Trying hard to figure it out

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klobird
Posts: 1375
Joined: Mon Apr 11, 2011 5:45 pm
Location: Washington State, USA

Trying hard to figure it out

#1 Post by klobird »

Well, here's the touchy subject....

I have been trying to figure out the justification for the cost of orthodontic treatment....I understand that this is a choice I made, and have accepted and agreed to the cost at $5116 (with a $600 discount from $5716). I am very happy I made the choice to get braces, and do not regret my decision at all. I am not angry about the cost--I knew what it was before I got braces, and accepted that also. I'm just trying to figure it out---that's all...

I manage a medical clinic. Our physicians have degrees from various prestigious schools, including Harvard. We have purchased a very expensive digital x-ray machine, as well as the building, have set up 10 rooms with exam tables, computers, and all of the many medical supplies needed in the process of treating patients. We have a minor surgical procedure suite also.

Besides the physicians we have nurses, receptionists, billing personnel, and other admin staff.

OK, so this is it---when we contract with any insurance, we have to accept their allowable--if we charge $105 for a regular office visit, we may get paid anywhere from $39 (Medicaid) per visit to $99 (good insurance) per visit.
We cannot bill the patient any more than the insurance allows. Private pay patients get a discount.
On a very good day, the physicians will see 5 patients in an hour. They may only see 1 in an hour, depending on the medical needs of the patient.

Soooo....here's the rub.....I figure that I will see the ortho maybe 12 times in 2 years. That's a generous guess, as it was 3 months from brace day to my 1st adjustment. That averages out to approx a little more than $400 per visit, per patient!
My ortho usually has had AT LEAST 4 patients in a line of about 8 chairs at each of the times I have been in. On a board for all to see, he has the names of those to be braced that day. There are an average of about 3 each time I go in.
The ortho moves from patient to patient as if he has a hyperactivity disorder. (Meaning he sees the patients bing bing bing--just pumping them in and out of the chairs.) He applied my braces in about 6 minutes, and the assistant did the rest. I understand that he is brilliant at what he does. He does have a good reputation.

So, I guess I just don't get the justifications for the financial inequity between a physician and an orthodontist. Our physicians are making life and death decisions. I have seen people survive because of the physicians in our office, and have watched people go thru the process of dying from cancer etc. I have even watched a patient die while in our office.

I know that many people believe that physicians are overpaid. From my experience, I truly do not believe that they are.

So, any insight into this would be appreciated, and accepted. :)

ArchWired28
Posts: 636
Joined: Mon Jun 20, 2011 10:44 am
Location: Tampa, FL, USA

Re: Trying hard to figure it out

#2 Post by ArchWired28 »

I have paid about the same price for my treatment. Hopefully, my insurance will reimburse me for $1500, but that has not happened yet.
I know many adults who were quoted about the same price, 5 to 5.5K. All of us had very different bite issues and different treatment courses, too (i.e. invisalign vs traditional braces vs self-ligating braces). For myself, I started thinking that this is just how much it currently costs to have your teeth aligned if you're an adult, regardless of your issues (unless you need TADs or surgery or something more involved).
I try to not think about the cost per visit. I just know that, for me, if they can achieve everything that was discussed - they money will be VERY well spent. I know that, untreated, I will end up with the TMJ issues that will cost me much more in the future. Both financially, and emotionally.
But, if we think in that venue, I would guess that dentists are even more overpaid than are orthos. Think about it, the root canal + porc crown averages somewhere at 2K. That is, 3-4 visits + the cost of anesthesia and the crown itself that is comparable to the cost of braces itself. But, this is just how much it costs, take it or leave it.
Had full mouth metal braces for 21 months. Debonded April 2013. Now wearing clear plastic retainers every other night.

I have no formal dental or orthodontic education. Hence, all opinions expressed by me on this forum are those of an "informed consumer" and by no means intended as an expert advice.

ArchWired28
Posts: 636
Joined: Mon Jun 20, 2011 10:44 am
Location: Tampa, FL, USA

Re: Trying hard to figure it out

#3 Post by ArchWired28 »

klobird wrote: The ortho moves from patient to patient as if he has a hyperactivity disorder.
Ha-ha, I think that is just their professional behavior as mine is the same way :lol:
Had full mouth metal braces for 21 months. Debonded April 2013. Now wearing clear plastic retainers every other night.

I have no formal dental or orthodontic education. Hence, all opinions expressed by me on this forum are those of an "informed consumer" and by no means intended as an expert advice.

klobird
Posts: 1375
Joined: Mon Apr 11, 2011 5:45 pm
Location: Washington State, USA

Re: Trying hard to figure it out

#4 Post by klobird »

I agree with you Archwired28--I will be ecstatic to see my final results, and to know that I will be able to have my own teeth for a lifetime! And yes, it will have been worth every penny to me.

