Do you know why I am a fee for service office?
Because insurance companies don't give a damn about what the correct treatment is for an individual patient. They only care that the codes relating to the patient's treatment are submitted correctly. And if there's a code submitted that doesn't follow that company's rules or guidelines, it is denied.
For example, I used to take Medicaid for frenectomies (it was important to me that I participate in our community's safety net). I even lost money every time I did a Medicaid frenectomy. But one day Medicaid said that I did too many frenectomies (uh, yeah, it's what I do), and they said from then on I would need the patient's pediatrician's permission (who is likely not trained in oral function/tethers), among other things, for them to approve it. So my staff spent many extra hours over the next 3 months making sure we had every signature and document needed for each of our Medicaid patients. Guess what. I didn't get a single penny from Medicaid for those patients. Would you keep being an in-network provider for an insurance company that doesn't pay you?
Well that's an extreme example, but it is the same concept with all insurances. Would you be an in-network provider if they paid you 25% of what you're worth? 50%? 80%? What if they ultimately were the ones who told you which procedures were necessary or unnecessary for your patients (who they've never met). Would you keep working with them?
I became a dentist because from age 5 I thought teeth were freaking cool, and I wanted to help kids have healthy teeth. I then had this bizarre transition to becoming a tongue dentist (is that a thing?) because I realized it was impacting breastfeeding. And then I learned that tongue function in childhood impacts jaw development which impacts breathing and sleep through the lifespan, and I realized those are the foundations of health (along with diet and exercise).
I've always wanted to help people. How I help people has changed, but the underlying drive is still the same. And I won't sacrifice best treatment because an insurance company tells me they won't pay for it.
And you know what? I do that to the detriment of my own finances. I'd make a lot more money if I played by the insurance companies' rules to maximize payment. Let's say I need $400/hour to run my office, and an insurance company pays me $100 for a frenectomy. That means you get 15 min of my time, including diagnosis and surgery time. No follow ups, no education, no answering questions. No lactation help, no massage, no myofunctional therapy. But hey, you got to use your insurance!
Good healthcare has become a tightrope walk between helping people and staying in business. Because if you don't stay in business, then you don't help people at all.
I'm trying to find the right balance (I've been working for free for a long time). I want to help more people but also support my family so that I can keep my business and therefore help more people. I haven't found the right solution yet, but at the end of the day I want to help you. I will always try my hardest to make it work - so we can look each other in the eyes and know that we did our best by each other.