Dental Survey Reveals Dentists Hesitant To Raise Fees

Dental Survey Reveals Dentists Hesitant To Raise FeesAre dentists raising their treatment fees to keep ahead of the rising dental practice management costs?  A new The Wealthy Dentist survey aimed to find out.

The survey asked dentists when was the last time they raised their treatment fees.  One California dentist responded, “Expenses seem to keep going up. So must fees.”

In fact, many dentists have decided not to run small private practices due to rising costs and administrative hassles, but instead choose to join larger dental management groups so they can spend less time dealing with the administrative side of a dental practice and spend more time treating their dental patients.

Here’s how the dentists responded:

  • 9% raised their fees 5 years ago.
  • 20% raised their fees 3 years ago.
  • 20% raised their fees 2 years ago.
  • 35% raised their fees 1 year ago.
  • 16% raised their fees 6 months ago.

The reason many dentists don’t like to raise fees is the fear that they will lose patients. Combine this fear with the fact that most Americans don’t budget for dental care and you find a lot of dentists who need to raise their fees but won’t.

Here’s what the dentists in this survey told us:

“We are still waiting for the economy to stabilize. Too many of our patients are still unemployed or without insurance coverage. I also discount my fees more than ever before.” (Texas dentist)

“I know I need to raise them but people are constantly complaining of cost. Treatment acceptance is down. Maybe it my own fault but I worry that revenue will decrease further if I do it.” (Georgia dentist)

“It’s tough to raise fees in such a depressed economy.” (Illinois dentist)

“That’s a hard one. Our cash clients are watching prices closely.” (Nevada dentist)

“We only raised a few selected fees and decreased the amount of discounts.” (California dentist)

“I am stuck with fees for insurance plans, therefore unable to raise fees easily.” (New york dentist)

“Managed care destroys fee increases.” (Virginia oral surgeon)

“I know I should be doing it more often.” (Tennessee dentist)

“Inflation from gas and food prices is on the way, so the time to raise fees is now.” (New York endodontist)

“I do not raise fees often enough!” (North Dakota dentist)

“What is the point, if dental insurance dictates reimbursement?” (Missouri dentist)

“Fees need to be reviewed annually. Not necessarily raised but reviewed.” (General dentist)

“We do it annually right before staff reviews.” (Pennsylvania dentist)

“They will probably be raised next year, but I will wait until after Presidential election. If Obama wins fees will have to go up…” (General dentist)

It’s important for dentists to take a look at their fee structure annually and make adjustments accordingly — even during a tough economy. What are your thoughts, dentists?

When was the last time you raised your fees and what impact did it have on your dental practice?

Some Dentists Fire Patients After Missed Appointments

Some Dentists Fire Patients After Appointment No-Shows36% of dentists don’t charge for missed dental appointments — no matter how many times a patient is a “no-show.”

Only 5% charge a fee for the first offense, while 39% charge a fee after the second missed appointment. 20% of dentists charge after the 3rd missed appointment.

With the current economic conditions, The Wealthy Dentist decided to ask dentists if they have been charging for missed appointments.

Boston’s Pilgrim Hospital is in the news this week for reveling that in the first 10 months of 2011 patients failed to attend almost 17,000 appointments. Thats about 49 missed medical appointments for every day of the year.

“Time is money!” complained one dentist, and he is right. A missed appointment is an appointment that can be filled by other patients. Missed appointment fees ranged from $25.00 to $150.00. The average fee is $55.00.

In this survey, 42% of dentists said they rarely or never fire patients, 34% will fire a patient after the third missed appointment, and another 24% sometimes fire patients, but they have more than three chances.

