I recognize the benefits health insurance has provided to society by granting access to medical and dental service to many who would otherwise not seek care due to fear of large medical bills or even worse decide to seek treatment when their illness or health condition deteriorates to the point where it outweighs any monetary concern which can have greater financial and/or health consequences. Generally speaking, when the healthcare model involves two sides, the patient and the provider; it aims towards providing the best treatment of choice indicated for the patient’s condition. Which maintains an equilibrium from both sides that share the goal of managing and/or resolving the condition or concern that brought the patient initially to our office. Granted this model is not perfect because it is thrown of balance by variables such as: fees which some patients can’t afford, lack of understanding in the value of the treatment of choice recommended, and their benefit over other treatment modalities from patients that can afford the initial fees, etc. This unfortunately prevents some people in seeking and receiving outstanding healthcare. Although health insurance has provided the benefit to society by increasing people\\\'s access to healthcare it has also created new obstacles affecting both providers and patients. Managed health care and health insurances have become a 3rd player in our modern healthcare model exerting pressures on both ends by the incorporation of a business driven healthcare model which in many cases questions the treatment of choice and challenges its necessity affecting the time and frequency treatment can be given. These obstacles also impact our patient’s decision on where, when, and what treatment they will accept; and exerted pressures on providers that can sadly influence many in their decisions on where to practice, what equipment, instruments, and materials they acquire and worst what insurance to accept (who do I treat), which all directly affect the decisions on how and when to treat and what time should be invested in treatment. This is a controversial topic because it is viewed from 3 very different perspectives being the provider, the patient and the insurance company. I believe most people would agree to rank them in the priorities stated below: 1) First and most important the patient receiving the best treatment of choice which can resolve their condition. 2)The provider being able to recommend and administer the best treatment of choice with out time restrictions and/or financial restriction from a third party. 3) The insurance company maintaining and increasing their pool of satisfied and healthy customers and network providers while financially benefiting for its services. From my experience I feel that in many situations the ranking of the above mentioned priorities are inverted and shift towards insurance companies benefit being first on the list and our patients falling last on the bottom of the list.

Sorry you lost money on those types of patients, Daniel. I love your "goal setting," Anna. Too many people just go with the flow and never assess what has transpired, often over many years. This happens with financial planning as well. Maria, not speaking perfect English has nothing to do with how capable is a dentist. The issues that arise are often over misunderstandings due to language differences. This is especially true when explaining treatment plans, fees, alternatives and so forth. An area of practice that really suffers from language differences would be psychology/psychiatry. In those cases, not only are there problems with communication, there could also be cultural differences that make the process less than ideal.

I did not have much knowledge how HMO works. When I bought my first practice, the previous owner accepted two HMO plans and I decided to keep them for 6 to 12 months or so. My plan was to get to know patients and when I drop the plan, hopefully many of them will stay because they like me. I was wrong! Dead wrong. I still remember there was #14 Zirconia crown I did for a patient. She had HMO and without asking, I placed a PFM crown. The crown fitted well, looked good and she liked the crown. However, the patient called me very next day, saying \\\"I see a dark line on the crown. What is that?\\\" She was upset. It was a metal collar on the palatal surface at gingival line. It was no more than 1 mm thick. It is extremely hard to see that metal unless you tilt your head back and thoroughly look around the crown. She was going crazy about it. To make a long story short, I replaced the crown with Zirconia at no additional charge or $20 more. It was on the HMO fee schedule plan. This was a costly lesson. 4 visits for this patient. She paid $275.00 for the crown, HMO paid $4 per person/ mo. My income was $279.00, My lab fees alone $115 for PFM and $210 for Zirconia. This is without rent, staff salary, loan and etc. This was very costly!! Later on I learned how other offices play the HMO game. They tell patients how PFM metals are so CHEAP. If patients want a \\\'COSMETIC\\\' crown, they are going to pay upgrade fee of $800 or $1000 whatever. I personally don\\\'t agree with HMO. It is a lose-lose game for us as providers and patients. No one wins but insurance company. I ran a boutique practice as PPO in-network provider. I worked really really hard, paid everyone but for myself. At the time, I thought it was ok because I am a health care professional, I am supposed to do good for patients and etc. At the end, I was burned out. I did not enjoy doing dentistry anymore. There are always great patients out there who would appreciate your expertise, great service and are willing to pay for it. I have had enough with insurance and will NOT be participating in many insurances plans. $1,000.00 or $1,500.00 dental coverage with PPO plans is from the 70s, and this amount equates to about $6,000.00 in today\\\'s buying power. Insurance companies are not willing to budge, why should we?

It took me a little while to understand the joke about the lollipop stick and duck take, haha! Do you think those doctors who barely spoke english were less prepared than those who spoke fluently? I\'m just wondering.

New dentists have to often choose which type of practice they want to have. With the growth of managed care plans the percentage of private/high end insurance patients has decreased. When given the choice of being busy with lower compensation or struggling to find the few high paying patients, dentists often chose the former. As this post explains, it is a good strategy for building a practice and maintaining cash flow. With time, as the number of patients increases, a practitioner may be more selective and chose not to accept the lower-compensation. Many however become accustomed to the workload, anxious about changing the status quo. Long-term “intense” working conditions lead to burnout with potential psychological and personal ramifications. Therefore, doctors should set concrete goals for their professional and personal lives and, on a consistent basis, evaluate their progress; making appropriate adjustments accordingly. As I worked in private practice I was surprised to learn the lack of loyalty among patients. Often they will leave a specific doctor, even after many years of being under his/her care, for insurance/coverage reasons. It is an unfortunate reality that we as practitioners have to face and accept. It can be very discouraging as a doctor may interpret the action as a lack of appreciation of his/her efforts to provide excellent care despite of being undercompensated in many cases. It is unfortunate that many patients do not realize that there are different levels of quality in dentistry including practicioner’s skills and dental materials used. They often realize when it is too late after substandard work has been preformed on them. I wish more people understood that the concept of “you get what you pay for” also applies to the profession of medicine.