I guess it's all about business, and which businesses are more profitable than others for whatever reasons (supply and demand etc)...and that's just the way it is in all of industry...but somewhere, way back when, some really business savvy orthodontists established the norm regarding the cost of orthodontic treatment and it stuck!

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sm531
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Re: Trying hard to figure it out

#5 Post by sm531 »

Man!! It almost seems like you guys are getting off easy! Mine are costing me.....**drumroll please** ..... $6940 with NO insurance help!! Ta-daaaaaa!!! BUT: I'm doing the braces in prep for surgery, will have the post-op checkups on top of the permanent retainers both top and bottom... My ortho also does the whole bouncing from patient to patient but he's still the one that makes the decisions including your treatment plan and who he hires to be his assistants... He also works with the dentists and oral surgeons when you are prepping for a surgery to make sure everyone agrees with the gameplan and what's going to happen. Also, if he has his own business, he's the one that's basically "the boss" of the business.... You're paying for all that... I know I am and I'm ok bc my guy knows what he's doing :)
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Huggypillow
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Re: Trying hard to figure it out

#6 Post by Huggypillow »

Great Discussion,

I do see what you are aiming towards , I guess speaking from Australia I have a friend who is a dentist (but not where I live) and we were too talking about a similar topic. Firstly depending on the qualifications of the dentist besides being qualified in orthodontics they have to pay very hefty fees and insurances each year to be registered and insured.

For example fees for being a board certified Orthodontist aprox $ 10,000 per year, Fees to be a registered members of the Australian college of surgeons $5,000- $15,000 , then they have to undertake a certain number of update techniques courses in order to stay board certified with orthodontics and college of surgeons and those courses can be anywhere from $2000 -5000 each and imagine having to do 3-5 per year with no choice or to not stay registered, then there is indemnity insurance against malpractice, and insurance against them if they die or go bankrupt (this insurance will pay for current patients to seek continuing treatment or be re-imbursed for money paid).

So I guess a dentist has maybe more things behind the scenes to pay for, as they say if you die then it's up to your family to sue the doctor is a dentist botches up your mouth it's life long pain and suffering and psychological stress.

Sorry to be so long winded but here we have such stringent medical standards most would consider them to be over the top (I am not undermining the standards where you are, I can only speak from my country I mean no offence at all). But I at least know that here in order to touch my mouth it's cost them a lot of time and financial investment not to mention more then a decade of study and exams.

And not to forget wages,rent,cost of materials and tool, tax and superannuation ( which the employer must pay here from their pocket), and goods and services taxes which is 10% of everything you buy.

So i guess i kinda understand the cost here, In australia if your a GP the government actually heavily subsidise materials for your practice including free injections ect.

Again only adding from info gathered from my country

klobird
Posts: 1375
Joined: Mon Apr 11, 2011 5:45 pm
Location: Washington State, USA

Re: Trying hard to figure it out

#7 Post by klobird »

Thank-you Huggy for your response, and everyone else.

In the USA, most physicians are in private practice. They too have medical malpractice insurance to pay for and taxes, continuing medical education courses for which they have to pay--as well as travel expenses to get there. They have unbelievable educational loans to pay off (remember--Harvard--and her family is NOT rich)... So many of the expenses are similar to the orthodontist. I believe a physician has more medical supplies to purchase--considering the vast variety of conditions they treat--and many of those supplies are not cheap either. (A medical thermometer alone is in the neighborhood of $250--and we have had patients steal 2 of ours.... We are learning...)

We have had patients (basically criminals) distract our staff, and then steal our prescription pads. Two were caught and have served jail time for that. Fortunately, the medical community is figuring out other ways to prescribe medicines to get around these occurrences. But drug abuse is a major problem right now. The physician has to figure out who needs these strong drugs, and whether or not this patient is at risk of abusing the narcotics vs. how much pain they are in. Will this be the patient who overmedicates and gets in a car accident that kills someone? A physician has some risk of responsibility in these cases also.

Because many of a physician's procedures are invasive (surgical), there are higher risks of infection and also risks of being unsuccessful. A physician, much of the time, is working hard to find ways to combat the stress and pain of many, many kinds of illnesses and injuries. Sometimes, there is just nothing else that can be done. Sometimes a person can be in pain for a very long time before they eventually pass away.

I still don't get it. I would love to hear from an orthodontist. I believe that they can honestly appreciate the similarities and differences between an orthodontic practice and a physician's practice.

