Toddler dental visit with no insurance (where to go?) (Atlanta: health insurance, salary)

[atlantamoi]

Our 17-month-old has a little white line on the tip of one her incoming teeth. Mommy is worried, so we are going to take our daughter to the doctor and see what he thinks. Should he suggest a dental visit, we are in a small quandry.

My employer only allows changes to the policy every November (exception of a baby being born). So, for the next five months our baby won't have any dental. Didn't even think she'd need that last November when she was 11 months old with not one tooth! Ooops.

If the doctor says to go to a dentist for better advice, I'm curious if there are any doc-in-a-box type places for dentists in Atlanta (closer to Decatur the better)? I called my dental office and they want $180 for a consultation. I can pay it, but would rather get an opinion for less.

Ideas?

[MiriL]

We go to Ray Davis, off Clairmont near North Druid Hills. I don't know how much they charge (we have dental), but they are fantastic with kids and extremely nice, so it'd be worth explaining your situation to them and asking.

[CMMom]

OK, I'm sorry, but I just have to say this....

Being in a healthcare-related profession that (unfortunately) requires me to deal with health insurance and all the annoyances that go along with it, you need to be willing to pay for the service that you are seeking!

I am on the verge of having to quit my practice b/c so many people don't show up for appointments and I cannot charge either the insurance company or the patient (those who have PeachCare; 80% of my caseload) for a missed appointment. Times are tough for everyone, including those who provide healthcare services!

I'm not saying that you should not comparison shop for the cheapest provider; that is fine and I would certainly do the same in your position. But don't make an appointment with someone and then try to "negotiate" a lower rate on the spot. Unless I'm reading your post incorrectly, you CAN pay for the appointment. You should pay the rate charged by whomever you choose to see. And $180 is really not an outrageous fee for an initial consultation.

By joining insurance panels, providers agree to take a large (sometimes 50% or more) cut of their customary fee in order to get more patients through their door. So, having an uninsured person who can (by your own admission) pay out of pocket try to negotiate a lower fee is just adding insult to injury.

You need to know that very few healthcare providers (other than maybe plastic surgeons and dermatologists) are making much money these days. As a matter of fact, malpractice insurance and overhead costs are forcing more and more out of business.

So, if you CAN afford to pay and still want to see someone (I get the sense that this is not an emergency situation), you need to be willing to pay the provider's asking rate.

OK, I'll jump off my soapbox now. I am just having a really tough time right now (as are many others), and I think that most patients think that their doctors are rolling in the dough and should be willing to cut their fees. I assure you that the vast majority are not!

[atlantamoi]

CMMom, I don't mind your post. I'd be angry if people missed appointments or tried to cut deals after agreeing to a visit. That's not me... never done that before. It's always been my perception that medical facilities charge more because they can when it involves insurance. Correct me if I'm wrong (well, I did see what you said about insurance panels so I guess I am wrong on that). I think I was listening to Clark Howard say to call around for prices if you are paying out of pocket. He seems rather disgusted by hospitals not having a "menu" so people can compare easier. I don't need him to tell me that though, I'd check prices in my situation anyway. This might be the first time in 20 years I've had to pay for something outside of using insurance. Sort of gives me a taste of what it'd be like to not have any health insurance.

I realize $180 might not seem like a big deal to you, especially if that's a normal rate. To me, that's a lot of money for someone to take one minute to say whether or not there's a problem. That's why I'm going to my insured doctor first. And if there is a problem with my child, it's gonna suck dropping major cash when I wouldn't a few months from now.

Anyway, I'm not trying to negotiate any deals. But I will check rates.

Too bad my father-in-law dentist lives in another country.

[CMMom]

Here's how it works. I could charge $500/visit or $90/visit. It doesn't matter. If I agree to be on Company X's panel, I agree to accept a rate of $X/visit (virtually always quite a bit less than my customary fee). By signing the contract, I agree not to "balance bill" the patient for the difference between my customary fee and the contracted fee (unless it is for a service not covered by the patient's plan; then I can balance bill). So, it's a balancing act.

No, I totally get it about comparison shopping. But hospitals/clinics and private practitioners work differently. Clinics pay their folks on salary, so they don't have to sweat it when they're not filling their available appointment times. For private practice folks, we write off a portion of every managed care patient we see, and that hits us directly in the wallet. We LOVE to see private pay folks, but it is incredibly frustrating to have to argue with someone whether they can afford our fee or not once they're in the office. In order to negotiate a sliding scale, most folks now require some kind of independent verification (pay stubs, tax returnsA) to document the need. And, believe me, that is no fun for anyone.

I understand your situation. I just kind of wanted folks to see it from the provider side as well. Managed care already whacks us one, and then the economy is kicking us while we're down, so to speak.

Best of luck to you!

[genki]

We use Rebecca Barkley (kiddo dentist) in the medical office building next to the hospital in the City of Decatur. The office isn't fancy, but the staff is nice - no turnover in the 3 years we've been going. 404-377-8200

[CMMom]

Sorry-I just reread my post and realized that I said "folks" about a million times. I'm really not that cheesy!

[atlantamoi]

Originally Posted by CMMom

I understand your situation. I just kind of wanted folks to see it from the provider side as well. Managed care already whacks us one, and then the economy is kicking us while we're down, so to speak.

Best of luck to you!

You are providing some lessons for people like me who don't view it from your angle very often. Thanks... and to others for the advice.

[MiriL]

CMMom, I don't know if your post was in response to me at all, but I feel like I need to respond in case it was. What you're saying makes complete sense. You should charge what you need to charge. I certainly wasn't suggesting to make an appointment, show up and then start haggling! I can't see the harm in calling around ahead of time to shop for the best combination of care and price, though. The final cost of an appointment should never be a mystery, and very few of us are rolling in dough to the extent that we wouldn't notice paying $180 vs. $120.

Ironically, my husband is also in healthcare and he hasn't seen a patient with private insurance in probably three years... so I do have an idea of where you're coming from.

[CMMom]

MirL,

No, I wasn't responding to you. Just to the OP. I do understand the difference between $180 and $120. I'm all for market forces and capitalism. I'm frustrated by the way the managed care has providers hamstrung. In some parts of town, providers can get away without accepting insurance (e.g., Buckhead, Midtown). I work in Lawrenceville and that just wouldn't fly out there, so I'm kind of stuck. When I get a private pay patient, I want to do everything I can to keep them.