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Medical Forum / General / Dentistry / July 2006Why dentists charge differently for different patients for the same procedure?
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 > Hello friends, > [quoted text clipped - 12 lines] > > -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. > Hello friends, > [quoted text clipped - 12 lines] > > -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 > 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 [quoted text clipped - 3 lines] > > 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. >>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 [quoted text clipped - 8 lines] > 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  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Can't patients also demand that the charge(s) be the same as what insurance companies get? UM MOM Susan >>>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 [quoted text clipped - 27 lines] > > Steve > 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 SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > 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 > 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? > > 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. "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. >>As Steve has already pointed out, the office overhead in dentistry can >>be as high as 75% or even 80%, [quoted text clipped - 5 lines] > liablility, and the pay must be just a little higher than the pay of an > average computer geek then? From Managed Dental Care: The average U.S. dentist, the association says, including specialists, earned net income of $213,065 in 1998. Probably $275,000 now. Quite a bit for than a geek. 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 >> Can't patients also demand that the charge(s) be the same as what >> insurance [quoted text clipped - 43 lines] > Best regards, > - dentaldoc Then, offer to buy a HUNDRED Buicks, only if he will drop the price Watch the price drop! (This assumes you have credibility and th 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. Joe -- Joel34 "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 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. Thi historic document was printed by the American Banknote Company in th 1960's and has an ornate border around it with a vignette of th company logo. This item has the printed signatures of the Company’ President and Treasurer. This is the first time we have had thi 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 th developer of Muntz TV. Bill Wrote: > "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 [quoted text clipped - 23 lines] > > - dentaldo -- Joel34 Joel wrote: Yup, I know exactly who that is! Go here: http://www.scripophily.net/muntztv.html _____________________________________ Yep, that's the guy! At one time, his billboards were spread out all over Southern California. From cars to TV's to stereos, Madman Muntz was a big-time promoter for years. Given his history and his method of driving a car, perhaps he WAS a madman: "Muntz was married seven times, and until the end, he drove a custom Lincoln Continental with a TV built into the dashboard (he claimed it helped him to drive better)." The dashboard TV must help the driver when he gets bored with watching the road! - dentaldoc > 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. > 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 [quoted text clipped - 4 lines] > 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. In my neighborhood $1M will buy a nice apartment, but probably not on the best block. Neighborhoods aren's snobby---it's the PEOPLE! Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > In my neighborhood $1M will buy a nice apartment, but probably not on > the best block. > Neighborhoods aren's snobby---it's the PEOPLE! > > Steve What are they charging in Manhatten? I knew somebody renting there, they wanted $500,000 + for 1 bedroom apartment years ago? What did that famous investor say when asked what he would change? "If I could change one thing i would have bought up every square inch of Manhatten when I had the chance" Nommuch in Manhatten ...... Clinton Wrote: > > In my neighborhood $1M will buy a nice apartment, but probably no > on [quoted text clipped - 8 lines] > "If I could change one thing i would have bought up every square inch > of Manhatten when I had the chance -- Joel34 Joel344 Wrote: > Nommuch in Manhatten ...... I mean not much in Manhattan ...... -- Joel34 >> In my neighborhood $1M will buy a nice apartment, but probably not on >>the best block. [quoted text clipped - 7 lines] > "If I could change one thing i would have bought up every square inch > of Manhatten when I had the chance" It varies greatly by neighborhood and building amenities. My wife works exclusively in Brooklyn, which is relatively reasonable (relative only perhaps to Manhattan). I'm sure you can still find a decent 1br in Manhattan for 500K (to buy). There are also rent regulations in NYC which do distort market prices. You still hear about little old ladies living in a palacial 4 br apartment on the UW side paying $200/month rent, but the market is gradually being deregulated, so you don't see much of that anymore. Still, there is no question that rent regulations have had a terrible effect on the condition of housing in some neighborhoods. I am inclined by temperament to favor low-income renters in areas besieged by real estate speculation. But since being married to someone who has been in RE partnerships, I definitely see the other side of the argument. Steve > In my neighborhood $1M will buy a nice apartment People buy apartments, there? I've never heard of that. I've heard of buying condominiums and houses, but apartments are always rented. > > In my neighborhood $1M will buy a nice apartment > > People buy apartments, there? I've never heard of that. I've heard of > buying condominiums and houses, but apartments are always rented. Well, I don't know, obviously someone has to own them. I think the landlords had listed the price of the apartment on a website in case anyone wanted to buy, either for themselves or to rent out. Do you know how much the rents are in NY city? Now the Bush