With all of that said--I still am not sorry that I have paid $5116 for my braces. I chose braces, the same as someone would choose a gastric bypass to alleviate their numerous medical conditions. I didn't have to have braces, I chose to, for my dental health. I feel like it has been a wise choice. I am not complaining about the cost--that's how much I want what I am paying for.

Maybe that's where the financial differences are---somewhere in the realm of want, need, supply (as in number of physicians available vs available orthodontists) and demand.

Yes, I agree, this is an interesting discussion...I welcome any opinions.....

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QueenElizabeth
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Re: Trying hard to figure it out

#8 Post by QueenElizabeth »

klobird wrote: With all of that said--I still am not sorry that I have paid $5116 for my braces. I chose braces, the same as someone would choose a gastric bypass to alleviate their numerous medical conditions. I didn't have to have braces, I chose to, for my dental health. I feel like it has been a wise choice. I am not complaining about the cost--that's how much I want what I am paying for.
I waited until I was 31 because the cost was so high. But now wish that, that had not been a road block because if you really want something that is for YOUR HEALTH then why not do it? Perhaps a part of me didn't care enough before? I recently had bone grafting done because I had really deep pockets, which set me back a bit. :| However, I care enough about myself now to not care how much it costs to keep me healthy. Oh what was I thinking at 21?! :roll: Well part of it was that I was not living with my parents (moved out at 15) and trying to get good coverage at my places of employment, well I had a better chance of winning the lottery. Anyways I won't drag this out too long, but I think regardless of how much any of us have paid to have braces it's the best thing that we could have done for ourselves. :-V My fiance today saw my pictures (well he looks at my mouth everyday) and realized why I never smiled before. He finally knew why I was always very quiet and didn't feel pretty enough (even though he assures me otherwise). I smile more now, and I don't care who knows or sees that I have braces. In one month, I have felt better about myself than I have in my entire life. I may not have a supermodel's body (now), but I feel a million times better. And that is priceless. :BigGrin: :rose:
"One good thing about music, when it hits you, you feel no pain."
-Bob Marley

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Huggypillow
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Re: Trying hard to figure it out

#9 Post by Huggypillow »

Hey Klobird,

I forgot to mention that i was actually shocked to hear that in USA the ortho assistant does most of the work, and the ortho just pops on by for a looksee. So in a way i guess i justify the hefty costs i guess things are so vast from one country to another. Although in a way it's great to compare different treatment.

Here that is not heard of, the ortho's here do everything from lig changes, wire in/out you name it they do it. so i guess in a way i can appreciate that they are physically doing they work, I was actually in shock when i found out that the ortho ass do practically everything in the u.s, infact i still cant get my head around that.

And no i don't regret the decision for braces and cant wait for the final result.( although may winge from time to time)

ArchWired28
Posts: 636
Joined: Mon Jun 20, 2011 10:44 am
Location: Tampa, FL, USA

Re: Trying hard to figure it out

#10 Post by ArchWired28 »

About the physicians' fees - a shoking example from my OWN experience.
I have one of the major medical insurances (through work) + good coverage. Anyhow, I had to go to the Energency room (true emergency, I was taken in an Ambulance). Payed my emergency copay ($100), the rest was billed to the Insurance.
Here is the kick: the total bill for that visit was approx $11,500, while my insurance lowered it to around $600 (of which they only payed $500 since I payed $100). The difference is DRASTIC, and I am still thinking: so, how much did my treatment actually cost? And another question: for someone who happens to be a self-pay patient, they would have gotten stuck with a 12K medical bill. Is it fair, to charge someone w/o insurance 10 times the cost of treatment?
Another example, not involving Emergency room: scheduled MRI of the brain. Billed around $3600, while Insurance payed only around $300 - again, 10x lower. So, how much does it actually cost, and why such a difference?
At least the orthodontists don't practice double standards (or at least it is not THAT bluntly obvious).
Had full mouth metal braces for 21 months. Debonded April 2013. Now wearing clear plastic retainers every other night.

I have no formal dental or orthodontic education. Hence, all opinions expressed by me on this forum are those of an "informed consumer" and by no means intended as an expert advice.

ArchWired28
Posts: 636
Joined: Mon Jun 20, 2011 10:44 am
Location: Tampa, FL, USA

Re: Trying hard to figure it out

#11 Post by ArchWired28 »

klobird wrote:They have unbelievable educational loans to pay off (remember--Harvard--and her family is NOT rich)..
I personally don't think this should be a major factor. This was her choice to attend Harvard, and it is not like Harvard is the only place that "cooks" good MDs... I know that our Med school at the University of South Florida is already expensive enough, but thier assistanship rates are approaching 100%, so pretty much anybody who got admitted can get some sort of financial aid should they so desire.
Had full mouth metal braces for 21 months. Debonded April 2013. Now wearing clear plastic retainers every other night.