The following dentists’ comments were selected to share how dentists are handling missed appointments —

Pre-paying is popular …

“We ask the patient to pre-pay for future appointments.” (Illinois dentist)

“Repeat offenders are put on ‘probation’ where they must pre-pay (the full price, non-refundable) before we will schedule them again. This way we don’t ‘fire’ them, they either pre-pay or leave the practice. They are usually on ‘probation’ until they consistently show up.” (Kentucky dentist)

“We have them pay before the appointment and if they break the appointment, the fee is deducted from their account.” (Missouri dentist)

After three missed appts we will not reschedule unless they prepay in full for whatever the appointment is for. It works great. We have a great practice and people know the value that they receive here.” (Colorado dentist)

“We ask the patients who no show for 2 appts or more to prepay for further visits.” (General dentist)

“We just charge them little more when they come next. Also if they are entitled for any offers or discounts don’t give them that.” (General dentist)

Confirming helps …

“Confirm. Confirm. Confirm.” (General dentist)

“Have your patients give you the cell number where they receive texts and text them their appointment. Works like a charm.” (California dentist)

“We confirm by phone, email and text message.” (General dentist)

“We double book or call patient the morning of appointment.” (California dentist)

“We send a sms reminder the day before the scheduled appointment.” (General dentist)

Same day or on-call appointments only …

“After the second time we choose the option of putting the patient on our short call list only.” (Georgia dentist)

“We don’t give 3rd time offenders the opportunity to schedule in advance. We put them in our ‘Short Notice Club’ and call them when we have an opening or they can call to see if they can get in that day.” (Oklahoma dentist)

“After 3 missed, the patient must call on a day they would like to come in and see if there is an appointment available.” (Pennsylvania dentist)

“We don’t “fire” them but put them on a VIP list where we call them when we have a same day appointment available.” (New Hampshire dentist)

Fire them …

“My letter to the patient who I am dismissing is actually very nice. It states that our priorities do not match and that they would be better served by another dentist and to please let us know where to forward their records. A lot of times, the patient begs us to let them come back to the practice and they become our best patients ever about being there for their appointments even in bad weather, etc.!” (Alabama dentist)

“We send three letters and then dismiss patient with a 30 day emergency window so they have ample time to find a new dentist that will be more conducive to their schedule.” (Missouri dentist)

You must get rid of them because you can not afford them. The other thought is to give them a stand-by appt. They may have to wait a while to be seen.” (North Carolina dentist)

“After a new patient reschedules/misses an appointment twice, we fire/do not reschedule. When existing patients break numerous appointments we notify them to call us on a day when they have extra /free time on their schedule and we will see if we can work them in at that time (this way we are not blocking an actual appointment for them). The best approach would be to require a credit card at time of scheduling to hold the appointment.” (General dentist)

How do you handle missed appointments? Have you ever “fired” a patient?

Dentist Update: 28 States Considering Legislation on Dental Insurance Fee Capping

Dental insurance fee capping
Our latest survey revealed that 98% of dentists oppose dental insurance companies setting fees for services they do not offer. [Check out the insurance fee setting survey results]

Known as fee capping, this practice has upset dentists nationwide – and legislators have taken notice. According to the AGD, this year, “a total of 28 states introduced 46 pieces of legislation to stop insurance carriers from requiring dentists to accept caps on fees for services the carrier does not cover.

It would seem that more and more dental insurance carriers are moving into the arena of discount dental plans. The insurance companies are trying to negotiate discounts on services they don’t cover. Perhaps they’re getting ready to try both sides of the equation?

It’s important to note that discount dental plans are monitored separately from dental insurance plans. I don’t know what will happen, but I expect it will be interesting…

The AGD provides additional explanation:

Putting Caps on Fees for Non-Reimbursed Services

Several major dental benefits carriers are adding language to provider participation agreements to allow them to set fees for dental services that they do not pay for, i.e., non-covered services. That is, if a dentist agrees to the contract language, he or she will be required to charge the patient what the carrier has told him or her to charge even when the carrier will not pay for the service.

To enact a fee cap on non-covered services, a dental benefits carrier must amend the current contract it has with its existing providers. Here’s an example of such an amendment:

Dentist may bill a Member for non-covered services (which are defined as any service for which no payment is made under the applicable plan or arrangement for any reason, including but not limited to, services in excess of contractual maximums, services not covered under plan design, and services denied due to contractual limitations). Dentist’s charge to Member for non-covered services may not exceed the Maximum Allowable Charge for the applicable CDT code as specified in the most current Maximum Allowable Charge schedule. Fees for all non-covered services will be collected from the Member, and not billed to the Carrier.

