Ep. 20: Q&A With Dr. Dan - Part 2

Part 10:00

This is Beyond the Arches, where full-arch dentistry meets real talk. Let's get into it. So, welcome, Dr. Noorthoek. Thank you, thank you. Yeah, glad to be doing this again. Absolutely. Always a pleasure. Yeah, so, yeah, let's start with treatment fees. And this comes from Antoinette, and she asked,

▶why are there, why is there such a spectrum of treatment fees? Why do they range all the way from, you know, X amount all the way up to X amount? And why is there a lack of transparency? And I clipped these questions a little bit short. Some of these people were submitting entire paragraphs, but I do remember her question was going into, I understand you can't always put an exact price on a procedure because everybody's anatomy is different. Everybody may need different treatment options, and this person may need bone grafting, and this person might need surgical extraction.

And it's, you know, et cetera, et cetera. But even a ballpark, just to give people an idea of whether or not they can afford this thing would be helpful. But there are a lot of companies out there that do not put any number on their treatment at all. I think, well, I know we have a very different way of going about that, but what's your experience before you kind of came up with the, the, um, the way to handle this that you did? Was that, was that a frustration that you had noticing that, that people were being confused by this or having these questions or was it a hurdle? What, what made you decide to go the route you did?

It's a good question, uh, regarding, you know, the transparency of the fees and why fees are, are such that they are. To answer that question, I think you kind of have to look back to sort of historically and, by historically, I say, let's say 15 years ago and, and beyond that, but you had these cases that were very complex and very involved and didn't have a lot of, I won't say repeatability because there was, was a stable sort of protocol instead of lists of things that you were trying to do, but it was highly variable how your surgeon and your prosthodontist or your general dentist restoring these would go, what would go about it.

And so 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. If you need bone grafting, removal of a tooth, does it require a high speed handpiece, you know, as a surgical, or is it just 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, very long list of things and can get very expensive.

Sure. It also comes from back when there were two centers doing the process. You had a, let's say a periodontist like we have in, in downtown Boca. We have a regular periodontist and he works with a restorative dentist around the area. Those fees are, and still are separate. Right. Because you're not allowed to share or split fees between patients. Right. And so I can't collect at the periodontist office, we can't collect a global fee of $50,000 and then share 25 of it to the general.

Right. Or the, the prosthodontist when he completes the teeth, that has to be collected by him and sold by him. And then, um, that he has rights and responsibilities to the patient separately. Sure. So it's illegal to, to share in that type of way. Right. So you had this sort of 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, because what they're doing individually is a little bit different and complex and not as straightforward as it is today.

It also was not allowed to share fee schedules and share that burden and share the money in

Part 24:10

between each other. And so that's where a lot of frustration came. That's where these multi-center practices came from is the frustration involved with, but I just paid for an implant. Now I have to pay for the tooth on top. It, a lot of signals would get crossed up. Yeah. And so part of that comes from there. Part of that also came from the fact that I had to pay for an implant. It 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 for their whole life, have some access to credit and can't afford 95 grand. They can't afford a hundred grand. They can't afford 70 grand, but they might have enough credit to afford a new car.

Yeah. They might have enough credit to get to it. So I always wanted to offer a pricing that would allow them to have an ideal, like I can afford this, you know? And so when we were able to start offering it for a little bit less, and as a side note, we offer for our fees generally less than most, not because of any corner cutting, but because we've built out a lot of efficiency in this machine because we only do it one.

One particular way, more or less it's custom, but it's more or less very repeatable and very assembly line, if you will. And that reduces a lot of the costs and it really reduces a lot of the hours that I have to spend sweating over a case and gives a lot of repeatability for the staff. And so we were able to bring that cost down into the achievable goal for a blue collar. And so the idea was why hide it? Why would we ever want them to not know how much that's going to cost?

Because it's still a big undertaking. If somebody gave me this bill, I say it all the time, I'd fall over. 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 XYZ car is versus the red. I want to know that because I want to know, can I afford the blue versus the red? And so we've decided from the very beginning to always put our fees in as transparent. And one thing that's kind of cool is you and I have fought in those.

Not fought. We fought for the transparency in our marketing meetings and such because they said, nobody else does this. 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. Huh? Wonder where they got that idea. People want to know how much this costs and that's important. So luckily we were able to position ourselves a little bit in front of that and be the original, hey, we're the transparent pricing people. It is predictable enough.

