Let me start off by saying that opening my own practice from scratch was one of the scariest moments in my life thus far. I knew I had a good portion of dental knowledge amassed over the last few years, but what did I know about running a business? I could sit down and talk to patients about decay and occlusal wear; however, could I sit down and talk to a team about the goals of the practice and how to achieve them? What about how much my fees would be for my services, and what insurances I should take? How would I go about preparing my office for HIPAA and OSHA protocols?
Many of these questions I later found out could be answered through various departments and locations through the ADA’s resources. In this article, I will be discussing several of those resources that can be huge assets when you decide to make the leap into practice ownership.
Shortly after setting up my own practice, I was contacted by one of the local representatives of a dental benefit plan. They wanted to know which carriers I would be in network with and also inquired about participating with them.
Since I was just starting out my own practice without any patients, I knew that participating with insurance plans would provide me with an influx of patients. However, I wondered what it would cost me down the road. Just as a refresher, if I became a contracted provider with this insurance company, I would be held to their fee schedule and would only be allowed to charge a patient what they had deemed an appropriate fee. For example, let’s say if normally I were to charge $1,200 for a crown but the insurance company only allowed a charge of $800 for their patients; then I would be looking at a loss of $400 in profit without even picking up the hand-piece. Looking on the opposite spectrum I also had to consider that by becoming a participating provider I may have an increase in 25 new patients a month as opposed to 5 without participation.
This arises the question of how do you know when it makes sense financially to participate with an insurance company? Well, good news, the ADA has developed a benefit plan analyzer that gives you information to see if participation with a certain insurance company makes sense for your office. The program will actually sync with your current system and give you a rating from one to 100—100 being in the best interest and financially speaking for the dentist to participate with the plan. There is nothing worse than starting a practice participating with 10 or 15 insurance plans only to be busy but not productive. It can be a very tough road to recovery from there, which is why I recommend you take a look at this program to help you make those decisions from both a capacity and financial perspective.
This blog post, reprinted with minimal edits and permission, originally appeared in the Virginia Dental Association journal. Dr. Cappy Sinclair is a New Dentist Now guest blogger and a 2009 graduate of Virginia Commonwealth University. Dr. Sinclair currently serves on the Board of Trustees at the Academy of Cosmetic Dentistry, as member of 3M’s Council for Innovative Dentistry, and as an ambassador for the Dawson Academy. He started his own practice Coastal Cosmetic Dentistry 3 years ago from the ground up and is more than happy to share his success and failures with fellow new dentists. He is a member of the American Dental Association and the Virginia Dental Association. To contact Dr. Sinclair, email him firstname.lastname@example.org.