Note that this is just one of many variations of such a provision that you may find in your participation contract. The provider then has the choice of signing the new contract, thus accepting the new fee caps, or terminating his or her contract. If the provider elects not to sign, then he or she will be excluded from the provider networks presented to patients by that carrier’s dental plans.

What are the non-covered services?

Non covered services are those services that a patient’s dental plan has chosen not to pay for. Note that a carrier may offer numerous dental plans. Often however, dental plans without coverage for expensive, cosmetic, or other dental services are cheaper for employers to purchase for their employees. This is especially attractive to employers in the current economic climate. Each dental plan may have a different list of non-covered services, and therefore one cannot specify any particular services as universal ‘non-covered services.’

Rationale of carriers enacting such policy

To stay competitive with one another, dental benefits carriers use the argument of market pressure or gaining a marketing advantage as one of the reasons they are implementing this policy. Market need, the carriers assert, is being driven by patients who can save money on services not covered by their dental benefits plan and see value in limiting their out-of-pocket expenses. However, limiting dentists’ charge to patients for non-covered services allows these carriers to market their dental plans as costing patients less without bearing any of the financial risk of the discount; that is, these carriers gain the marketing advantage by shifting the risk to the providers. Therefore, the market trend will drive all carriers to implement similar restrictions in order to avoid a competitive disadvantage. Accordingly, any legislation enacted against the practice of fee-capping for non-covered services must be sufficiently broad to prevent all carriers from engaging in this practice.

Impact to Patients and the Practice of Dentistry

As primary care providers of oral health care, general dentists strive first and foremost for access to quality care for all as the ultimate goal of the profession. However, to serve its patients, a dental office must be viable and sustainable. Today, more patients than ever rely upon dental insurance to be able to afford oral health care. Studies have shown that, without dental insurance, far fewer persons will choose to see a dentist. Understandably, in the present economy, each of us must make cutbacks to our expenses in order to survive. Public awareness and understanding of the impact of oral health on systemic health issues such as diabetes and cardiovascular afflictions is still at its fledgling stages. Therefore, out-of-pocket expenses for oral health are often among the first to be avoided by the public.

Concurrently, businesses including those of dental benefits carriers and employers are also seeking cutbacks. Carriers striving to maintain or increase their revenues and marketshare in this economy offer employers cheaper plans for their employees by covering fewer services and paying less than true market value even for those services they cover. However, by covering fewer services, carriers compel patients to pay for more services out-of-pocket, which they may be unable or unwilling to do. Second, by paying less for the services they do cover, carriers compel dentists to function at a net loss when providing these covered services.

Therefore, today’s dentist must often rely upon billing at market rates for non-covered services to compensate for the loss he or she absorbs in accepting paltry fees from carriers for covered services. However, unlike the carriers’ actions of limiting services they cover, the dentists’ actions do not impose an undue burden upon patients. Here’s why. In the absence of fee-caps for non-covered services, dentists work with each patient on a case-by-case basis to charge what each patient may be able to afford with an understanding that some patients may be able or willing to afford more than others.

Fee capping takes away this opportunity! If fees for non-covered services are capped across the board without regard to what each patient can afford, the practice of the participating dentist may become unsustainable. The result may be two-fold. He or she may no longer be able to offer that specific service to that carrier’s patients, thus limiting the patients’ treatment options. In some markets, providers may feel compelled to stop participating with certain carriers in order to survive. In either case, the patients would face decreased access care.

Call to Action

AGD is currently tracking legislative activity in all states, including fee capping legislation. To see whether your state has a fee capping bill, please click here. The AGD’s Legislative & Governmental Affairs Council and the Dental Practice Council have also approved a legislative lobbying guide called a ‘toolkit’ for AGD constituents. The toolkit will help constituents push the passage of state laws to stop insurance companies from capping fees for services they do not cover. The AGD asks you to contact and work with your constituent organizations to help them use the toolkit to lobby for these state laws. Several states have already introduced legislation to prohibit fee capping by insurance carriers; AGD members are asked to contact their legislators to encourage them to pass this legislation. Click here to see if your state has an action alert on fee capping, or to find your state’s elected officials.

AGD Advocacy: Caps on Fees

Dentists: what are your thoughts on the subject?

