Dentistry Uncensored with Howard Farran
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1347 Danielle Ichelson on Billing Management & Addiction in the Dental Field : Dentistry Uncensored with Howard Farran

1347 Danielle Ichelson on Billing Management & Addiction in the Dental Field : Dentistry Uncensored with Howard Farran

2/4/2020 3:00:00 AM   |   Comments: 0   |   Views: 97
Danielle Ichelson, CEO of Dental Accounts at Ease, was a Las Vegas Showgirl on Ice turned Dental Practice Master.  Danielle who had no desire to be in dentistry, as she was a professional figure skater, was brought into our field and found she was gifted at managing Dental Practices and understanding all areas of the Billing Department.  While many others have tunnel vision in their positions, she had a gift of seeing the practice as a whole.  “One position does not work without the other” is her constant motto.  She worked locally in Phoenix, AZ and made a name for herself that brought dentists knocking at her door after-hours to help.  In 2013, after assisting a failing single dentist practice in Gilbert, AZ hit over $120,000 in revenue within 90 days through her restructure plan, she launched her idea of outsourcing her services around Arizona, not realizing it would become a need around the U.S.  

VIDEO - DUwHF #1347 - Danielle Ichelson 2

AUDIO - DUwHF #1347 - Danielle Ichelson

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Howard: how lucky am I on a Monday morning to be podcasting none other than Danielle Ichelson CEO of dental accounts at ease da AE she was a Las Vegas showgirl on ice turned dental practice master Danielle who had no desire to be in dentistry as she was a professional figure skater was brought into her field and found she was gifted at managing dental practices and understanding all areas of the billing department while many others have tunnel vision in their positions she had a gift of seeing the practice as a whole one position does not work without the other is her constant motto she worked locally right here in Phoenix Arizona and made a name for herself that brought dentists knocking at her door after hours of help in 2013 after assisting a failing single dental practice in Gilbert you made a name for yourself down here in Delta Dental of Arizona so I met with Allan Aleph Ord Thursday we were at the St. Vincent de Paul he'd given dealt had given those guys a million dollars and they go they're like two years ago and but you used to work for Delta Dental of Arizona and my next column next month which I'd love for you to read before I put out it was about a thread on dental town about because Delta's dropped you know their letter January 1st to lower all the  fees like 5% but  the bottom line is I'm these dentists I have to wear so many hats it's so hard your dad was a dentist you know it's so hard to learn how to do a root canal and a crown and a filling and not have sensitivity and rubber dams and bonding agents and implants comes with bone grafting in recent it's so much that when you ask some kid to sit there and say do you do patient insurance verification they don't know what you're talking about dental billing everything you do how many hours of dental school was spent teaching us how to do all this stuff 

Danielle Ischelson: you guys don't learn in dental school it's not taught to you you're not required to take business classes to get into dental school people can major in zoology they can major in music they as long as they have that math and that science you know and they hit all those pre reqs they can go into dental school they don't teach you guys the business side of things and the business side of things you can be the best dentist but if your front is not operational it doesn't matter it's gonna be you know you're either floaters saying type of situation and it you know I see it all the time I see the reviews up on Dennis when they enquire with us and it'll say oh such a great dentist oh I love the assistant over at the front office or oh I love the dentist but they can't get their billing department right and it's when you see that because Dentist works so hard to become an expert at what you're supposed to do which is treat the oral cavity you know and  we're supposed to be the ones that are now supposed to be your expert to take care of the rest of it so you get paid for that and 

