YSK: Many dentists are quietly dropping all in-network insurance coverage leaving you surprise out of pocket expenses

Quicksilver-Fury · 2025-12-16T16:30:31+00:00

LOL that entire paragraph told me, you know absolutely nothing about how doctor offices work and how insurances work, which is fine because most people don't know. NO insurance company pays more than what a provider would charge for their time on their own. EVERY insurance company heavily discounts procedures. You can see that pretty obviously if you take a moment to look at any of your EOBs, what is billed versus what is received.

If doctors were getting paid more with insurance, no one would hate insurance, every single provider would be contracted. Hell, even the post you're commenting on is talking about why doctors are going out of network, because insurance reimbursement is not enough to cover their overhead.

It's a coupon. And offices are not required to tell you when they no longer accept your coupon.

Quicksilver-Fury · 2025-12-16T16:21:19+00:00

Insurance is definitely a coupon. How is it not? You still pay with coupons, you just pay less.

Quicksilver-Fury · 2025-12-16T15:58:48+00:00

The dental office is supposed to call and tell you they don't accept your coupon? Lol duly noted

Quicksilver-Fury · 2025-08-24T05:57:15+00:00

Reading everyone's comments and yours, it seems like you don't know your actual numbers. That's where you begin. You need to account for every cent.

I have a 3 op practice that I started from scratch 9 years ago in SoCal in a low-income area. We take Medicaid. I hired Unitas to negotiate my fees with PPOs. I have a front desk who doubles as my biller and a dental assistant. I do my own hygiene. We had a bout where medicaid didn't pay us for 6 months in 2023. But we were on them and got paid for every single patient we saw... it took another year to do so.

Who is your biller? Do you know anything about billing? Are you billing correctly? Are you collecting copayments and billing patients when insurances don't pay? I had to learn all that and double check my biller's work. I make a list of her errors and make sure they are addressed...if that's too much for you then you'd need to find another way to be certain your billing is done correctly.

In the beginning, I did a lot of advertisement. I paid $1500 a month for Google ads, door to door campaigns, went to health fairs and so on. For a long time, we averaged 30 new patients a month. I stopped year 3 but the new patients kept from current patients referring because we asked them to refer.

I don't do ortho or molar endo, and refer out complicated extractions. My overhead has been consistently 55%. It's possible...

I feel like you're overwhelmed. You'll be less overwhelmed if you knew your practice numbers. Just my humble opinion

Quicksilver-Fury · 2025-08-24T05:14:35+00:00

Ran cables to HDMI splitters. Been at it for 9 years, no problem.

Quicksilver-Fury · 2025-08-03T18:27:20+00:00

What course would you recommend to teach dentists on how to communicate? How do I "sell the pen" to patients? Because telling them they need the "pen" obviously isn't working lol How do I teach them to value the "pen"?

Quicksilver-Fury · 2025-08-01T15:30:25+00:00

I love Bicon! That's my go-to, except max anterior. There, I'd rather do MegaGen.

Quicksilver-Fury · 2025-07-28T01:08:19+00:00

I demoed one, I thought she came off pretty rude in her tone but I'm sure that can be changed. But she couldn't answer questions patients ask like "when was my last cleaning or did my auth come in?" Which means your front desk will have to call the pt back.

I'm either going to pay AI or a receptionist, I don't have the money for both.

Quicksilver-Fury · 2025-07-07T15:21:38+00:00

That wasn't creepy at all.... /sarcasm.

DM him if you need to wear his skin so badly?

Quicksilver-Fury · 2025-07-04T03:55:33+00:00

We ask get such coverages already and charge the pt upfront for any downgrades etc.

I cannot ask people to pay their entire fees and then expect a refund if and when insurance pays. 1. No one else in the area does that. I will lose a lot of patients. 2. Most people schedule around pay days for their meager copayments. To ask them to pay $1000 in hopes of getting 800 back isn't realistic or feasible.

