TorilMUD Forums

http://health.usnews.com/health-news/ma ... caid-study

Children with a need for urgent care frequently cannot get an appointment in Illinois if they don't have private insurance. Dentists frequently offer to see the patient if they will pay cash.

http://www.foxnews.com/health/2011/05/2 ... tudy-says/

I hadn't gotten around to posting on this, but heres a related article.

You know whats coming next... dentists will have rules/laws written to penalize / prosecute them for considering a patients ability to pay before accepting them as a patient or treating them... Or they will be barred from participating in dental exchanges unless they accept medicare patients... or licensure... or government contracts or something.

they did it for hospitals in the 90s... you must accept all comers to emergency rooms and provide treatment regardless of ability to pay... which was used as the justification for ACA, the uninsured are a burden on the insured...

If I were the dentist, I'd probably take a case like the one presented in the original article on moral grounds. Problem is, I suppose I would not be a very successful dentist.

The problem is dealing with government takes too many resources. Couple that with the low reimbursement rate and why would you want to take more business where you don't make your expenses.

... and then theres the actual folks. I've posted an article in the past on concierge medicine (think subscription servce for private access to a doctor). One doctor said literally, i like it better because I don't have to help people who don't help themselves. If you won't go on a diet even though I've told you 10x, why do i keep wasting my time seeing you? If your kids don't brush their teeth after meals year after year, why do i keep seeing them?

Really, unless you've worked for a provider and billed medicare/medicaid you have no idea how hard it is to get anything done or find out information on anything. You literally have to pay people to sit on the phone. That aint making you any money.

I'm on the fence on whether i'd take medicare patients. I think that I would as long as I could make at least what I do now which is substantially less than a dentist probably makes. I've never aimed at being rich, only comfortable so it doesnt much matter to me if I give away my excess wealth... but in a way I decide to do so.

I think it may be more a shortage of dentists. I mean, dentists should prefer 50% reimbursement to zero work. My take away from the article is that US dentists are busy enough that they don't have downtime.

Money is probably usually the #1 thing, but don't discount the role of bureaucracy.

You're dealing with highly intelligent people at the top of society... and forcing them to deal with a government bureaucracy that makes no sense where every time they turn around theres a new subltety to some specific type of insurance claim that is a new problem. If I have a problem in my life, I get rid of it.

There is plenty of money to be made administrating dental care to children under Medicaid.

http://www.nieman.harvard.edu/reportsit ... ?id=100963

Of course, a good part of that money is paid by the bureaucrats to corrupt dentists for unnecessary procedures.

kiryan wrote:Money is probably usually the #1 thing, but don't discount the role of bureaucracy.

You're dealing with highly intelligent people at the top of society... and forcing them to deal with a government bureaucracy that makes no sense where every time they turn around theres a new subltety to some specific type of insurance claim that is a new problem. If I have a problem in my life, I get rid of it.

Kiryan: smart people hire not as smart people to navigate it for them.

In a small office where your intake person is also doing your back end billing, who do you think they escalate to when theres a problem. Its not the dental hygenist, its the dentist. When the doctor is looking at his books or meeting with his office manager/accountant, what do you think he does when he finds out theres 27k in pending reimbursements from medicare? He tries to solve the problem because thats the kind of person he is.

A good competent biller who has the experience and competence to handle these issues for the dentist will run you 16-20 bucks an hour. Pay less than that then the dentist is more involved.

My aunt worked in denistry for 30 years. Small practices employing at most a couple of front office, a couple of back office 5-10 associate hygenists and 1-2 dentists. Billing issues with public insurance are a nightmare and you generally do eventually get your money, after you spend 10x the amount in soft costs to get it.