Robert: Hi, and welcome back to another episode of Beyond the Arches. We’re going to be doing our Q&A with Dr. Dan Noorthoek—Part 2. We have some really good questions here. These are user-submitted questions that people have emailed to us at bta@getdoneinone.com, that have been requested in our Facebook group, and pulled from some of our social media channels. So these are all listener-submitted questions. If you have any questions of your own, feel free to submit them in all the ways I mentioned. Join our Facebook group—we’re available. Reach out and we’ll get you taken care of. In this Q&A episode, we’re going to discuss treatment fees and their lack of transparency. We’re going to discuss proper hygiene and how many hygiene visits are really necessary after a full-arch procedure. And we’ll have a little bit of talk—if we have time—about insurance, and why teeth are treated as cosmetic by insurance companies. In other words: why your dental insurance may not cover as much oral-wise as your health insurance does for the rest of your body—which is confusing for a lot of people, and understandably so. So—welcome, Dr. Noorthoek. Dr. Dan: Thank you. Thank you. Yeah—glad to be doing this again. Robert: Absolutely. Always a pleasure. So, let’s start with treatment fees. This comes from Antoinette. She asked: why is there such a spectrum of treatment fees? Why do they range from X amount all the way up to X amount? And why is there a lack of transparency? I clipped these questions a little bit short—some people were submitting entire paragraphs—but I remember her question went into: “I understand you can’t always put an exact price on a procedure because everybody’s anatomy is different. Somebody may need bone grafting, somebody might need surgical extractions, etc.” But even a ballpark—to give people an idea of whether they can afford this—would be helpful. And there are a lot of companies out there that don’t put any number on their treatment at all. I know we have a very different way of going about that. But what was your experience before you came up with the way you handle this? Was it a frustration you had—seeing patients confused by this? Was it a hurdle? What made you decide to go the route you did? Dr. Dan: It’s a good question—regarding transparency of fees and why fees are such that they are. To answer that question, I think you have to look back historically—by “historically” I mean, say, 15 years ago and beyond. You had these cases that were very complex and very involved, and didn’t have a lot of repeatability. There was a stable protocol—things you were trying to do—but it was highly variable how your surgeon and your prosthodontist, or your general dentist restoring these, would go about it. We have a list of codes—just like the AMA has a list of codes. We have ADA codes that correlate to placement of an implant, whether you need bone grafting, removal of a tooth, whether it requires a high-speed handpiece—whether it’s surgical or simple. And so when these cases came about, they became very complex to write out. If you have to write out a quote for that, it’s a very long list of things—and it can get very expensive. Robert: Sure. Dr. Dan: It also comes from back when there were two centers doing the process. You had—let’s say—a periodontist (like we have in downtown Boca) who works with restorative dentists around the area. Those fees are—and still are—separate. Because you’re not allowed to share or split fees between providers. So I can’t collect at the periodontist’s office—we can’t collect a global fee of $50,000 and then share part of it to the general dentist or the prosthodontist when he completes the teeth. That has to be collected by him, sold by him, and then he has rights and responsibilities to the patient separately. So it’s illegal to share in that type of way. And you had this architecture where you have two independent businesses trying to come together on one thing—but they can’t come together on the price, per se. What they’re doing individually is complex and not as straightforward as it is today. That’s where a lot of frustration came from. That’s where these multi-enter practices came from—the frustration involved with: “I just paid for an implant, now I have to pay for the tooth on top.” A lot of signals get crossed. So part of it comes from there. Part of it also came from me recognizing that the majority of our patient base—our sweet spot—is blue-collar, 50–60 years old, lifetime smoker… maybe they put their kids through braces… they’ve worked for Blue Cross Blue Shield or CSX or Ford their whole life… they have some access to credit… and they can’t afford $95,000. They can’t afford $100,000. They can’t afford $70,000. But they might have enough credit to afford a new car. So I always wanted to offer pricing that would allow them to have an ideal—like, “I can afford this.” And when we were able to start offering it for a little bit less—side note: our fee is generally less than most—not because of corner cutting, but because we’ve built out a lot of efficiency in this machine. We do it one particular way, more or less. It’s custom, but it’s very repeatable—assembly line, if you will. That reduces cost. It reduces the hours I have to spend sweating over a case. It gives repeatability for the staff. So we were able to bring the cost down into an achievable goal for blue-collar patients. And the idea was: why hide it? Why would we ever want them not to know how much it costs? It’s still a big undertaking. If somebody gave me this bill, I say it all the