Howard: and that's why I tell Dentists do not don't ever get in bed with the government Medicaid Medicare don't do it because you just said the obvious that none of them know what they're doing and I have been doing this 32 years I know Dennis who's lovely beautiful wife Karen was up at the front doing everything she thought right turned out to be she screwed all up in anyway the Medicaid Command they get a lawyer and they were advised to leave the country and go to another country so they spent the last years of their lives last time they moved to Mexico and  this is an interesting thing when you're on a cruise and you're in the Caribbean and you go to Cabo every time you meet a local dentist who looks like they're running from the law nine times out of ten I have not met one that moved down there legit and a lot of the stories are I had the greatest receptionist she was great but anyway it turns out on Medicaid she was doing this and that and this and that next thing I know I'm looking at ten years in jail and it's like you know so you know that's why I tell you the you know the history you know we have 5,000 years of recorded history that you no matter what crazy theories you want to come up with describe the world you have to account for five thousand years of data where families kill about one percent of her own yeah but the governor's over here killing six percent and in our family if I had a problem I can't just say we know what go kidnap that person and we'll put him in a cage and maybe shoot him but every time you pass any law like  a speeding ticket they pull you over II didn't pay well you give them the authority to kidnap you to put you in a cage it doesn't end pretty so when you live in a very aggressive country like the United States that's been at war all but 20 years since 1776 don't play with those guys Saudi have you seen Medicaid bill and I'm sure there's people who do too intense I'm not naive there's people that are just missing a bolt or two and I'm not just talking about myself others but um so have you seen Medicaid fraud where it was accident where it turned bad or is it all intentional and you were doing that with Delta Dental of Arizona

Danielle Ischelson:  so with Delta how I got involved with them was I had knew some local auditors who are work for Delta that would go into the office when you get that nice letter that comes in the mail saying they're gonna audit you and they're gonna come in they're gonna pick their 25 patients that they're gonna look over and they never bring doughnuts no I give a million dollars to DePaul they don't show up with doughnuts what if they go back to your office twice and they've got a director with him you're in some trouble and that's actually how dental accounts ADIZ and really getting pushed into offices here locally was we were one of the first ones that right there working alongside the auditors that were like okay well we're gonna come in and we're gonna help you guys figure out how much fraud is really going on in this office and you know we ended up taking that knowledge and then using it to help guide our own providers on how to stay compliant you know and then this last year we started our ACF e which is we're doing the Certified Fraud examiner's and you know we're trying to go into that area of the field just because we do see this all the time and a lot of times I see the dentist who didn't know and he's like 

Howard: but you but your dad was a dentist you've been doing this you're the same age as my oldest child if you saw a hundred people with this issue how many are intent like I'm stealing I know what I'm doing versus I take all my classes in root canals I had no idea what's going on I see it's 5050 okay right now you know it used to be that the dentist's would always say oh I didn't know I didn't know when they come to us and we get this urgent call that they're up for you know auditing and they're like they're they say they're coming in the next 45 days and you know I have a as most the auditors Delta 

Danielle Ischelson: um Delta's pretty much one of the main ones gonna walk in Cigna HMO they're gonna walk in on you MetLife and Aetna I'm not really seeing them going to doors offices and Medicaid Medicaid is gonna always pop in if you're a high producer or you're producing more of a single code than anyone else in your air radius 

Howard: I know I made that mistake one time they called me up it was Anna it was some dental insurance covers 1987 this is 88 or 89 this is out dumb I was a totally dumb as a rock and they told me I had done more occlusal than anybody in my zip code and I said well thank you I got the gold merit badge my god no that's not a compliment and I'm like how is it not a compliment I mean if you met a fireman he said you put out the most fires yeah and I were to get you get a trophy so how is this not good news but it turned out that I it was because I was not a believer I and I'm still not a believer in sealants I mean you're  taking acid etch which is designed for enamel and dentin and your acid etching pits and fissures are filled with Oreo cookies and crumbs and cheez-its and crap and then you want to know why all the research shows that 40 to 50 percent fall off the first year they're all fallen off the second year and this Kym couch guy taught me to spray out all those pits and fissures and get them all clean and when you did that you were in Denton so I did preventative resin restoration or ACLU's will compile and I did you know how you would call it a preventative resin rest restoration when you can take all that junk out and you can culture streptococcus mutans I mean it's so so anyway so so when audit people that are auditing mostly or Medicaid Delta MetLife who else did you say

