It is a tough problem!

    Don't hold that against him.  Just go to a Endodontist for those few
occasions.  (That said, my GP seems to know which ones to tackle himself and
which ones to refer)

    The short answer is that you find a good dentist in exactly the same
fashion that you find a good plumber.

    A longer answer is:  If you can find a friend, or a friend-of-a-friend who
works in the dental lab biz and is willing to give you an honest answer, you
will have a good chance of finding the dentist you are looking for.  My dentist
is only fee-for-service and I am convinced that is the cheapest and best route
over the long haul.  If you can't find that person, then try anyone else who has
been in the dental biz in your local area for at least a few years.  Catch them
away from their job; such as church, supermarket, PTA meeting, somewhere where
they can talk freely.  Everybody has a reputation, you just need to find the
friendly person who is in a position to know them.

Vaughn

The vast majority of dentists I have met for over 30 years are NOT "con
artists." They expect to work hard and provide decent care for a decent
fee.

We need to clarify what is meant by "accepting" dental "insurance."

There are at least three types of "dental insurance," depending on
definitions. Others may have their own preferences, but I divide dental
"insurance" products into three main categories: UCR insurance, PPO
insurance, and capitation plans (which like to call themselves HMO's).

UCR and PPO insurance plans are fee-for-service. Capitation plans are
mostly NOT fee-for-service, though they may contain some co-payments
for various services.

The majority of dentists, but not all, accept fee-for-service dental
insurance. So it's not hard to find a dentist who takes most dental
insurance.

The majority of dentists do NOT accept capitation dental plans, because
such plans do not pay the dentist for the actual work he performs. Most
people want to be paid for their work and dentists are no different.

These capitation plans pay a dentist a small amount each month for a
predetermined 'list" of captive patients. The dentist accepts this
small fee, which is ENTIRELY INADEQUATE for the treatment he agrees to
provide these captive patients.

So, you may ask, if the fee is inadequate, WHY do dentist sign up for
these "plans?"

There are several answers. First, a dentist may just not understand how
these plans work. The salesmen are pretty good at telling dentists they
will have plenty of cash flow and plenty of patients. But if a young,
naive dentist takes these plans and delivers normal treatment with
normal expenses with this inadequate compensation, his office soon will
go broke. A few dentists learned this the hard way and went bankrupt,
losing their offices and their livelihoods.

I have even been told by some HMO plan salesmen (who sell the plan to
dentists, not to patients) that their particular plans prohibit their
dentists from taking more than 40% of their patients in HMO plans!
That's because those plans recognize that the dental office LOSES so
much money treating their patients, because the monthly capitation paid
to the dentist is so grossly inadequate, that the dentists run the
danger of bankruptcy, and the HMO plan then would have to scurry around
to find a replacement dental office.

So those capitation plans I checked out are guilty of hypocrisy. They
tell the dentist that he can make a living but their actions prove
otherwise.

Second, some dentists join an HMO plan because they think that most of
the patients won't actually make appointments to be seen. If the
dentist gets a captive list of 100 patients, and only 50 of those show
up each year, that has the effect of doubling the paltry HMO monthly
payment made for 100 patients. Even then, the dentist eventually
discovers that the fee won't even cover the cost of treating 50
patients!

Thirdly, a few dentists may figure they can beat the system. This can
be done by "bait-and-switch" or by "pacing."

"Pacing" is the practice of postponing the appointments of HMO-plan
patients by as many weeks as possible. The dental office paces itself
in how many appointments are given to HMO patients and how many to
profitable patients. The dental office calculates how much money it can
afford to lose, then "paces" the flow of any more money-losing HMO
patients by postponing them into the future. This, in effect, means the
dental office actually sees far fewer patients than the number for
which it receives monthly payments. In some cases it makes the
difference between profitability and a dead loss.