I don't have to worry about if I need to add extra implants. It is predictable enough. I don't have to worry about if I add bone grafting or not. And so the pricing works out fair for us, works out

Part 37:14

fair for the patient, but they have that mindset coming in. When I first started working at the office that I was working at in Jacksonville, one thing that really shocked me, it was a heavy marketing agency or office. And we had one guy come in and he literally brought in $17,000. In a Crown Royal bag. And he said, I've been watching your commercials for years. And it was just a random patient, but it hit me so hard. And 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. And so here I am, I'm ready. And that always caught me. The price was the most important for him, more than getting an idea of the situation, et cetera. And he knew it was going to cost him a lot of money. And he said, I've been watching your commercials for years. And it's going to be expensive. So if you know it's going to be expensive, why not be transparent with the price? And why not give him a goal to reach for? And why not be communicative about what you've charged and such? The old guard doesn't like it so much because they're a little bit built on getting a premium by adding codes like bone graft here and extraction here and surgical extraction there. And that's fine. That's not to knock them. But that's why the pushback is there is because there's a group that wants it to be that you have to triple mortgage your home to be able to afford the teeth. And I won't say anybody's names or anybody, but there's a big push in that industry to say that's not right. 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 fully 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 to do that. I don't want a person to have everything they have in this entire world riding on their teeth. And that's not to say that this isn't expensive. It's very expensive. But we want to break down as many of those barriers as we can. And so we're pushing constantly for continuing to provide quality, continuing to provide a great service, be friendly, concierge, if you will, boutique, if you will, but at a lower and lower price point, not to undercut the competition, not to undercut what other people do, but to be able to make it so that it's attainable for people that are in this category of lost their full sets of teeth, et cetera.

Yeah. I think just from a marketing perspective, one of the things that companies who are not transparent with pricing, for whatever reason, and what you said makes a lot of sense if they're not transparent with pricing, but for whatever reason, and what you said makes a lot of sense. They're working with another dentist and there's a lot of variables. They don't want to give you the wrong price and then it ends up being this price and then you lied to them. And I get that. I understand it. But one of the things they don't have to deal with is when you are transparent with pricing and you do throw a price out there, one of the biggest questions we get

Part 410:25

is, well, how can you afford to do it so much less than what I was quoted over here? My dentist told me twice that amount. How can you do it for half that amount? It's time in the chair. A traditional case using traditional methods, and it's not their fault because they can't afford necessarily the same scanners and such that we do. And maybe they can, but they don't buy it or something. It takes a lot of time to do a case right in the old way.

It takes a lot less time to do it the way that we've assembled. And that will become more and more prevalent and you'll see prices fall across the board. And you'll see guys, traditional dentists get more and more upset about it. And I'm at a point in my career where I can kind of finally say, I'm fed up with it. I don't want to feel like my patients are getting screwed by my fees. And I don't want, I don't need to drive the absolute nicest car or feel like my per hour fee is X, Y, Z. I've built, I've tried to build one-on-one on the basics. I've tried to build one-on-one on the basics. I've tried to build one-on-one on the basics.

Let's do heavy volume. Let's get tons of experience. Let's get 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 into something that they deserve and that they should have. And if we can help them do that, why wouldn't we? You're doing the world a disservice if you're saying, well, I went to school for X, Y, Z, and I get X, Y, Z for my arches. Well, it's really good for you. And I'm really happy for you. And I'm really happy for you. And I'm really happy for you.

And the five patients that you see per year. This might be a little bit more bold than you were expecting me to come out. And I'm coming out swinging. I'm here for it. But I'm really sick of the old guard saying what they're worth. Because they're not. The technology has 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. And quite frankly, it enrages me.

▶There was one meeting I went to. It was a roundtable discussion. And there were maybe 20 guys in the room. And this was probably 10 years ago. And a guy raises his hand. The question was, let's discuss things that upset you about full arch. What are the problems that you have, the conflicts that you have, the issues that you have? What prevents you from doing more cases? And one of the guys raised his hand. He said, the undercutters. He said, what do you mean?

The undercutters, the people that do lower quality work for less money. Right? Well, that may seem like a pretty simple statement. Naturally, we kind of all look at prices and we say, well, this one's so much cheaper. It can't be worth it. This guy must be doing worse work. That car must be worth less. Right? But I raised my hand. And to the point, I might have thrown some fists. Undercutters are not the same people as doing worse work.

