What is a Fee-For-Service practice?

According to Avrom King, founder of the Nexus Group, a healthcare/dental consultant, writer and entrepreneur, the dental delivery system has evolved into three distinct segments; the cost conscious or contract program, the convenience or open panel program, and the quality oriented or wellness model.  This statement accurately reflects the current patient belief when it comes to choosing an in- network (contracted) or out of network (fee for service) practice.

Many new as well as existing patients frequently ask, “Do you take this insurance or that insurance?” Our response is that we file with all insurance companies, but we are a fee-for-service practice which means we have found our patients receive far better personalized care and have a better experience in our practice than if we were in network with any insurance company. We accept the patient’s payment at the time of the appointment or we establish a mutually convenient payment plan, we file for benefits with the insurance company and the insurance reimbursement goes directly back to the subscriber/patient. The very next question is, “What does fee for service mean?”  A fee for service practice by definition means that procedures are not determined by a certain fee schedule dictated by an insurance company. I do not bill treatment based on what and how an insurance company will pay. This flawed thinking leads patients to believe that if insurance doesn’t cover or pay very much for a procedure, the recommended treatment must not be necessary, which is not the case at all and can cause detrimental effects to the health and welfare of patients. I cannot do my best dentistry if I am only concerned with what a certain insurance company will reimburse. I determine my fees based on my skill level, my experienced clinical judgment, highest quality materials and labs, a large amount of time spent with each patient, the development of a lifelong relationship with each patient, and the ability to deliver a personalized, comprehensive treatment plan to each and every patient.  I like to think of it as a freedom of choice arrangement. When compared to most dentists in the same geographical region, on average my fees are very comparable.  Most insurance companies set fees based on zip codes and how many dentists participate in those zip codes and for this reason those dentist accept about a 30% reduction in fees by participating in insurance networks or managed care plans. This acceptant in a reduction in fees has a ripple effect.  Managed care dentistry means more patients are seen per hour to make up for this deficit which makes dentists intensely busy, which leads to difficulty in scheduling much needed appointments sooner than later, costs have to be cut by allowing less time per patient, less time per procedure, reducing and possibly eliminating doctor and patient communication, utilizing less expensive materials, using less expensive labs and hiring staff at lower salaries, therefore, compromising patient care with less experienced staff. I base my quality of care not on what insurance companies will pay but my relentless dedication to deliver a superior experience for my patients. As always, I welcome any and all questions that you may have. I look forward to seeing you or hearing from you soon.

With warm regards,

Alexander Rossitch, D.D.S.