a
big rip-off. And I just do not understand their logic. Whether I have
insurance or not should not matter as long as I pay more than what
insurance pays.
Do all dentists work like this? Should I complain to FTC. Can they have
different prices for different people for the same procedure?

-p


It works the same way for medical doctors with insurance. If you have
insurance you get highly discounted rates. It is sort of like a volume
purchasing agreement.

Unfortunately, there is nothing illegal about it.
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Steven Bornfeld
medicine forum Guru


Joined: 28 Apr 2005
Posts: 492

PostPosted: Wed Mar 22, 2006 1:48 pm    Post subject: Re: Why dentists charge differently for different patients for the same procedure? Reply with quote

Pump wrote:
Quote:
Hello friends,

I have a problem with dentists. I do not have any insurance and I have
to pay cash up front for the work they do. That is fine and
understandable. For fillings for my son they charged $220. If I had
insurance, they are happy to accept only $70 and they do not mind. I
tell them I will pay $70 or even double $140 and they do not want to
accept. They want $220. So for the same procedure they agree their
charges are more if you do not have any insurance. Is it fair? It is a
big rip-off. And I just do not understand their logic. Whether I have
insurance or not should not matter as long as I pay more than what
insurance pays.
Do all dentists work like this? Should I complain to FTC. Can they have
different prices for different people for the same procedure?

-p



This is a very good point, and one that many people do not grasp--with
medical as well as dental insurance. Doctors in a competitive
environment will contract with insurance companies to accept a reduced
fee in return for anticipated volume. Obviously if you can fill up your
schedule with full-fee patients there would be no need to accept reduced
fees.
What happens is that patients paying their own bill wind up in effect
subsidizing those with insurance. It's happened to me with medical
procedures (I was billed through a hospital radiology department because
they screwed up the insurance billing; when their billing was corrected
they accepted a reimbursement lower than what they'd billed me for, and
it was NOT necessary for me to pay the shortfall because the hospital
participated in my insurance plan).
Having said that, I am not aware of any insurance plan that pays less
than 1/3 of a private fee that any dentist I know will accept. Most
dental offices run with an overhead of maybe 70-80% of gross production.
You'd lose money on every treatment you provided (the only explanation
being that there could be compensation somewhere else).

Steve
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Mark A
medicine forum Guru Wannabe


Joined: 30 Apr 2005
Posts: 226

PostPosted: Wed Mar 22, 2006 2:37 pm    Post subject: Re: Why dentists charge differently for different patients for the same procedure? Reply with quote

"Steven Bornfeld" <dentaltwinmung@earthlink.net> wrote in message
news:442155AB.4080801@earthlink.net...
Quote:

Having said that, I am not aware of any insurance plan that pays less than
1/3 of a private fee that any dentist I know will accept. Most dental
offices run with an overhead of maybe 70-80% of gross production. You'd
lose money on every treatment you provided (the only explanation being
that there could be compensation somewhere else).

Steve


I don't know about dentists, but many doctors and hospitals will charge
patients about 3 times the rate for non-insured patients that they accept
from insurance companies. This is mostly for surgical fees and hospital
fees, not for office visits.
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Mark & Steven Bornfel
medicine forum Guru


Joined: 30 Apr 2005
Posts: 888

PostPosted: Wed Mar 22, 2006 3:07 pm    Post subject: Re: Why dentists charge differently for different patients for the same procedure? Reply with quote

Mark A wrote:
Quote:
"Steven Bornfeld" <dentaltwinmung@earthlink.net> wrote in message
news:442155AB.4080801@earthlink.net...

Having said that, I am not aware of any insurance plan that pays less than
1/3 of a private fee that any dentist I know will accept. Most dental
offices run with an overhead of maybe 70-80% of gross production. You'd
lose money on every treatment you provided (the only explanation being
that there could be compensation somewhere else).

Steve



I don't know about dentists, but many doctors and hospitals will charge
patients about 3 times the rate for non-insured patients that they accept
from insurance companies. This is mostly for surgical fees and hospital
fees, not for office visits.



