#AskT-Bone – Flat Fee Implants


Hello and thank you for tuning in again, this is another episode of T-Bone speaks and I am T-Bone Dr. Tarun Agarwal and I’m coming to you from Raleigh North Carolina and, you know, I wanted to introduce a new part of the podcast today. It will be a segment called ask T-Bone. One of the things that I think is important is to deliver exceptional value for your time, and listening to a podcast and often times, what I’m guilty of is, we’ll talk about the topic while throw an idea out there and we don’t have the time to create the clarity on that particular topic. And one of the things I’d like for each of you to do, is take an opportunity to submit a question.

If you visit www.tbonespeaks.com you can submit a question and this question is going to be the basis for this part of our podcast. And what will do here, what I’ll do here is I’ll simply answer your question. It will produce a brief shorts podcast segmented very focused and very dialed in on the question that you’re asking about. So this would be unbelievably informal, honestly they’re going to be recorded not in a podcast Studio, but instead often times wherever I have the opportunity. Sometimes it may be in the hotel room on the road, sometimes it’ll be like today when I’m sitting on the back porch, while the kids are sleeping, and recording this so you may hear some wind noise you might hear some the birds chirping some different things like that but I just want to be able to get some clarity and help drive your practice forward.

Nothing means more to me than helping each of you achieve your definition of practice success. So today we’ve been submitted a question it’s a rather long question but I’m going to read it all and then we’ll break it down into the individual sections.

You mentioned on one of your podcast that you do a flat fee for anterior and posterior implants. How do you build that to the patient’s Insurance? Thinking of a situation where there might be the extraction graft and membrane for one reason another we weren’t able to place the implant that day and then the implant later and then the abutment and crown after that. There is potentially 6 codes to bill for. How does that get broken down and separated out. Seems to me you have to charge a different amount for the individual codes for that patient, then for one that’s already has a tooth out and doesn’t need the graft and membrane for example. Thanks for your advice and clarification.

So I’d like to start by addressing the flat fee for the anterior and posterior implants. And first let’s talk about the flat fee. One of the things that made my life easier in my practice and quite honestly made my team’s life easier, which in turn made my life easier, was going to a flat fee for a dental implant. Now, what this does is for example if I were to ask each of you listening if I came into your office already missing tooth in the nineteen, could you tell me how much it costs? Could you team members tell me how much it cost? And the truth is 90% of you listening, and maybe even more, couldn’t answer that question. You have to ask me additional questions: well doesn’t need a bone graft, doesn’t need a custom abutment.

You know all these things add up and something can go from being X dollars to X+1,000 dollars. And that’s a lot of difference to patients, and that’s a lot of difference in the communication and conversation that your team member is going to have with your patients. So to combat this issue, one of the things that I went to was a flat fee for a dental implant.

Now, I do want to provide some clarity on this. One: our flat fee, number one, for example in our practice is $3,500 for a posterior tooth from start to finish. What this includes, this $3,500 flat fee includes: the dental implant fixtures and includes the cone beam scan, include the surgical guide, and includes any minor grafting, it includes the abutment and the crown. So essentially covers everything from A to Z for in dental aside. Now if the patient has the tooth there, they will be an additional fee for removing the tooth.

Now, when I said minor grafting, what constitutes minor grafting in my world?

To me minor grafting is anything that can be done, at the time of implant placement. So, if I have a threaded through tooth showing and I want to graft that, well, that’s part of our fee. We just do it at the time of placement. If I need an internal sinus lift a small bump of two, three, four millimeters, that’s part of our fee. If I have a situation where we are taking out a tooth, and I would like to graft the gap, not glide to, I want to graft the gap, then that’s included as well.

So this allows me to have a flat fee that covers 90% of the situations. Now again, when the patient has a tooth we simply tack on the tooth removal fee, in that situation. Now in our practice we have a separate fee for interiors and then the anterior, our fee is $4,000 and that includes start to finish.

Now, why a separate fee for the anterior?

Number one: an anteriors were always using the provisional, so whether that’s provisional is placed at the time of placement and immediate load situation or if the immediate load wasn’t a good solution, we would place a provisional prior to going to final restoration help train the tissue. So in that particular case, that’s why we charge an additional fee and also with anteriors there is sometimes a custom abutment that needs to be done, so our fee covers that.

So hopefully that will help answer the question of the flat fee.

Now just to repeat, I think it’s ultimately important to move to a flat fee. It makes your life easier and makes the life of your team members easier, it makes a life for the person answering the phone because our patients are calling and they are looking for fees. Some people say that they are shopping, I don’t want to entertain those, but listen, at the end of day patients are going to do it, you need to break down the barriers, I need to be able to sell that you provide an “all-inclusive fee” for your treatment. It’s an advantage of coming to your office.

So for example Mrs. Jones we don’t nickel-and-dime our patient, Our fee includes everything to get you from A to Z, there won’t be any additional fees to this.

And patients like that and appreciate that. You like that and appreciate that in your own life, so why wouldn’t those things that you like in your own life not apply to your practice.

Now the question is, how do you bill that to the patient’s insurance?

That comes into a coding question, so the way that we code these is, one: will have code and fee for the surgical guide, will have a code and fee for the implant fixture, will have a code and fee for the stock abutment, and we will have a code and fee for the implant crown. Now, if we do a graft in a situation, we will simply post the graft at zero. Now if we do a CT which obviously always do, we will post that at zero. So that way the patient can see what we did, and their fee for that. So hopefully that clarifies that.

So next part of the question is:

What happens if we are planning on taking out a tooth and we determine that immediate placement isn’t possible?

So that’s a unique situation and honestly using cone beam we can pretty much 80-90% of time predict when an immediate placement is viable and not viable, and in instances where we plan and media placement and the immediate placement was not possible due to some circumstances during surgery, then we simply will go ahead and graft the site, our patient is already committed to full treatment to start to finish, now instead of taking four to five months before treatment it takes eight to nine months before treatment. So we don’t go back and then charger socket preservation fee to a patient. Once we commit to a fee to our patient, we will honor that fee for our patients.

So, hopefully that makes sense and I want to thank you for submitting that question.

If there’s more clarity that’s needed on this or anybody else listening that would like more clarity please don’t hesitate to get in touch with us simply visit www.tbonespeaks.com, and we would love to have your questions submitted.

Thank you very much and have a wonderful day.

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