Insurance Plan (PPO) Dentists: Can They Afford to Be Conservative in Their Care?

Insurance plan dentists sign contracts to accept maximum fees that they may charge to their patients. While this may sound great for patients, the downside is that the fees much more closely approach the cost of doing business. In other words, the profit margins are significantly decreased. Why should this matter? Profit is bad, right?
Profit is not a bad thing. They contribute to income, viability, and improvement of a dental office. It is excessive profit that many have a problem with. I am not talking about that.
So with the profit margins being squeezed significantly by the insurance companies, can an insurance plan dentist afford to be conservative in their care? If a digital x-ray shows some decalcification within the enamel but is not all the way through the enamel to be considered a cavity, can the insurance plan dentist afford not to do a filling anyway? If a patient presents to the office with a toothache that is not caused by an unhealthy pulp within the tooth, can the insurance plan dentist afford not to do a root canal and then perhaps a crown? Can the insurance plan dentist afford to look into other reasons why the toothache may exist? There are other potential causes.
There are other occasions to be conservative. When a patient arrives for a regular teeth cleaning, can the insurance plan dentist afford not doing a “deep cleaning” if it is not clearly needed? If a patient has deeper decay and needs a crown on the tooth, can the insurance plan dentist afford not to do a root canal procedure “just in case” the tooth would have become a problem later on?
We see these scenarios apparently play out with patients who either return to my practice or who are new to our practice. You have one set of adult teeth. Low fees sound great, staying in-network with a dentist seems financially prudent, yet the insurance companies are severely undercutting the fees their contracted dentists may charge. This then places more pressure on the insurance plan dentists to make a profit in some other way. How that additional profit is found is determined by the insurance plan dentist, or by their employer.
There are still dentists who are not under contract from insurance companies, who are not forced to squeeze their profit margins, and who can very much afford to be conservative with their dental care. If treatment is clearly not needed, then it should not be done. That is in your interest. I am fortunate enough to be one of those dentists who is not being pressured by any insurance company. We truly care for our patients, and we actually to provide conservative care for our valued patients.
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