time—I’d fall over dead. So they need to know that cost. I don’t want to walk into a car dealership and not know how much the blue car is versus the red. I want to know: can I afford the blue versus the red? So we decided from the beginning to be transparent. And you and I have fought in those rooms—marketing meetings—fought for the transparency. Because people said, “Nobody else does this. You can’t do that.” We fought for it. And what are we seeing now? The big guys following suit. Transparent fees. Wonder where they got that idea. People want to know how much this costs. And it’s predictable enough that I don’t have to worry about adding extra implants. Predictable enough that I don’t have to worry about adding bone grafting or not. Pricing works out fair for us, fair for the patient, and they have that mindset coming in. When I first started working at the office in Jacksonville, one thing that shocked me: we had a guy come in and he brought $17,000 in a Crown Royal bag. He said, “I’ve been watching your commercials for years. I know my teeth are going to be expensive, so I saved everything I could to be approximately what I thought it would be. Here I am. I’m ready.” That hit me hard. The price was the most important thing for him. So if you know it’s going to be expensive, why not be transparent? Why not give him a goal to reach for? The old guard doesn’t like it because they’re built on getting a premium by adding codes—bone graft here, extraction here, surgical extraction there. That’s fine—that’s not to knock them—but that’s where the pushback is. There’s a group that wants it to be that you have to triple-mortgage your home to afford teeth. There’s a big push in the industry to say, “This guy is scamming us. He’s undercutting us.” I’m not undercutting anything. I’m providing a better service, a better product, a better timeline, and I believe in it to the point that I don’t have to charge as much as you. My ego is not built on people taking a triple and a quadruple mortgage. I don’t want a person to have everything in their world riding on their teeth. This is expensive. But we want to break down as many barriers as we can. We’re pushing constantly for quality, service, friendly—concierge, boutique—but at a lower and lower price point, not to undercut competition, but to make it attainable for people who’ve lost their teeth. Robert: From a marketing perspective, companies that aren’t transparent with pricing—what you said makes sense. If they’re working with another dentist and there are variables, they don’t want to give the wrong price and then it ends up higher. But when you are transparent and you throw a price out there, one of the biggest questions we get is: “How can you afford to do it for so much less than what I was quoted over here? My dentist told me twice that amount.” Dr. Dan: It’s time in the chair. Traditional cases take a lot of time in the old way. It takes a lot less time the way we’ve assembled it. That’ll become more prevalent. You’ll see prices fall across the board, and you’ll see traditional dentists get more upset about it. I’m at a point where I can finally say I’m fed up. I don’t want to feel like my patients are getting screwed by fees. I don’t need the nicest car. I don’t need my per-hour fee to be XYZ. I’ve tried to build Done in One on heavy volume—tons of experience—lots of happy people. As many as we can get. What’s your bottom fee? I don’t know—really low. Because at the end of the day, it’s helping a fellow human get something they deserve. If we can help them do that, why wouldn’t we? You’re doing the world a disservice if you say, “I went to school for XYZ, so I get XYZ for my arches.” Good for you and the five patients you see per year. I’m coming out swinging—but I’m sick of the old guard saying what they’re worth—because they’re not. Technology got us to a point where we can do things fast and economically. It’s supposed to make it better—not just benefit one person. It enrages me. I went to a roundtable discussion about ten years ago—maybe 20 guys in the room. The question was: what prevents you from doing more cases? One guy said, “The undercutters.” Meaning: people doing lower quality work for less money. I raised my hand. Undercutters are not the same as worse work. I know plenty of people charging premium dollars who do not do good work. Undercutting—our price—lives because we want to make it affordable. Quality is separate from the fee. I’d put our teeth up against anybody’s—even if they charge $100K. I guarantee we’re really close. That attitude—this is my profession. I’m supposed to love it. “What are you worth?” You’re worth what they’ll pay and what you’ll do surgery for. For me, it’s less because I want to do a lot of cases. I’ve done 6,000 arches. It’s a lot. I’ve seen a lot. And it was always worth it. So yeah—that topic is hot. I get mad about it. Robert: No—absolutely. Passion on both sides. The way I usually explain it: there was a lot of investment in infrastructure to make this as efficient as we’ve made it. That comes down to the lab—machinery, equipment, designers, finishers—stuff the average strip-mall dentist isn’t going to invest in for a procedure they’ll do rarely. If you’re doing it day in and day out, those investments pay for themselves quicker. You get experience that others won’t gain in years because you’ve compressed it into a shorter timeframe. If you did two arches a week—one double-arch a week—that’s 100 a year. You’d have to work for 60 years to catch up to you. Dr. Dan: It’s a lot. I know. I don’t