Dentists Oppose Dental Insurance Fee Capping

98% of dentists oppose dental insurance fee cappingFully 98% of dentists think fee capping by dental insurance companies is totally inappropriate. Only 2% say it’s a legitimate business move.

“Fee capping should be illegal, especially since the insurance company fees have not kept up with the standard of living cost increases,” opined a California dentist.

[Related article:28 States Considering Legislation on Dental Insurance Fee Capping]

Here are just a few of the comments from dentists on dental insurance companies setting fees:

  • “I believe it is restraint of trade.” (Pennsylvania dental hygienist)
  • “It’s inappropriate for insurance companies to set ANY fees. Their choices are who to insure, and what levels to reimburse at.” (Michigan dentist)
  • “Dental practice was FAR better prior to dental insurance. Patients budgeted for treatment, and proceeded with necessary Dentistry. Today, they believe the insurance processor instead of the treating doctor for their dental needs. If the insurance does not allow it, in their minds, it must not be needed!” (Illinois dentist)
  • “Free enterprise?!? Not if insurance has it their way. If I wasn’t ten years from retirement, I would change careers!” (Pennsylvania dentist)
  • “I don’t like it, but the contractually lower fees is something of value that the customers of the insurance company are paying for with their premiums.” (Oregon dentist)
  • “If they want to have a say in the fees, then provide coverage for the service.” (Connecticut prosthodontist)
  • “It’s crippling dentists.” (Texas dentist)
  • “They are only feathering their own nests by being able to offer a lower fee for non-covered services for which they do not collect a premium thereby making the insurance plan more attractive to purchasers.” (Orthodontist)
  • “I am so glad I stuck to my guns and never became part of PPO’s or other insurance plans.” (New York dentist)
  • “We aren’t supposed to compare our fees to other dentists, which they call price fixing. If insurance companies cover the services and we are providers for that insurance, then it is appropriate for them to ask what the fees are. If they do not cover the services then they do not have a right to know the fees we charge for the non-covered items.” (Arizona dentist)

Read more: Dentists Oppose Dental Insurance Setting Fees for Non-Covered Services

Dental Fees Raises: Not This Year, Say 50% of Dentists

Half of dentists have raised dental fees in past yearCommon sense – and dental management consultants – would dictate you raise dental fees regularly. But this survey found that only 50% of dentists have raised their fees within the past year.

Many dentists cited the current economy as a reason for postponing any increases.

“The cost of living rises nearly 3% every year. If you don’t increase your fees to AT LEAST keep up with the cost of living, you are losing,” pointed out a prosthodontist. “We’ve been increasing our fees 3-5% once every year and have had no complaints.”

But others disagreed. “My patients are actually leaving for less expensive dentist prophies,” said one dentist. Another said, “Usually we raise fees annually, but with current economic climate, we’re actually giving financial incentive (reductions) instead of raising fees.”

In this survey, here’s what dentist respondents said:

  • 50% have raised fees in the past year
  • For 31%, it’s been over 1 year
  • For 15%, it’s been over 2 years
  • For 3%, it’s been over 3 years
  • For 1%, it’s been over 5 years (Ouch!)

And here are some comments:

  • “Smaller increases more often create less hassle than larger ones every few years.” (New York dentist)
  • “I usually raise fees yearly, but this year we have done what we can to maintain last years fees on most procedures.” (Michigan dentist)
  • “I get the Zip code fee analysis. Any fee below the 90 percentile, I raise to the 90 percentile on an annual basis. If it is above the 90th percentile, I usually leave it alone.” (Kentucky dentist)
  • “Everything else goes up (except insurance reimbursement), so why not raise my fees?” (Pennsylvania dentist)
  • “I really feel the need to do so, but feel that to do so in these economic times would send the wrong message.” (Kansas dentist)
  • “In the past I have raised fees every three years, but with the economy I decided to wait until April 2010. This will have been 5 years since my last fee change.” (General dentist)
  • “We evaluate our change in costs to do business every 6 months and adjust fees accordingly.” (Texas pediatric dentist)

Read more: Raise Dental Fees? Only 50% of Dentists Have Raised Fees This Year


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