Danielle Ischelson:  no not so much about life I'm gonna see Cigna on the HMO side total general administrators there are one here locally total what general administrators total dental administrators yep Delta data they're right here in feet in Arizona yeah they're out in Gilbert and is that a dental insurance yes yeah they're gonna be they manage a lot of the hospital employees plans I do not in feature I like to network with everybody in my backyard yeah okay so what's some more Liberty Dental any Medicaid there you're there goes that a big one um they're not too big they're kind of like TDA they're pretty small you're gonna see them usually when you see plans like TDA or UFCW which is you know Labor's union or liberties and so I thought Healthplex you see them kind of section to an area so you know if I moved servicing my Nevada offices I'm gonna see Liberty if I'm servicing my New York offices I'm gonna see Healthplex you know it's kind of like that kind of scenario but you know I don't normally see Aetna come in on the PPO side Tata you on the edge of outside the DHA oh yeah MetLife have never seen them do an on-site audit definitely think that they should be but not necessarily the plans that I do see I thought I had a 

Howard: I thought I had okay here it is today's dental insurance accepted so I'm right up the street I'm just right up the street there so we accept Delta Insurance Aetna which has assurance Sun Life Financial Sigma Delta Dental guardian premiere access of visa those are all the same company humanity care that live united concordia principal financial always care solstice america's physician Mutual TRICARE and united healthcare financial Lincoln and yeah and so so let's go through those I get I'm gonna see it again so because I'm a selfish bastard and I want to know which one of these is I okay so let's um okay so auditors you so let's go the first one man I'm Aetna which their plans are called assurance Sun Life Financial are they big auditors not unless you're on the DHI both side but I'm on the assurance sudden so you're on the PPO site so no that's P ok Cigna do you take the HMO no no Delta Dental yes so walk-in Guardian which is the premier access of aces anyone necessary dentistry on Guardian does what you're saying bill unnecessary Guardian you should be out of network because Guardians when the only ones that still pays off your office fees if you build them on a claim at your fee and then a Humana Medicare Humana will walk in on the Medicare side definitely so so so that Medicare sorry for you international viewers but in the United States has a federal government that's Medicare and then it has fifty states that's Medicaid so Medicare was designed for the old people over 62 that was on devised by Kennedy who got assassinated son-in-law by Johnson when I was one in 63 but the local states are supposed to be there not for the elderly that's national medicare local state is Medicaid so that's Humana Medicare then MetLife not really so unite concordia united concordia don'ts and sometimes like a utilization letter

Danielle Ischelson:  i haven't actually seen them walk into an office and then principal financial when their plans are called always care or solstice emeritus physicians mutual TRICARE not usually gonna walk in either because when you're dealing with plans like principal and Assurant and son life and guardians the amount of money that an office gets from those plans they're not seeing twenty five and fifty thousand dollar checks coming in a month for those plans you're seeing you know maybe one to two patients a day with those plans so you're never gonna pop up on a utilization for them to have to come audit you it's not like delta dental as being the largest dental provider of insurance for you know all of us they're like the Walmart of Dentistry you know when it comes down to the way that they manage their fees their non-negotiable I always say Delta Dental doesn't negotiate with terrorists because they won't negotiate their fees it's just how they are and 