say it as a brag—my mission is I want to do a lot. I want people to know I’ve done a ton of these. Because I want to be affordable, but also the guy who’s done a bunch—so it’s smooth, efficient, and you get the service you deserve and expect. Robert: And we don’t have to pay to keep the doors open and the lights on off each patient. So we don’t have to make as much to clear overhead, marketing, payroll, etc. It doesn’t have to be made off one or two patients. We can increase the bulk, lower the price per patient, help more people. We don’t make as much off each case—but we make up for it by doing so many cases, plus the experience and efficiency advantages. Dr. Dan: Running Done in One has been a learning experience. I wouldn’t trade it. I have a responsibility to provide a livelihood—not only so our employees can go home with a clean conscience, but so they can earn a living wage and be proud of what they do. I spend no time looking at other offices or chains and trying to mimic trends. I spend time thinking: what can I do to improve our process? Over time, things we do get adopted by others. Many of our processes, products, pitches have been copied. What is it—the ultimate form of flattery? Robert: Yeah. Dr. Dan: I’m not so flattered. I wish they’d stop. I’ll never forget seeing copy from our website literally copy-and-pasted on another website—what you’d think is a big conglomerate, not just our family here. And what upsets me is those are the same people that criticize us. The haters are the ones that adopt as well. Anyway—now that my blood pressure is up—let’s go on to the next question. Robert: Sounds good. That’s probably the single hardest vein anyone can strike with anger. It’s been a wild ride. But that’s why we fight. We want people to see transparent pricing. We want people to understand there are real costs on our side. We’re not just thinking about how big a yacht we can buy. We’re trying to build something stable, boutique, friendly, and upfront. Dr. Dan: Amen. Robert: Okay—another question here, Antoinette again: Why are teeth often treated as cosmetic by insurance companies? Why hasn’t dental insurance caught up with health insurance—and will it ever? Is dental insurance a scam? Dr. Dan: That is a deep, deep question. Let’s start with: is dental insurance a scam? The issue with dentistry being apart from healthcare is that teeth are very fallible—they’re prone to needing maintenance and upkeep. It’s very easy for it to cost a lot of money. Insurance isn’t there to provide you service for free. Insurance is there to make a profit. On something like dentistry, you can’t make a profit if you’re charging, say, $200 a month ($2,400 a year) but paying out $500 a month on every patient. They know the likelihood is high that everyone will use the benefits. And as an example, we’ve probably used our dental insurance more than we’ve used our car insurance to total a car. So is it a scam? Not really. Dentistry is expensive, and it’s easy to need replacement. Why isn’t it treated the same as medical? Same motif. You’re more likely to need a crown than you are to break your arm. The chance and likelihood you’ll need to use it is higher—so the model behaves differently. Will it ever change? I don’t see it becoming mainstream. I see it becoming more privatized and localized. Even though ours is technically not insurance—our warranty replaces the person’s need for insurance because we know the parts, how it was treated, and how to fix it. So I think you’ll see miniature privatizations: “I’ll take care of you, Mrs. Smith, because you’ve done ten crowns with me, and for $400 a year of cleanings—as long as you come see me—we’ll take care of it.” Dentistry is getting cheaper on the production side, so maybe there’s a chance, but I don’t see mainstream change. Now—working back toward “why are teeth considered cosmetic?” I don’t know that answer. I think it’s crappy. At minimum, you should be able to get your teeth removed and a denture placed with medical insurance. Why? Because health is very dependent on teeth. Teeth affect overall health. What’s the main goal of medicine as a society? Reduce the burden of costs and chronic disease. How do you do that? Reduce preventable things. Dentistry is part of that. If I could ask for anything, it’d be movement where medicine reimburses removal of teeth and placement of a denture—at minimum—so people can be healthy and sustain life with their ability to eat. Do I think medical should cover hybrids? No. Hybrids are a want rather than a need—unfortunately. When you have a denture that could sustain life, that seems to be the logic. Robert: Yeah. Makes sense. All right—thank you. Looks like we’re out of time, but I can see this being a series that continues. We’ll do a Part 3, Part 50—whatever—as long as listener questions keep coming in. I like hearing the questions. I like having answers for them. I like giving people a reason to tune in and hear their questions answered. So we’ll keep collecting questions—you keep sending them—and we’ll keep having these discussions and try to educate. I like how off the cuff these discussions have been. I know broadly what’s coming next because we outline topics, but the specific questions are fun because you get a more raw, real answer. Dan—absolutely. Love it. Emotion, Dan. That’s what we’re here for. Dr. Dan: Great. Well, thanks for having me. Robert: Yes—thank you for letting me host. We’ll do it again sometime soon. And thank you everyone out there for listening, and we will do it again soon. Thanks, everybody.