I have no formal dental or orthodontic education. Hence, all opinions expressed by me on this forum are those of an "informed consumer" and by no means intended as an expert advice.

klobird
Posts: 1375
Joined: Mon Apr 11, 2011 5:45 pm
Location: Washington State, USA

Re: Trying hard to figure it out

#12 Post by klobird »

It really isnt my intention to get into a conflict about this. I am trying to make it clear that I am willing to pay the ortho the amount he charges, and I willingly chose to do that. I also am not trying to say that one type of doctor is better than the other.

In the USA, hospital charges are outrageous. They differ from a physician's office, and I don't know why they charge what they do.That is not my area. Same with MRI's etc etc etc. One of our nurses had to go to the ER. She received a tetanus shot, and the hospital charged her $175. It is $30 in our office, and after insurance pays--we only get about $12. We could charge $1,000 for that shot, but in the end would only be paid the same $12 because of our contract with the insurance companies. We would not be able to charge the difference to the patient. Not in our office, and not with our contracts.

We find many legal ways to make it so a private pay patient's out of pocket expenses are similar to one with insurance. We charge $30 because there may be that one insurance company that will pay us $28 for that shot, but if we didn't charge the $30 and only charged $12, we would miss out on that insurance company's additional payment. Because of our contracts with the insurance company, we write off thousands and thousands of dollars each year. From my experience, my orthodontist doesn't have to write off anything.

I appreciate what an orthodontist does, and like I have said, I am willing to pay for the treatment and will be very happy to have my orthodontic issues corrected.

I am coming to the conclusion that an orthodontist and a physician just can't be compared to each other--and maybe it's like comparing an orthodontist to any other random business that is or isn't financially prosperous.

ArchWired28
Posts: 636
Joined: Mon Jun 20, 2011 10:44 am
Location: Tampa, FL, USA

Re: Trying hard to figure it out

#13 Post by ArchWired28 »

I was reading another orthodontic forum (professional one where orthos discuss issues amongst themselves), and there was one ortho that wanted to start his private practice. He aksed if 50 new cases per year is a reasonable estimate in his case. They responded, that it is, providing he offers free consults. But to me, 50 new cases per year is not that many, it's only 1 per week! Let's say he charges, on average, 5.2K per case - that's $260,000 of total income per year - not much. And he has to purchase supplies, hire at least one assistant and a secretary, pay rent, their fees, taxes etc and etc.

Of course, an established practice does more new cases, but even if it's 100 new cases per year, that yields $520,000 - that is not crazy money as well. Providing that they need several assistants and secretaries, more supplies, bigger space, advertisements etc.

klobird, how many patients (per one physician) your practice sees, on average? I bet it is more than 50 or even 100 per year. I know it is impossible to compare accurately, but lets at least try.
Had full mouth metal braces for 21 months. Debonded April 2013. Now wearing clear plastic retainers every other night.

I have no formal dental or orthodontic education. Hence, all opinions expressed by me on this forum are those of an "informed consumer" and by no means intended as an expert advice.

klobird
Posts: 1375
Joined: Mon Apr 11, 2011 5:45 pm
Location: Washington State, USA

Re: Trying hard to figure it out

#14 Post by klobird »

Hey ARCH--

OK, I give!! Our practice has about 150 new patients a month......The physician/owner is paid $156,000/yr. . Right now, we are really struggling financially, but I'm not sure that has anything to do with our practice. (The owner won't get his hands off the finances and let us do our job!). There are so many bills you wouldn't believe it. Plus he has to pay the other physicians, and their malpractice, and everyone's medical/dental insurance etc etc etc etc....So ya, we're kind of in the red right now, but who isn't....well, except maybe orthodontists....ok, just kidding---trying to lighten it up a little....I have no idea what their struggles are right now........

Well, I have to go to work and play around with money!!! I've been on vacation. I don't even want to think about payroll coming up!!!! :yikes: :yikes: :yikes:

klobird
Posts: 1375
Joined: Mon Apr 11, 2011 5:45 pm
Location: Washington State, USA

Re: Trying hard to figure it out

#15 Post by klobird »

I was curious, so I just looked up online to see what the average physician earnings is in the city in which I live. It's
$104,000/yr.

Guess what I will be suggesting to my boss this week??? :idea: (My boss being the physician/owner).

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