I can't speak for hospitals. The financing of hospital care is
byzantine enough that fees lost on one patient may be compensated by
public dollars and other sources.
I'm not aware of any surgeon who can do this--I can't discount this,
but I know several surgeons and have discussed this. What you shouldn't
do is look at the fee billed on the invoice and assume that uninsured
patients in fact pay that. There are a variety of techniques used in
insurance billing (I'm hardly an expert here--this refers more to
medical than to dental billing) to "puff up" reimbursements--such as
so-called "unbundling" that in reality aren't charged to paying
patients. This is just one example of the dance "providers" (they're no
longer doctors) do with insurance companies ("payors").
While we can argue about the actual ratios, I don't argue with your
basic premise--that the uninsured patient gets screwed twice. This is
of course a bigger problem with medicine than it is in dentistry, but
this is not to minimize the problem in dentistry.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
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Sdores
medicine forum Guru Wannabe


Joined: 24 Mar 2005
Posts: 254

PostPosted: Wed Mar 22, 2006 3:11 pm    Post subject: Re: Why dentists charge differently for different patients for the same procedure? Reply with quote

Can't patients also demand that the charge(s) be the same as what insurance
companies get? UM MOM Susan
"Mark & Steven Bornfeld" <bornfeldmung@dentaltwins.com> wrote in message
news:bLdUf.2150$hA2.740@trndny02...
Quote:
Mark A wrote:
"Steven Bornfeld" <dentaltwinmung@earthlink.net> wrote in message
news:442155AB.4080801@earthlink.net...

Having said that, I am not aware of any insurance plan that pays less
than 1/3 of a private fee that any dentist I know will accept. Most
dental offices run with an overhead of maybe 70-80% of gross production.
You'd lose money on every treatment you provided (the only explanation
being that there could be compensation somewhere else).

Steve



I don't know about dentists, but many doctors and hospitals will charge
patients about 3 times the rate for non-insured patients that they accept
from insurance companies. This is mostly for surgical fees and hospital
fees, not for office visits.

I can't speak for hospitals. The financing of hospital care is byzantine
enough that fees lost on one patient may be compensated by public dollars
and other sources.
I'm not aware of any surgeon who can do this--I can't discount this, but I
know several surgeons and have discussed this. What you shouldn't do is
look at the fee billed on the invoice and assume that uninsured patients
in fact pay that. There are a variety of techniques used in insurance
billing (I'm hardly an expert here--this refers more to medical than to
dental billing) to "puff up" reimbursements--such as so-called
"unbundling" that in reality aren't charged to paying patients. This is
just one example of the dance "providers" (they're no longer doctors) do
with insurance companies ("payors").
While we can argue about the actual ratios, I don't argue with your basic
premise--that the uninsured patient gets screwed twice. This is of course
a bigger problem with medicine than it is in dentistry, but this is not to
minimize the problem in dentistry.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
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Mark & Steven Bornfel
medicine forum Guru


Joined: 30 Apr 2005
Posts: 888

PostPosted: Wed Mar 22, 2006 5:17 pm    Post subject: Re: Why dentists charge differently for different patients for the same procedure? Reply with quote

Sdores wrote:

Quote:
Can't patients also demand that the charge(s) be the same as what insurance
companies get? UM MOM Susan

You mean the fees charged to patients in groups the dentist is
contracted with?
You can demand anything you wish, but the dentist is under no legal
obligation to charge everyone the same fee--as long as discrimination is
not on the basis of race, sex, religion, etc.

Steve


--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
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Bill
medicine forum Guru


Joined: 01 Jun 2005
Posts: 346

PostPosted: Wed Mar 22, 2006 6:14 pm    Post subject: Re: Why dentists charge differently for different patients for the same procedure? Reply with quote

Sdores wrote:
Quote:
Can't patients also demand that the charge(s) be the same as what insurance
companies get? UM MOM Susan
_________________________________



Generally, if a dentist is willing to accept a slightly smaller fee
from an insurance company, it is only done in anticipation of a much
higher VOLUME of business.

Go to a Buick dealer and offer to buy one car. Get the best price you
can, where the dealer says he can't drop it any further.

Then, offer to buy a HUNDRED Buicks, only if he will drop the price.
Watch the price drop! (This assumes you have credibility and the
ability to deliver millions in cash for the offer).

The Buick dealer knows he will make less per car, but make up for it
with high volume.

One single patient is not in a position to offer a higher volume of
business to a dentist -- he is only one person, not fifty or a hundred.

Insurance companies have credibility and the assumed ability to deliver
the volume promised. If they don't deliver the volume, they know
dentists will simply drop out of the program.

The fee differences in dentistry, between insurance and private
patients, are not as large as in medicine. I know of many cases where
the dental office gets MORE from the insurance company than they can
charge cash patients. This often occurs in neighborhoods of
middle-to-lower income.

I see this fact every week where the dental office advertises a special
"coupon" examination price to get the patients into the office (and as
some former patients have told me, for a bait-and-switch spiel). The
local coupons clearly state that the coupon price is NOT applicable if
the patient has insurance! That's because the dental office can bill
the insurance company much more than the "teaser" coupon price.

As Steve has already pointed out, the office overhead in dentistry can
be as high as 75% or even 80%, so a dentist can't lower the fee by more
than about 15 - 20% without working for free. With a family to support
and huge college loans to pay off, an honest dentist is forced to set
his fees at a realistic level.

