Awesome display of tech in that room. A lot of money sitting in there as well. No wonder your having fee reservations. Look at your costs. Not to rib you, but Lab fees are not your problem. It's the salesmen who sold you all that equipment and pitched all the money you would save on impression materials and chair time. You've gone bulldozer in a shovel situation, then wonder why no one wants to spend $1200 to dig a mailbox hole.
I applaud you for your adoption of digital dentistry and the learning of the technology, however because of your investment, your gonna have to go FFS with maybe 1 good in network if you have too.
Dentists have to face the fact that insurance companies are not your business partners but are the same as predatory lenders. Their job is to sit in a cubicle and cold call dentists to "loan you their customers" to help your business for a cut rate. Then hope outta fear of losing customers, you'll "make your payments."
I'm sure the ADA gets a kickback, otherwise they would tell you guys to stand against it.
The problem isn't the equipment - equipment is all paid for and then some. The equipment is what allows me to operate at optimal speed/workflow without the bottlenecks of equipment. I can definitely understand the hardships that some of my colleagues are going through with that the huge note that they took out to finance cadcam equipment, but I've been fortunate enough to have generated enough equity to have the equipment paid for.
Pure FFS is not too feasible in my area. I am still able to make it work through volume, but I prefer predictability of reimbursement from insurances rather than empty promises from insurance. I dropped one insurance that was asking us to take them, offering higher fee schedules that everyone else. However, the reason we refuse to take them is due to the games that they play. They include downgrading/downcoding implants/bridges to partials, downgrading veneer/crown fees to composite fees, and downgrading composites to amalgams. I'd rather take a lower predictable fee schedule than having to waste significant administrative time chasing for payment. In my current setup, I can still accept 543 dollars for a crown and make an acceptable profit, but that may not necessarily be the case for other dentists that have relatively higher breakeven points OR are not fast enough to compensate via volume (as required by contracted fees to remain afloat). If I took an hour of chairtime to do an insurance crown, I'd probably be broke.
I've learned not to trust salespeople, but rather look at my office's objective needs and inefficiencies. The most important questions to ask any salesperson is: what applications does your equipment have, what's my ROI, how is it better than what we have right now, does it improve the quality without increasing cost, and how can I integrate it into my existing workflow? What you see in that photo is an addition of each equipment until I was able to saturate my work capacity and I became the limiting factor, rather than the equipment. I'm also a big fan of redundancy and think that relying on one piece of equipment as the cornerstone of your operations is not necessarily the smartest idea. That's why I have 2 vacuums, 2 compressors, a bunch of extra deployable computers/monitors/motors, etc... just so that there is virtually no downtime or waiting for service. An example is that if an op computer goes down, I don't have time to troubleshoot the darn thing. I'll just tell the staff to grab an extra computer in the back, switch out all the cables (it's all the same computer, a dell optiplex 3020) and just plug and play. Same deal with electric handpieces... if the motor control gives out, they just need to unplug the 5hole airwater, plug another one in, we can get it fixed once we're done with the day.
Anyway, going back full circle to Dandy, I think Dandy is a symptom or "perceived market need" as dentists are trying to reduce their capital investments but wanting the benefits of an digital IOS at the same time. The big variable is the quality of the lab(s) used by Dandy.
Will someone explain to me how this works? I always here the the excuse for dentists wanting low priced crowns is that insurance only pays them $500-$550. But then I hear from the patients, either friends or people I meet and they find out I make crowns, that their insurance paid that amount then the pt pays another $200-$400 out of pocket on top of that. I've seen the itemized invoices. One of my cerec docs has an added line for her cerec crown if they decide to use that crown and it's an ADDED $150 for an e.max. So the patient pays an additional $150 for that service... meaning they still pay the regular fee if they had me make it PLUS $150 for the cerec crown!!
So what is the percentage of cases that doctors only take the insurance coverage without adding several hundred dollars on top? From what I consistently hear it's rare.
The common term is unbundling. I think it's horrendously shady and just a way for unscrupulous dentists/corporations to line their pockets. I know it's a common practice in corporate practices and some private practices, but I am thankful I don't have to do it. Some of the things that you'll commonly hear or see are things like, "porcelain upgrade fee", "periodontal irrigation", or "endodontic irrigation"; Those are just fancy terms for zirconia, irrigating with chlorhexidine during periodontal treatment, and irrigating with MTAD or Qmix during a root canal. I approach it another way: just be more efficient in your workflow and you won't have to create upcharges to compensate for your time.
Now, you may ask, what if the cost of providing a service exceeds the contracted compensation? I don't do it - I'll refer the procedure out. Some of the procedures that I can't make work are gingival grafts, impacted 3rds and dentures... so, I don't do them.
Creative service fees. Honest doctors try to hold up to their contract and struggle. Some practices use salesmanship for "upgrades". Digital impression fee vs goop. Moist towelette fee. Custom shade appointment fee. Crown in a day or wait 3 weeks.
Like a restaurant, you get a meat and 2 sides. wanna add shrimp, $9, want a side salad add $5. Would you like dessert, that's $6. Diner's insurance covers your entree, but that's all. Insurance companies don't care about their customers. They got them a contract for a fee. As long as that contract was honered, insurance company doesn't care if they got fleeced with a $1200 crown cleaning kit as long as its outta pocket and not insurance companies money.
Its what I've seen a lot of younger dentists struggle with because they come at it honest, fair, and naive. Then wonder why they can't win in an arena of salesman. The lab man is the only guy on his side.
Labs aren't the enemy, that's for sure, but the market pressures are definitely there for a lot of dentists and may be short sighted in trying to cut costs in certain areas that shouldn't really be cut - especially if it's been working out for them this long. I think it would be important for labs to emphasize the importance of a good lab, the long term benefits, lack of headache(s)/positive relationships in delivery, and the risk of switching to an unknown/cheaper lab. Sometimes, we can take things for granted that things just work without understanding that it takes a solid team to make things work seamlessly.
Now regarding being off the Dandy topic, you bet 