Pacing is less prevalent than it was 20 years ago, as most HMO's now
prohibit the practice. And most contract dentists realize that pacing
does not increase office income by a single dime, it just means fewer
patients seen for the same small monthly compensation.

"Bait-and-switch," on the other hand, has the potential of solving the
capitation dentist's problem of inadequate compensation by selling the
patient on services that will actually provide a living income. It
places the patient in the difficult position of trying to determine
whether the proposed services are needed or not -- and that decision
usually takes a great deal of dental education and expertise.

Most dentists are not so bereft of business sense as to sign up with
HMO plans. They recognize that REAL insurance (UCR and PPO) pays
according to the work done. UCR insurance pays part of the fee for each
procedure done, and the patient pays the rest. That is simple and
straightforward, though the paperwork can sometimes be something of an
impediment, depending on the case.

Most PPO insurance also covers some treatment even if the dentist is
not a member of the PPO. For this reason a dentist can view a PPO
policy as a UCR policy that just pays less. The patient still pays the
portion of the fee that the insurance doesn't cover.

In a nutshell that's why most dentists accept insurance. It doesn't
matter to most dentists who pays the bill, as long as the bill is
properly paid. If the insurance doesn't cover much, the dentist is
still paid properly by the patient for the difference.

PPO plans generally pay a higher percentage of the fee if the dentist
is a PPO member. However, the PPO also sets the fee, which is always
somewhat lower than the going rate. If the PPO fee is near to the
dentist's normal fee, then many dentists become members. They believe
the PPO plan will steer patients to that dental office, without much
loss of income for the dentist.

If the PPO fees are too low, then the dentist does not join the plan.
He can still see PPO patients but the insurance just pays less, and the
patient pays the rest.

If a dentist considers joining a PPO, he must make an individual
decision as to whether that PPO's fees will cover his own fees or not.
If not, he just doesn't join. He can still see the PPO patients, but
the patient pays the difference up to the normal fees.

What do I

I would not advise choosing a dentist simply on his unwillingness to
file insurance claims. If you have real insurance, not a capitation
plan, you should be able to find thousands of good dentists in
California who would be happy to see you.

There are very good dentists who take insurance, and there are some
very good dentists who do not take insurance. So you can't judge dental
skills on the basis of whether he "accepts insurance."

Please remember that capitation plans are not insurance, they are
captive-patient dental plans, so anything I say about insurance does
not apply to such plans.

I don't know why your friends go to the dentist so seldom. Nationwide
statistics say that people are actually going MORE often for dental
visits than ever before.

It may also be that your friends are full participants in our modern
"mobile society." Perhaps they move so often that they don't say in one
place long enough to be a part of the local community. This is a real
problem in establishing a long-lasting relationship with a dentist.

In years past, people lived for a long time in their communities, and
everybody knew which dentists had which reputation. If people no longer
reside in the same place for more than a few months, it's difficult for
them to establish the time-honored rapport that used to be common
between dentist and patient. It is also difficult to form a feeling of
community with neighbors who are essentially transients.

Unfortunately some dentists may also lose motivation to establish a
long-lasting rapport when the patient is just going to move in a few
months anyway. It would be best to look for a dentist who is known for
good relations with his patients.

If you restrict your choice of dentists to those who have been signed
up by one of those capitation plans, you may be eliminating any
possibility of ever meeting the majority of fine dentists in your
community.

Of the better dentists I have known in my own Southern California
community for over thirty years, not a single one of them would ever
sign up with a capitation plan.

Look outside that small list of HMO-captured dentists. Consider the
vast majority of dentists who work for the patient, not for the dental
plan.

These costs vary enormously from one dentist to another. As it has been
stated by others on this forum before: you don't always get what you
pay for. Sometimes you get less. But does anyone really think they will
get MORE than what they pay for, as these HMO plans seem to hint?

Best regards,
- dentaldoc

Have you tried the local dental school? They usually have residency
programs, and you'd get good treatment there.
SP