I know plenty of people that charge a premium dollar that do not do good work. Right? ▶Undercutting is only to get that patient something that's affordable. That's where our price lives. The quality of our work is completely separate from the fee. Right. The quality of our work stands on our own. We still, I put our teeth up against anybody's, even if they charged a hundred grand for it. I guarantee you we're really, really close. And so that really enrages me that that attitude is out there. And then that's my profession that

Part 513:58

I'm supposed to be fighting for and in love with. Because it's not, what are you worth? Well, you're worth whatever they're willing to pay and you are willing to do the surgery for. And for me, it happens to be less than you, because I want to have done a lot of cases. I've done 6,000 arches. It's a lot. I know I've seen a lot. And for me, it was always worth it. So yeah, that's a topic that's like hot. I get so mad about that topic. No, no, absolutely. There's passion on both sides. And the way I usually, I don't know, I don't know. I don't know. I don't know. I don't know. I don't know. I don't explain to people that ask me is there was a lot of investment done in the infrastructure to be able to make this as efficient as we made it. And that comes down to a lab that comes down to all the machinery that goes into the lab, the equipment and all of the designers and finishers and all of that stuff that goes into this. And that's probably more than your average dentist over in the strip mall down here wants to invest to be able to do this procedure they're not going to do very often. And they do need to charge more for it because this is one of the few cases they're going to do that year. And now they have to buy this additional stuff that they didn't have before and et cetera, et cetera. When you are doing this procedure day in and day out, it's literally what you do every single week.

Those investments pay for their self quicker. Like you mentioned, you get the experience that these other practitioners aren't going to gain in years of doing this because you've compiled it all down into a shorter timeframe. ▶Think about it. If you did two arches a week and one double arch a week, that's a hundred a year. You'd have to work for 60 years to catch up to me. Yeah. It's a lot. It's a lot. I know I've done a lot. And I don't say that as like a lagging point, but that's been my mission is I want to do a lot. I want people to know that I've done a ton of these cases because I want to hold myself out as being not only affordable, but the guy that's done a bunch that is able to do it efficiently and smoothly for you and be able to provide you the service that you deserve and expect.

Yeah, absolutely. And that leads into the second way I answer that is, you know, we don't have to, to pay to keep our doors open and our lights on off of each patient. So we don't have to make as much to clear our overhead and what we need to do for our marketing and our payroll, et cetera, et cetera. That doesn't all have to be made off one or two patients. We can increase the bulk, lower the price for each individual patient so that we're able to help more people.

And yeah, we don't make as much off of each case, but we make up for that by doing

Part 616:59

so many cases, which comes with all the advantages that we mentioned, like the experience, like the efficiency. It reminds me for some reason, this is not applicable that well, but it reminds me of the joke that's, so you're buying this product at $2 and you're selling it for $1.50. How are you going to make a profit? And the guy goes, we're gonna make it up in volume. But that's not true. You know, running Dun & One has been obviously a learning experience. It's been amazing.

I wouldn't trade it for the world. I have a responsibility as being the person that sort of runs it to provide a livelihood, you know, not only so that our employees can have a good conscience, like we've mentioned, going home and going to bed, but that they can come home with a living wage and that they can come home with their family and say, this is what I do. ▶And go to a family reunion and say, we do it the best. We do it quick and we do it awesome.

And that's, you know, that's the charge that I have to live by, not let the rest of dentistry control me. We don't, I spend very little time, if any, actually, I spend no time looking out to the dental office, other dental offices, chains, etc. And trying to mimic what they're doing or follow any sort of trends. I spend a lot of time thinking about what can I do to improve our process? You know, and over time, it shows things that work or get adopted by other places. And many, many, many, many, many, many of our processes and our products and our pitches have been copied. They say that that's the, that's the best thing to get, right? What is it?

It's the ultimate form of flattery. Yeah. I'm not so flattered. I wish they would stop. Yeah. I'll never forget seeing some of the copy from our website, literally copy and paste it on another website of, you know, what, what you think would be a big conglomerate company, not a company. Not just our little family here. So I'm like, wow. And what upsets me is those are the same people that criticize us. You're the haters are the ones that adopt as well. And that's very frustrating. So anyways, now that my bow pressure is up, let's go on to the next question.

Sounds good. So next question. That's probably the single hardest vein that anyone can strike me with anger. Yeah. Understandably so. It's been a, it's been a wild ride. It's a fight. It is a fight. And it's a, it's a, but that's why we, we fight is we want people to see a transparent pricing. We want people to understand that there are costs involved on our side. We're not just here thinking of how big of a yacht we can buy, et cetera. This is a very stable boutique position that we're taking and we just want to build it and grow it and be as friendly and upfront with everybody as we can be. Yeah. Amen. Um, so yeah, we do have, uh, another question here, Antoinette, and I'm just going to read this one out. Um,

Part 720:05

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? That is a deep, deep question. Um, so let's start off with is dental insurance a scam? Mm-hmm. ▶So the issue with dentistry being apart from healthcare is that dentistry is very fallible and dentistry teeth are very fallible rather. They're very prone to needing a lot of maintenance and a lot of upkeep and it's very, uh, quick to cost a lot of money.