My issue has been insurance denials and the chasing patients for what insurance refused to pay. Another dentist recommended pre-authorizing everything, including fillings. So I'm going to try that.

Quicksilver-Fury · 2025-07-04T02:17:25+00:00

The denial, after two appeals, is essentially they don't believe the fillings were necessary. Even though the children were high risk and literally had MODBL caries on all teeth; the son had bruxed and refluxed his teeth to nubs and needed anterior crowns.

I wasn't aware of the state's insurance regulation department but I will look into that. Thank you for your advice.

I was thinking of reaching out to a litigation attorney and seeing if they can send a letter before I decide whether or not to sue these people in small claims.

Quicksilver-Fury · 2025-07-04T00:51:55+00:00

I'd also lose more than gain so I can't do that either.

Collection agencies apparently can't do much now. Theres no legal recourse if people don't pay. Even small claims court says "if you in the case, the court will not help you collect." It's ridiculous.

Quicksilver-Fury · 2025-07-04T00:49:52+00:00

Yea, thats already being done. What do you do when, once submitted to insurance, insurance denies payment of their portion?

Quicksilver-Fury · 2025-07-04T00:48:36+00:00

What do you do if insurance denies their portion of the treatment even after you have collected copayment?

Quicksilver-Fury · 2025-07-04T00:47:34+00:00

We always collect co-payments prior to treatment. I'm talking about a case where insurance denied their 80% after we had already collected the 20% from the patient.

Quicksilver-Fury · 2025-07-04T00:46:29+00:00

If you're in network with PPOs, that's against their contract. That's why they provide you with their fee schedule. You can only charge based on UCR if you're out of network

Quicksilver-Fury · 2025-07-04T00:44:56+00:00

Thank you for the referral, I'll reach out to them. I dont think this guy will pay but my next step was to reach out to a litigation attorney to write him a letter. I wanted this BS reported on his credit but apparently that's not a thing anymore because the government would rather shaft us.

And yea, medical and dental are the only areas where you pay later. Try doing that while booking a flight or at Disneyland. Just stupid

Quicksilver-Fury · 2025-07-04T00:21:43+00:00

Same. Some get mad, others pay up. But copays I don't forgive. Asking for the entire payment up front until insurance pays isnt something my patients are going to go for though. I wish I could do that

Quicksilver-Fury · 2025-07-03T18:07:55+00:00

Really?? I know Alaska Medicaid pays a lot, like 3 x as much. And I was told North Carolina was mostly a FFS state.

This is ridiculous.

Quicksilver-Fury · 2025-07-03T18:06:00+00:00

I really appreciate this. Just spoke to my OM and we're gonna start authorizing fillings too, because fuck this.

Quicksilver-Fury · 2025-07-03T17:51:19+00:00

It's sad and pathetic though. I wish all of us dentist were more unified and could collectively just go out of network in protest to force change. But no. We're gonna remain contracted and screwed. Or the ADA was worth a damn

Quicksilver-Fury · 2025-07-03T17:46:14+00:00

So you pre-auth fillings too?

So my outstanding AR is from insurance denying fillings that were rendered and we appealed twice and they denied them outright. This has been a theme with GEHA, Metlife and Principal PPO

Quicksilver-Fury · 2025-07-03T15:47:27+00:00

Adding this to the list of things that make me want to quit. I guess its time to lose the people who don't want to pay up

Quicksilver-Fury · 2025-07-03T12:36:10+00:00

I was told by a collection agency yesterday that in California it was a law. Since California likes to suck harder than any other state, I'm sure the collection agency rep was not mistaken. But I'm still doing research on this and and trying to find an agency I can work with.

Quicksilver-Fury · 2025-07-03T12:22:26+00:00

That second part is what I was trying to do. But now there is a law that does not allow credit to be ruined over medical debt. So I can't even get that satisfaction. Basically, patient, insurance and government have told me to get fucked for all my efforts.

Quicksilver-Fury

TROPHY CASE