TMJ treatment VA jaw surgery The Case of the Sensible Surgeon Flickr credit Phoney NickleToday is a bit different from my previous blogs. Today I am going to speak about the experiences of my oral surgeon who does the TMJ surgery for my patients when they need the disc repaired or removed in the jaw joint. His name is Dr. Eugene Gregory and he has allowed me to use his name and explain what he does in this blog. Dr. Gregory has been doing TMJ surgery for about 30 years now and he has done thousands of joints- that’s right folks, THOUSANDS. In the past month I have had 4 or 5 of my own patients who needed the surgery try to find a surgeon ‘in their plan’- well that was a disaster of epic proportions. One of them actually called 19 – NINETEEN- surgeons hoping to get a discount on the procedure. As it turns out, not one of the nineteen surgeons really did TMJ surgery, although the insurance carrier said they did. (The patient was terribly misdirected by the insurance reps…but that’s a whole other blog) Anyway, all of these people ended up working with Dr. Gregory because no one else seemed to have the experience that he has.

The problem these people had with the surgeon was that he does not participate with their insurance plan – his fee of $6500 simply is not covered. The patient has to pay him the $6500 for his services and the hospital fees are usually covered by the insurance company. I actually asked Dr. Gregory the other day how he set his fees and why insurance did not cover that fee. He explained to me that 30 years ago, Blue Cross paid him $6000 to do the surgery and they also covered the hospital fees as well. It turns out he set his fee according to what the insurance company would pay and figured that would be fine as the years go by. Well, dear readers, what actually happened was that as the years went by the insurance carriers paid less and less for the TMJ surgery and today they only pay around $1500 or so to the surgeon who participates with their so called ‘plan’. This whole thing smelled kind of fishy to me. Instead of keeping up with inflation, ever increasing fixed costs, and higher malpractice rates the insurance company has undercut the surgeon to the point where there is no logic in participating!

I can see how sensible Dr. Gregory has been about all this, but I am also a bit perplexed. He has barely raised his fee in the past 30 years! To me this is incomprehensible for such a sensible surgeon! And when I asked him why he has barely raised his fees, he responded that he was just trying to keep it as simple as possible and help the patients out. So here I am, a guy who has an MBA and lots of business background, absolutely floored that his fee is that low and yet the insurance company has cut their payment by more than 75% over these past years – and this is based on THEIR original reimbursement plan, not Dr. Gregory’s, he was just following their lead years ago and being cooperative.

The way I look at it, these insurance companies are very readily taking over how we look at health care in this country and quite honestly it makes me sad. Just the other day on Facebook I was lambasted by two people – one said their fees would be set based on insurance company current rate plans (good luck with that) and the other said we had a free market system (that comment made me laugh for a good while). What we really have is insurance companies indoctrinating our people into thinking that the insurance company is doing right by them and the doctor is the real enemy who is ripping them off. Every week I explain to the patient who needs surgery that Dr. Gregory charged $6000 thirty years ago and today insurance would only pay him around $1500 if he participated. They are first a bit shocked, then angry, then really not sure what to do. Just imagine that your salary was cut, year after year, instead of going up. If you are smart, you would go find another job. Well folks, that’s what the good surgeons have done it seems- they do not participate because there is really nothing to participate with. But then, you have to wonder, who is really making the money when insurance rates go up, up, and up every year and benefits go down?

Dear reader – did you know carriers like Delta Dental in the past paid about $1000 per year to each of their dental subscribers for their benefit plan? And today, they pay about $1500 per year on many plans. There’s something quite wrong and really rotten with this. If subscriber fees were let’s say ten dollars a month forty years ago, and today it’s more like fifty dollars per month, then the benefit should be something like five times what it was forty years ago, not just 50% more. Do the math- you are being ripped off people!

So to finish up, my conversation with Dr. Gregory was a real eye opener the other day. He has only raised his fee by less than 10% over the past thirty years. I think if I was a patient, I would be quite grateful for a surgeon like that. If the insurance companies were run by people who could actually appreciate this, they would realize that he is doing remarkable work at a fee that is fair and reasonable, but alas, that is not how they think. I guess the motto of the story is that it might be more sensible to trust your doctor more than you should trust the insurance company!