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<<When you opened your practice and decided to be fee for service, I assume it was because you were fed up with the insurance companies. I am considering doing the same thing, and would like to know how long it took to meet expenses for your practice?>>

Well, in principle, I have no beef with insurance companies or third party payment in general. In practice, attempting to run an ethical enterprise when the price for the services is fixed at an arbitrary and artificially low level is impossible.

In my neck of the woods, it's not a particularly smart financial decision to do this unless there's a secure back-up or you're prepard to work 2nd or 3rd jobs.

Believe it or not, it's taken me over 7 years to consistently pay my bills. I'm currently going through yet another lean spell....don't know whether it's the economy or war fever, but the appointment book looks similar to the way it did after Sept. 11th. Of course, if I belonged to every PPO going, the book might well be packed with names but I wouldn't necessarily be making any more money.

One less risky way of cold-starting an office might be to sub-let space where someone else has spare capacity (of course, them having spare-capacity might be a heads-up about the area)

I don't know how to advise you about start-up without insurance as a safety net. I don't think too many folk have my tolerance for fretting and worrying to try it my way....conversely, colleagues who've joined all the plans as a start up aid with the intention of effecting some sort of conversion to fee for service at some vague time in the future have ended up being so immersed in the insurance mentality that they never do.

I do accept assignment of benefits BTW, if it's possible to predict reimbursement. However, my fees are my fees and I don't do discounts based on patients' perception of their financial circumstances. I should add that the community where my practice is situated is an upscale affluent neighbourhood, not the sort of middle class area where the majority have jobs with union negotiated dental benefit packages. I'm about 70% self pay....just about reflecting the demographics of the community....so, my problems aren't entirely due to not accepting insurance in full. Dental health isn't a priority for most, regardless of income, and looking for the best deal is something of a national hobby these days, I feel....even when folks ought to know better.

Good luck in your endevour.....but go into it with your eyes open


Vivienne
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