If you have PPO insurance, your immediate cost of treatment is lower due to the nature of Preferred Provider Organizations, but in the long run costs go up because of it. The insurance companies come up with some contracted rate which is lower than usual, customary and reasonable (UCR) and then try and encourage dentists (and physicians) to join by stating we will have an increased number of patients to make up for it. A contracted provider cannot charge the patient the difference between the contracted fee and the normal office fee. Often times these discounts are quite large. If a provider’s office fees were within UCR and now he is suddenly providing the same services for less, he took a pay cut when he became a PPO provider, unless that is replaced by higher volume or others pay more to make up the difference. Volume would go up if the provider were the only contracted provider in the area, since patients would have no one else to choose from. That is rarely the case however. What is more likely to happen is an escalation of normal office fees to make up the difference. It is really no surprise that hospitals charge what they do to cover PPO discounts and the uninsured. Once a contract is in place, there is little incentive for the insurance company to raise the rates. Everything else gets more expensive; office rent, supplies, staff wages, but insurance PPO payments remain static leading to more escalation of regular office fees. If there is no discount, there is no point to having a PPO.
Over the years our office has been a preferred provider for multiple insurances and that list has been shrinking with time for a variety of reasons including 1) discount is too steep, 2) no cost of living adjustment, 3) a mandatory reduction to an already discounted fee, 4) insurance executives getting substantial pay raises while reasons 1 through 3 happen at the provider level. As of July 14, 2017 we ceased being a Delta Dental of Missouri Premier provider and as of November 1, 2017 we will cease being a Cigna provider. While I will no longer be a PPO provider for any insurance company, I am also putting my money where my mouth is. My regular office fees have been reduced 5-20%. I will no longer be asking any group of patients to be paying more or less than another group of patients based upon whether you have a specific insurance or not.
How does this affect you? I am hoping it doesn’t. Your insurance is still accepted here. We will continue to file all claims for you and unless it is Delta Dental of Missouri or a Medicare advantage Plan, will continue to accept assignment of benefits. Delta Dental of Missouri does not allow assignment of benefits unless it is to a contracted provider. If you have Delta Dental of Missouri insurance you will be responsible for the entire bill and will receive a check from Delta, usually within two weeks. If your insurance was a PPO plan that we participated in, you will no longer have a discount, but you will be billed my new lower fees, the same as everyone else. For the most part, checkups and cleanings are typically covered at 100% of my fees anyway. If you need other treatment, you will pay your deductible and co-pay percentage based on the new lower office fees, rather than the PPO contracted fees.
If you don’t have insurance, you will no longer be subsidizing those who have PPO insurance. If you have any questions, please call and speak with Leslee who handles your insurance, or ask her for a little extra time at your appointment to discuss it with me. We have also put together a few examples to illustrate what some procedures would have cost under discontinued PPO plans vs. the new lower fees. If you would like specifics as to which companies were doing what and how much their executives are getting paid while you try and afford insurance premiums, we can share that as well.