The Reality of Dental Insurance You May Not Know, But Should

The most common question we get from perspective new patients is not “Is Dr. Shvartsman gentle?” or “Is Dr. Shvartsman a good dentist," the most common question we get is “Why aren’t you on the list of my company says are Preferred Providers?”  or " "do you take my insurance in full?" These is questions are also asked by our existing patients when their employer switches their dental insurance to a cheaper HMO/PPO or a Capitation plan. I could give you a wishy-washy, sugar coated answer-some dentists do. But I think my patients deserve the real answer.

Every dentist is solicited by three or four insurance companies each month to join their plan. Contrary to popular belief there is no quality control or screening process even though it sounds like you will be joining an elite family of dentists. The “elite” are simply whoever wants to sign up and be a discount dentist. “Preferred Provider” is an insurance industry term; it has nothing to do with a dentist’s skills, knowledge, training or experience.

The Free Lunch

The promotional material we get from these multi billion dollar insurance companies is very appealing.  It appears everyone wins in this deal: the patients now get FREE (or greatly reduced) cleanings, x-rays, exams and perhaps even fillings. Even the major treatment is much cheaper.  They’re ecstatic! Your employer has much cheaper dental insurance premiums to pay each month, they’re ecstatic! If you have been following the profits of the HMO/PPO industry you know they are making money hand over fist. The insurance executives are the most highly paid in the business world. So we know they’re ecstatic too.

This must be the mystical free lunch at last. Who could lose? Unfortunately someone has to absorb the costs of all this free or cheap treatment. You guessed it-it’s the HMO/PPO dentist. No dentist that I know is willing to move to a smaller house or buy a smaller car, so how do they do it?

Now, you ask, “Why would anyone work harder for less money?”

Well, my friends, that’s the million dollar question. Let’s look at why anyone would do this. The insurance industry dazzles dentists with promises of endless patients and busy practices. Then they add, “Oh, did we forget to mention that you have to give away many services for free and cut the rest of your fees by 30-50%?  But, don’t worry about that,” they point out, “because you will have two to four times as many patients to try and see in order to make up for the lost revenue. You’ll just have to work faster.”

OK, so that’s the dentist’s problem: do more work in less time. What about you, the patient. How does all this affect you? Here’s how:

Understand that an HMO/PPO dentist is paid 6-10 dollars per month per family or patient whether or not that patient ever shows up in your office. Now if that patient does want to come in and get their teeth cleaned or a filling done (which the dentist is by contract required to do for FREE) do you think that dentist (or anyone else in the practice) actually wants that patient to come in? Of course not. He doesn’t make any money when the patient comes in. Does it make any sense to pay someone not to perform their craft or practice their profession?

The main reason a dentist would voluntarily choose to become a Participating Provider for a Dental Insurance discount plan is when not enough of the existing patients refer their friends or family members to them.  They simply do not have enough patients to treat. Do you really want to trust your oral health to a dentist that does not get enough patient referrals to sustain a viable business and turns to Dental insurance companies to fill his empty schedule?

Now do you see why it might be difficult for you to be seen for a routine visit or in an emergency in one of these practices?  The biggest complaints from patients about HMO/PPO practices are they can’t get an appointment and they never see the same dentist twice.  Is there any mystery now as to why?

Too Many Cut Corners

In my opinion to be an HMO/PPO dentist I would have to sacrifice quality, service and the personal attention we give to our patients.  In short we would have to give up our ethical and clinical standards.  I won’t do that and it’s an easy choice to make.  I won’t see two to four patients at the same time, sacrificing quality for the sake of quantity. I won’t have my assistants perform parts of my patients' treatment while I see someone else in the next room. As an HMO practice we would have to use cheap labs usually located in Malaysia, Costa Rica, Pakistan or China or a dirty basement or garage. I would have to use cheap dental materials, rush my work and cut corners.  Some of the corner cutting would come in the area of sterilization, by not providing as many disposables as we now do.  My patients are too important for us to do that to them.

The medical profession has all but lost the war to the insurance industry. Ever feel like just a nameless number when you wait for one or more hours for your “scheduled” appointment.  The story has been well documented in a recent TIME magazine cover story. Don't be fooled: Government controlled health care is really scary. I  know first hand. I grew up in Communist Russia where the Government controlled everything.

The dental profession still offers the freedom to choose your own dentist and level of care (Although some lower-end insurances will not pay a penny towards your treatment unless you go to their discount dentist, I mean Preferred Provider). As long as that continues, I promise to provide you with the same high level of care that I do for my family and close friends.  You deserve nothing less.


Alex Shvartsman, DDS
Master of the Academy of General Dentistry
Fellowship in Dental Implants and Advanced Prosthetics

Click to schedule an appointment or call 631-361-3577

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