Some months back, we did an interview concerning practice management with Dr. Charles S. Horn. At the end of that interview, Dr. Horn told us about a letter he had written concerning working with insurance companies. He asked if we would like to look at it and possibly include it in our next issue. He sent it to us and we found it so “to the point” concerning the state of managed care today that we are including it in this issue of The Practice Solution Magazine. We hope you enjoy it as much as we do.
Dear Mr./Mrs. Insurance Company:
I read your letter with great interest. I am indeed honored to learn that I have been singled out of all the fine dentists in Delaware, by one of the fastest growing companies in the country, to be asked to join your health care organization. From the tone of your letter, it is humbling, indeed, to learn that I am one of the best and I am excited to hear about all the new patients that you assure me, will be flocking to my office. Though you mentioned something about my name on some sort of a list, I am sure it is a very short list and all of these patients will be coming to me. You asked me if I wanted a lot of new patients and then answered your own question by saying that I would get many new patients. I can hardly wait to greet these new people, eager to experience new and extensive dentistry, as you promised.
Your fee schedule was a little disappointing, since it seems you will be paying me about 40% less than I usually charge, but that’s OK, because of all the new patients I will be seeing. Considering all these wonderful things you will be doing for me, I feel compelled to ask a favor of you. Since my income will be cut by 40%, I must ask you to send a personal letter (not a form letter) to all the laboratories I deal with. This letter must inform them that I will discount their bills by 40% and not pay their normal charges; also a letter to all my supply houses (the names and addresses are enclosed on a separate sheet). My repair man may be upset, but, with the increased use of equipment, he will be called more often. You must be very tactful when you write to my wife, because, with a 40% cut, she will also have to cut back. My employees may be upset with a 40% pay cut, but, since we will be working so many extra hours with crown and bridge, precision partials and implants, they will not mind, I am sure. My accountant should understand since she will see from our records that we will be working longer hours yet producing less income, but that will be her problem. I will, of course, have to cut back on my vacation time since I will be spending more time in the office (with 40% less in fees). However, I could hire an associate at 40% less than the going rate, but he/she should understand. Our hygienist will have to cut down her appointment time from 1 hour or 45 minutes to 30 minutes, but I am sure she won’t mind. I think 30 minutes should be enough time to do a good prophylaxis, give oral hygiene instruction, take the necessary radiographs, answer questions and for me to do a thorough examination, a cancer exam, answer more questions and make the necessary recommendations.
With all these new patients, we will just have to work faster. With less time between patients, we will have to find short-cuts with our sterilization procedures, but if nobody gets sick or infected, I’m sure OSHA might not notice. We will no longer have time to establish a “dentist-patient” relationship, but that’s OK; with the increased volume, it will not matter that much anymore if we really get to know each patient. The patients might notice, but after all, they will be coming to me for cheap fees and average dentistry and that is what counts, isn’t it? Cheap dentistry? This should make up for the personal time I used to spend with them.
When I went into dentistry many years ago, I wanted to be my own boss and make my own decisions. I understand that if I work for you, (as an employee of some sort), you will take care of me and help me out whenever you can. It will be reassuring to know that I will not have to make my own decisions anymore, about fees and those kinds of things, because you will make those decisions for me. When I read your “Participating Dentist Professional Service Agreement”, some things were just a little confusing. I am sure this “agreement” is in my best interest and you only have me at heart because you want to help me, my patients and your clients. After 30 years of dentistry and my patients calling me “Doctor”, you want to call me only a “provider”. My son is a provider for his dog. Would it be OK with you if I still call myself “Doctor” around my friends and only go by “Provider” with all the patients you will send me? Your contract also goes on to state that I can only refer to one of your member specialists or, if there are none, I must give you notice and get your permission. Does this mean that I have to get your permission before I am allowed to send a patient who is in pain, with a swollen face and a highly infected molar to an endodontist at 4:30 on Friday afternoon? On the leader page that you sent me, you stated “No Paperwork Required from Plan Dentist”, then on your “Service Agreement”, you state “Dentist will provide patient utilization information to (the plan) on forms provided by (the plan) or on such other forms as agreed to between the parties”. My question is… “Are there forms or no forms?” Also, you state that you can inspect any books and documents relating to the dental care services rendered… I assume this also means that I can come to your office and “inspect any books and documents relating to the dental care services rendered”.
I received a letter today, at my home in Pennsylvania, from your company. This letter stated that I can automatically be accepted to your dental plan because I own a certain credit card. It is obvious that the person sending me this letter did not know that I was also a dentist. I noticed, however, that everything you stated in the “credit card letter” does not seem to fit with what you say in your “Dental” letter. The most misleading statement is… “every (dentist) has been extensively prescreened and approved according to our (your) high quality standards”. Your “high quality standards” are… my fax number, my degree, number of dentists and hygienists, number of operatories, do I carry malpractice insurance, my office hours, languages spoken, and my date of birth. I would not consider these high quality standards. It is interesting to know that you consider “high quality standards”, but what about the rest of the card holders? I wonder what they would consider “high quality standards”? All the letter to the card holders talks about it “no charge”, “savings”, “reduced cost”, etc. Whatever happened to caring, good dentistry, cheerful, honesty, truthful, high tech, value, improved care, understanding, listening to patients and, sometimes, free dentistry for people who cannot really afford good dentistry. With you, it all seems to come down to money, not good dental care or a caring dentist, just your bottom line profit.
After writing this letter, I think it would be in the best interest of my patients, my staff, my wife, my laboratories, my suppliers, my accountant, my associates and, yes, even myself, if I just continue doing dentistry the way I have done in the past and the way I want to do it in the future. I might not need all the wonderful things you can do for me or even all the patients you promised. I like the kind of high quality dentistry I have been doing and I do not think I should lower my standards to just adequate care for discounted fees. You can, therefore, keep your forms, cut-rate fees and “Big Brother” tactics. I think I will be happier the way I am… a dentist doing the best dentistry I know how, the way I think it should be done, referring to top rank specialists who do not have to get on a list and being my own man, making my own decisions without someone looking over my shoulder. I also am happy charging what I would consider a reasonable fee without cutting prices so that an insurance company can increase its bottom line profit.
At the fees you quoted, my employees will be making more money than I will. Please do not attempt to contact me in the future, because your literature and that of other insurance companies like yours, is cluttering up my trash can.
Very truly yours,
Charles S. Horn, III, DDS