adminitration would have believe that since the price of a loaf of bread hasn't gone up, there is no inflation! "Clinton" <clintonz@prodigy.net> wrote in news:1143207493.818360.247530 @j33g2000cwa.googlegroups.com: >> > In my neighborhood $1M will buy a nice apartment >> >> People buy apartments, there? I've never heard of that. I've heard of >> buying condominiums and houses, but apartments are always rented. > > Well, I don't know, obviously someone has to own them. Not just to live in, though. Anyone who owns apartments owns a set of them, and they rent them out. > I think the > landlords > had listed the price of the apartment on a website in case anyone > wanted to buy, either for themselves or to rent out. Individual apartments aren't bought and sold. At least not that I've ever heard of. > Do you know how > much the > rents are in NY city? I'm sure it depends on where in the city one chooses to rent. Steve wrote: "In my neighborhood $1M will buy a nice apartment." "People buy apartments, there? I've never heard of that. I've heard of buying condominiums and houses, but apartments are always rented." Clinton replied: "Well, I don't know, obviously someone has to own them." Lorm then replied to Clinton: "Not just to live in, though. Anyone who owns apartments owns a set of them, and they rent them out. "Individual apartments aren't bought and sold. At least not that I've ever heard of." ________________________________ OH YES, individual apartments are indeed bought and sold in New York City! Some folks are making millions from that fact. Long before the rest of the country had "condos," the folks in New York were buying and selling their individual apartments. The word "condominium" was not in common use, so people naturally called their apartments . . . well, "apartments." An early form of ownership was the "co-op." Many apartment buildings in New York City are owned by their residents in the co-operative form of ownership. Other buildings are owned by their residents in the condominium form of ownership structure. Most New Yorkers that I have ever met don't use the term "condo" like we do in California. The regional term used in New York has traditionally been "apartment." That's probably because New York had individually-owned apartments long before the rest of the country had condominiums. They were way out ahead of the rest of the real estate world. Some New York apartments are owned individually by the residents, and some are rented. The big money is made by ownership, and then selling at New York prices. I still think those Dutch who bought Manhattan (from the wrong tribe of Indians) for $24 in beads got a great bargain. - dentaldoc > ________________________________ > [quoted text clipped - 26 lines] > > - dentaldoc Bill: I'm sure there are regional differences in usage in real estate, as there are in other areas. In New York, the term "apartment" refers to the configuration of the living space (ie: a multiple unit dwelling usually with a common entrance and other amenities, such as parking lot, grouped mailboxes, corridors, garden, etc.) and not the mode of ownership. Condominium is usually considered owner-occupied apartments with common areas. There are common charges which pay for capital improvements and repairs, maintenance (incl. superintendent salaries), utilities to common areas, gardening etc. I believe that the concept of "cooperative apartments" is largely restricted to the New York area. In common usage coop apartments are owner-occupied, but technically they do not qualify as real estate at all. The owner legally owns "shares" of the building; they do not sign a deed, but a proprietary lease. In New York (at least) most coops have what is called an "underlying mortgage" on the building, which for reasons I don't understand is generally financed as a "balloon mortgage" which is an interest-only loan. At the end of the mortgage term it must be paid off or refinanced. This is not true generally for condos. For this reason common charges on coops tend to be much higher than for condos. The portion of the coop's common charges related to the underlying mortgage are tax-deductible to shareholders, as is any mortgage interest paid. Both condos and coops generally have a board of directors, but usually the amount of control exercised over the building is far greater in a coop than in a condo. For instance, coops generally must approve all purchasers. Unless this has changed recently, deliberations of coop boards are protected, and it's thus very difficult to prove charges of discrimination in these deliberations. In my condo building, the board must waive its "right of first refusal" in order to stop an owner from selling to another. Other than that, if the buyer gets a mortgage, they're in. There are rules about operating a business out of the home, but I doubt action would ever be taken against an owner unless they were very disruptive. Most disputes with owners in my building have been related to noise or dogs. Steve. PS. I was on my condo board for 3 1/2 out of the past 12 years, 2 of them as president. I'm not any kind of real estate magnate--I just happen to live with a RE broker. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 I heard aspirins are $16 in the hospital but a few pennies less outsid .. -- Joel34 In NYS, that's account of the legislation. You see, some compassionate person decided that everyone needed health care. So, they passed a law that said that anyone who could make it to the door of the hospital had to be treated, regardless of payment or lack thereof. I was (past tense) on a low risk plan for mostly healthy people. My insurance company left NYS, and now the companies who remain are far too expensive for me to afford. So, due to the law requiring health care, I no longer have health care. However, I can get Healthy NY, state run socialized medicine. I think that was the plan all along -- to socialize medicine. SignatureChristopher A. Young You can't shout down a troll. You have to starve them. . I heard aspirins are $16 in the hospital but a few pennies less outside ... SignatureJoel344 ---------------------------------------------------------------------- -- 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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