Best regards,
- dentaldoc
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abc
medicine forum beginner


Joined: 24 Mar 2005
Posts: 21

PostPosted: Wed Mar 22, 2006 8:15 pm    Post subject: Re: Why dentists charge differently for different patients for the same procedure? Reply with quote

Quote:
As Steve has already pointed out, the office overhead in dentistry can
be as high as 75% or even 80%,

If I understand correctly, this means profit margins are 20% to 25%?
That's not as much as I had thought. If people knew that, they'd
probably be much more sympathetic towards their dentists. I mean, it's
long time in school, then years to establish clientele, lots of
liablility, and the pay must be just a little higher than the pay of an
average computer geek then?
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Clinton
medicine forum Guru


Joined: 09 Sep 2005
Posts: 405

PostPosted: Wed Mar 22, 2006 10:17 pm    Post subject: Re: Why dentists charge differently for different patients for the same procedure? Reply with quote

abc wrote:
Quote:
As Steve has already pointed out, the office overhead in dentistry can
be as high as 75% or even 80%,


Are hospitals really that lacking in patients? Most seem pretty busy so
I'm not sure how an insurance companies guarantee to deliver patients
would boost income (at a lower cost per patient). Maybe it's more
psychological in that they are scared they will lose patients if they
don't follow the insuance plan. In that case you could say the
insurance companies are really blackmailing the hospitals at
the expense of the unisured patients.
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Sdores
medicine forum Guru Wannabe


Joined: 24 Mar 2005
Posts: 254

PostPosted: Wed Mar 22, 2006 10:38 pm    Post subject: Re: Why dentists charge differently for different patients for the same procedure? Reply with quote

I understand what you both are saying but.... with someone who has medical
problem, finances get in the way. I want to see my dentist for major stuff
and I am saving as much as I can to get this done, plus I have been on pred
twice now and need to wait. I need a bridge, repair (probably can get away
with new lining for now) on my upper denture and at least two teeth that
need major work. I have crohn's which is a killer for teeth since I have
absorption issues. I have had to wait now for too long. It stinks to be
honest. UM MOM Susan
"Bill" <dentaldoc@hotmail.com> wrote in message
news:1143047447.746741.234440@t31g2000cwb.googlegroups.com...
Quote:
Sdores wrote:
Can't patients also demand that the charge(s) be the same as what
insurance
companies get? UM MOM Susan
_________________________________


Generally, if a dentist is willing to accept a slightly smaller fee
from an insurance company, it is only done in anticipation of a much
higher VOLUME of business.

Go to a Buick dealer and offer to buy one car. Get the best price you
can, where the dealer says he can't drop it any further.

Then, offer to buy a HUNDRED Buicks, only if he will drop the price.
Watch the price drop! (This assumes you have credibility and the
ability to deliver millions in cash for the offer).

The Buick dealer knows he will make less per car, but make up for it
with high volume.

One single patient is not in a position to offer a higher volume of
business to a dentist -- he is only one person, not fifty or a hundred.

Insurance companies have credibility and the assumed ability to deliver
the volume promised. If they don't deliver the volume, they know
dentists will simply drop out of the program.

The fee differences in dentistry, between insurance and private
patients, are not as large as in medicine. I know of many cases where
the dental office gets MORE from the insurance company than they can
charge cash patients. This often occurs in neighborhoods of
middle-to-lower income.

I see this fact every week where the dental office advertises a special
"coupon" examination price to get the patients into the office (and as
some former patients have told me, for a bait-and-switch spiel). The
local coupons clearly state that the coupon price is NOT applicable if
the patient has insurance! That's because the dental office can bill
the insurance company much more than the "teaser" coupon price.

As Steve has already pointed out, the office overhead in dentistry can
be as high as 75% or even 80%, so a dentist can't lower the fee by more
than about 15 - 20% without working for free. With a family to support
and huge college loans to pay off, an honest dentist is forced to set
his fees at a realistic level.

Best regards,
- dentaldoc
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Joel M. Eichen
medicine forum Guru


Joined: 24 Mar 2005
Posts: 4062

PostPosted: Thu Mar 23, 2006 3:17 am    Post subject: Re: Why dentists charge differently for different patients for the same procedure? Reply with quote

Then, offer to buy a HUNDRED Buicks, only if he will drop the price.
Watch the price drop! (This assumes you have credibility and the
ability to deliver millions in cash for the offer).


R E P L Y

This is true. I made a couple of bad deals
and lost money on EACH transaction ... but
fortunately I made it up in volume.



