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  • Writer's pictureDr. T.J. Emmer

Why I don't participate with Insurance Carriers

Sometimes patients have a hard time understanding why we don't participate with their insurance companies. I will try to explain.

My responsibilities are completely different from insurance companies and most often, in conflict with them.

My responsibility to you is to make sure you receive the best care that I can deliver, in a setting that only delivers that care if you actually require it.

That responsibility is focused entirely on issues having to do with your health. The insurance company is focused on something completely different.

Because insurance companies are almost always public companies with shareholders expecting maximum profitability, those companies regard your benefits as nothing more than a cost -- a cost that should be minimized to the greatest extent possible in order to generate the highest shareholder value.

Notice that considerations about what is best for your health are not factors in this calculation other than to try to select patients who are healthy and require no to little care and avoid patents who are sick and affect the bottom line.

The way these companies operate is as follows.

They find dentists who are not busy and approach them with promises to supply them with many patients. They have no interest in determining whether these dentists are ethical, trained appropriately, or have distinguished themselves in any way.

In return for what they promise (an unending supply of patients) they require the dentists to cut their normal fee 30-40%. Now, many dentists at the highest level have an overhead in the 70% to 80% range. So, if a dentist reduces his or fee by 30%, he or she would either be working for nothing or operating at a loss.

So, what does the dentist do? He or she cuts his or her costs. These dentists find a way to reduce their overhead. They use cheaper labs, lower skilled employees, delegate more procedures, run from appointment to appointment in a frantic attempt to see more patients.

In dentistry, it's possible to lower your overhead tremendously but it comes with a terrible cost; it impacts the kind of care your patients receive.

For example, in your case, we discussed what will be required to treat you at the level of care appropriate for producing a successful outcome. I will be seeing you multiple times; in fact, as many times as it necessary to get the result we both want. In an insurance practice, at most, you will be permitted 40 minutes to an hour for treatment and it will be done in a single visit.

Can you get adequate care in this system? Yes, sometimes you can. Sometimes that is all you need.

The bottom line is that a practice that participates with insurance carriers operates in a different model with different objectives and different restrictions. That model provides a kind of care that works well for many people and that many doctors and patients are willing to accept.

I personally prefer not to operate in that model. I want to offer a kind of care that is focused on what is most important to me, your health and doing whatever it takes to generate positive outcomes. I need to make a profit, but when that desire trumps considerations about your health, when that day comes, I will find another profession.

I hope this helps you understand why I have personally chosen not to participate with any insurance carriers.


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