This is also known as capitation (literally meaning “by the head”). The payment per month is for a defined scope of services for a defined population set for a defined period of time, regardless of the actual number or nature of the services provided.
Of course, knowing that the dentist is paid a set amount per plan member, regardless of how much dental treatment is provided, should make you wonder if the dentist will provide the services that are in your best interest. It is certainly possible that the amount of dental treatment that an enrolled individual requires will exceed the amount the dental insurance company will ever pay the dentist to provide this treatment. In this case, the more dental treatment the dentist performs, the more money he or she loses. It’s a tough position that dentists put themselves into, and it’s hard to get out. Of course, the insurance companies love this method, as utilization of the plan becomes irrelevant. The cost of insurance is known down to the last penny, and that profit is 100% predicatable. Capitation makes the actuaries very happy.
But does it make the patient or dentist happy? Only if the dentist does not see you and only if the patient does not need to see the dentist. Capitation payments to dentists “per head” per month average around 8 dollars (that’s not a misprint).
This leads me to my explanation of the “acid etch fee”. As you can see in the photo below, there is no acid etch fee. There is no code for it in the CDT manual, which is put out by the ADA (American Dental Association). Many of the capitation dentists add “extra” fees to make up for the lack of payment for services they provide. The amount of acid I use to etch a tooth before I place the plastic filling costs less than a penny. Since there is no ADA code for it, I cannot charge for it. It’s considered by the ADA to be part of the process of restoring the tooth.
I would challenge this fee next time you are asked to pay for it. Tell them you will bring your own acid next time!
Mark Burhenne DDS