Right. And so if you look at insurance models, insurance is not there to provide you a service for, for free. Insurance is there ultimately to make a profit. And so on products like dentistry teeth, you can't make a profit if you're charging, let's say $200 a month, but so $2,400 a year, but paying out $500 a month on every patient. Sure. And they know that the numbers are pretty high and there's a pretty high likelihood that everyone's going to end up using a lot of those benefits. And, um, just as an example, we probably have all used our dental insurance, dental insurance more than we've used our car insurance to total a car.

Right. And that's, that's the issue. So is dental insurance a scam? No, not really. Dentistry is just really expensive and very easy to cause problems and need new, need new, need replacement. So, um, I don't really think of dentist dental insurance as a scam. Now where it comes with, does it, why isn't it treated the same as medical? It's probably the same sort of motif, right? It's probably the same sort of concept that dentistry, you're going to need a crown much more likely than you're going to break your arm, you know? And so reimbursement rates and such are very similar.

I think too, as I know, you know, medicine essentially gets what they're supposed to get from insurance at the, about the same rate as dentistry. Dentistry gets reimbursed on a crown. ▶We'll say the same percentage as a cardiologist would get on a, stress test or something. I don't know, but they're getting reimbursed similar rates. It's not like we get dentists have fought better and we get better, higher rates on our insurance. Right. I think it has more to do with the chance and the likelihood that you're going to have to need dental insurance and you're going to have to use that money and they're going to have to reimburse somebody. Sure. So there's that part, uh, in terms of, will it ever change?

I don't see it. I see it becoming very sort of privatized and localized. Like even though ours is technically not an insurance, like our, we're going to essentially replace that person's need for insurance because we know the parts and pieces that went into it because we know how it was treated and we, we know how to fix it. Yeah. So I think you'll see a lot of miniature privatizations of it in, in house. You know, I'll take care of you, Mrs. Smith, because you've done 10 crowns with me and for $400 a year of cleaning, as long as you just come see me, we'll take care of it kind of thing. Dentistry is getting cheaper on the production. So I think it's going to be a little bit more of a, you know, inside. Um, and so maybe there's a little bit of a chance, but I don't ever see it becoming mainstream. Now, one further level back, we're kind of working this, this, this question kind of ▶was asked a little bit in reverse of how I would answer. So now we're working back towards, um,

why is a teeth considered cosmetic? It's, I don't know that answer. That answer I think is a little bit crappy. Like, I think you should be able to get your, at the very, minimum, get your teeth removed and a denture placed with medical insurance. Why? We talked about last time in the question and answer that health is very dependent on teeth or teeth affect overall health. What's the main goal of, of medicine as a society? Reduce the burden of costs and chronic diseases. Yeah. How do you do that? Reduce and make preventable things go away.

And so dentistry is part of that. So I would like, if I, if I could ask for anything or want to see some movement in something, it would be that medicine somehow allowed for reimbursement of removal of teeth and placement of the denture. Uh, and so, you know, at a minimum beyond that, the reason why it's cosmetic, uh, you know, in a denture, you should be able to get enough nourishment to eat. I can understand that it would be cosmetic and sort of held by the people as, uh, or held by the higher ups to make those decisions as being like, not something they're going to cover. Right. Um, but we should be up. I feel very strongly that medicine should be able to find it in their heart to, to take that part on at least, or, or dentistry. I don't know how that would even work. Um, but that I feels like something that should be regulated into, we at least get them into healthy and can sustain life with their ability to chew something and eat.

Yeah. Do I think? It should cover hybrids now, right? Hybrids is a, is a want rather than a need, unfortunately. Yeah. ▶When you have a denture that could sustain life. That seems to be the logic. Yeah. Makes sense. All right. Uh, thank you. It looks like, um, we're out of time, but I could see this being a series that continues.

Part 825:47

We'll do a part three. We'll do a part 50 if you want. As long as, as long as the listeners questions keep coming in. Um, and I, you know, we can make up our own questions. But honestly, I like hearing the, the, the questions being out there and I like having these answers for them. I like giving them a reason to tune in and hear their, their questions being answered. So we're going to keep collecting questions. You guys keep sending them. We'll keep having these discussions and, and, and try to try to educate.

I like how off the cuff these, these discussions have been. I know what's going, coming in the next episode, because we have an outline of what we're going to talk about. So I have an idea of how, which direction it's going to go and how to move it. But this is kind of fun. Cause I haven't really seen the questions per se. I mean, you gave me the over broad topics, but, um, the specific questions are kind of fun. Cause you get more raw, real answer, Dan emotion, Dan. That's what we're here for. That's what we're here for. Great. Well, thanks for having me. Yes. Thank you for letting me host. Uh, we'll do it again sometime soon. And thank you everyone out there for listening.

And we'll, we'll do it again. Thanks everybody.