Joel


--
Joel344
------------------------------------------------------------------------
Joel344's Profile: http://dentalcom.net/forum/member.php?userid=12
View this thread: http://dentalcom.net/forum/showthread.php?t=4051
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Bill
medicine forum Guru


Joined: 01 Jun 2005
Posts: 346

PostPosted: Thu Mar 23, 2006 5:44 pm    Post subject: Re: Why dentists charge differently for different patients for the same procedure? Reply with quote

Clinton wrote:

"Are hospitals really that lacking in patients? Most seem pretty busy
so
I'm not sure how an insurance companies guarantee to deliver patients
would boost income (at a lower cost per patient). Maybe it's more
psychological in that they are scared they will lose patients if they
don't follow the insuance plan. In that case you could say the
insurance companies are really blackmailing the hospitals at
the expense of the unisured patients."
_____________________________________



Insurance companies control the purse strings. Since they have the
money, they call the shots.
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Bill
medicine forum Guru


Joined: 01 Jun 2005
Posts: 346

PostPosted: Thu Mar 23, 2006 5:51 pm    Post subject: Re: Why dentists charge differently for different patients for the same procedure? Reply with quote

"Then, offer to buy a HUNDRED Buicks, only if he will drop the price.
Watch the price drop! (This assumes you have credibility and the
ability to deliver millions in cash for the offer)."
__________________________



R E P L Y B Y J O E L :

This is true. I made a couple of bad deals
and lost money on EACH transaction ... but
fortunately I made it up in volume.

Joel
______________________


There was a used car salesman here in So. California back in the
forties and fifties who used exactly that line in his advertising!

It certainly got him a lot of publicity. He went by the moniker of
"MadMan Muntz." His billboards included a little cartoon figure of a
"madman" dressed in red longjohns and wearing a Napoleon hat, to
underscore how "crazy" his car deals were.

Years after the car business, he promoted 8-track tapes -- and that was
a little crazy too.

- dentaldoc
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Joel M. Eichen
medicine forum Guru


Joined: 24 Mar 2005
Posts: 4062

PostPosted: Thu Mar 23, 2006 7:07 pm    Post subject: Re: Why dentists charge differently for different patients for the same procedure? Reply with quote

R E P L Y

Yup, I know exactly who that is!

Go here:


http://www.scripophily.net/muntztv.html



Beautifully engraved RARE SPECIMEN certificate from the Muntz TV. This
historic document was printed by the American Banknote Company in the
1960's and has an ornate border around it with a vignette of the
company logo. This item has the printed signatures of the Company’s
President and Treasurer. This is the first time we have had this
certificate for sale.




[image:
http://us.st11.yimg.com/store1.yimg.com/I/scripophily_1889_570910139]



...



Its the same guy ,,,,, EARL MUNTZ inventor of the 8-track and the
developer of Muntz TV.


Bill Wrote:
Quote:
"Then, offer to buy a HUNDRED Buicks, only if he will drop the price.
Watch the price drop! (This assumes you have credibility and the
ability to deliver millions in cash for the offer)."
__________________________



R E P L Y B Y J O E L :

This is true. I made a couple of bad deals
and lost money on EACH transaction ... but
fortunately I made it up in volume.

Joel
______________________


There was a used car salesman here in So. California back in the
forties and fifties who used exactly that line in his advertising!

It certainly got him a lot of publicity. He went by the moniker of
"MadMan Muntz." His billboards included a little cartoon figure of a
"madman" dressed in red longjohns and wearing a Napoleon hat, to
underscore how "crazy" his car deals were.

Years after the car business, he promoted 8-track tapes -- and that
was
a little crazy too.

- dentaldoc


--
Joel344
------------------------------------------------------------------------
Joel344's Profile: http://dentalcom.net/forum/member.php?userid=12
View this thread: http://dentalcom.net/forum/showthread.php?t=4051
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Lorm
medicine forum beginner


Joined: 23 Mar 2006
Posts: 4

PostPosted: Thu Mar 23, 2006 7:13 pm    Post subject: Re: Why dentists charge differently for different patients for the same procedure? Reply with quote

Steven Bornfeld <dentaltwinmung@earthlink.net> wrote in
news:442155AB.4080801@earthlink.net:
Quote:

than 1/3 of a private fee that any dentist I know will accept. Most
dental offices run with an overhead of maybe 70-80% of gross
production.
You'd lose money on every treatment you provided (the only
explanation
being that there could be compensation somewhere else).

Please. The only reason the overhead is so high is that the dentist is
probably taking home a quarter million dollars a year as his paycheck. I
found my dentist's address in the phone book, and drove past his house
earlier today. Er, correction, I drove past his GATED COMMUNITY because it
turns out that he lives in one of those snobby neighborhoods with a wall
around it. All the houses in there are in the high six figures, and a few
probably break the million mark. The only reason his prices are high is so
that he can make the payments on his big fancy house.
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