Howard: you know that's why utilization gets so high on those plans but that but that's um that's not really that that's that what you just said would have been for the game for your father who I'm sorry passed away 2019 and August I'm so sorry and but that that's in our world but we know the DSO King pens they negotiate with these guys at a whole different record phones yeah so they're parties in like a unit ah because a lot of them have told me on this podcast said they go say they go by your office for a dollar and they're gonna make you know that's what Trump taught me and  that book had you know my little kids I mean love him or hate him but he told me he really shocked me when I read his art of the deal where the price doesn't matter II said III buy your home for a billion dollars if the terms are a billion a month for a billion months because I'll just give you a dollar this month and run it out for a thousand bucks I'm positive cash flow so price doesn't really matter it's the terms and these um these are HMOs are DSOs they'll go by your office for a dollar and say the payments gonna be a penny a month for a hundred months and that be then that's your usual ten percent return on investment well they can negotiate an increase higher PPO fees to get that one percent back so they're there that one penny a month back so they're really a lot of times they can buy an office for no money because they look at their private equity money and then they look at what they can negotiate up the the cash flow and so they're just and we're Ground Zero Arizona has the most dentists eighteen half percent worked for DSO and then on the full distribution five states aren't even at one percent we're number one yeah so so we were talking about um 50 50 where 50 percent of the dentists are intentionally trying to steal fifty percent are just dumb and ignorant like my friends that go to Mexico and really that white one just really you know whose uh his name was George and I you know I just thought you know how sad but anyway I'm so why are why are they auditing what are they looking for 

Danielle Ischelson: so what happens is whether you're on Medicaid or whether you're on you know Evo or HMO they look at utilization and they're gonna say okay how many is everyone doing an S RPS in this area and the offices that are doing maybe like an accelerated hygiene program where they are doing assisted hygiene or there have multiple hygienists they're gonna pop up higher on their utilization so then what they do is when they take all this utilization they start picking out you know whether that plan chooses to do the top ten practices or the top five in that zip code and that's when we all get those letters and say hey we're gonna be popping into your office to do an audit it's all about utilization do I see a lot of times that I don't agree medically necessary I think sometimes I read x-rays better than a dentist cuz I see you know we have over a hundred offices and I'm looking at patients all day long the biggest one that I do see is s RPS and when I see those letters a quarter my viewers are still in dental care okay so scale and route planning and that's different than a pro fee that is different than a pro fee and my only beef with that and III tell them is that I'm 

Howard: okay imagine that you had a lung infection and I said okay I'm gonna treat your left lung and then I'm gonna wait two weeks and do your right lung yeah well nobody in a hospital would ever recommend right so so I'm skewing replaying a lot of times you  can't do all four quadrants at once and I'm like and I tell my insurance friends I said well you know what when your granddaughter comes in and she has an infection how would you want me to do that when your granddaughters at the hospital you're getting a quadruple bypass you want that cardiology a well we're just gonna do the atrium ventricle left and then in a month when they I mean so you I mean obviously a fireman puts out the whole fire I always on SRP the first 10 20 years I like to just sit down and I'm up all four quads just like the oral surgeon does you shoot you kill your treatment plan acceptance rates the biggest way you lose it your eternal plan except Oteri's because you don't track it number two is because you don't do the same day dentistry and number three is you just shoot yourself in the foot every times they will you do the right the right side they come back what doctor does that no real doctor ever does that and people are busy so I say you know because I'm a doctor I want to numb up all four quads get all that stuff out you know ultrasound at all get it all out sometimes add you know mouthwash sometimes even I antibiotic if there if that's they look infected but um but insurance is decided that they don't want to play that game to sing without license but ok so tell me the other side

Danielle Ischelson:  so the other side of it is because I walk into offices that are DSO offices I walk into corporate offices and I do walk into the single practice dentist it's because we have gotten to the point where we let hygienists run the show on a lot of things and they aren't allowed the time to do the four quads so you'll have a dentist who's like I'm not letting you take two hours in your time block to have four clubs put in or an hour and a half and I've seen Dentists where I've walked into that RDSO ran where they have a quota to hit every single day do they really have quota they do yes okay sorry and I won't say what one here locally but I was at an office here locally when I was still sinister and censored what's the name I don't want to blast them because it is a big one here I will say that they text all areas of Dentistry both general ortho oral everything but and they actually are now ran by the same person that I walked out that day and I my words to him I worked right before I started dental account studies I said to him you know you're treating dentistry with these quotas like were Chipotle like five ten crowns get the eleventh one free I say you can't give quotas because when you give quotas people forget how to diagnose because they're trying to hit their quotas and you know and so that's what I do see I do see where you know they wanted to make sure that they wanted to make sure that the hygienist you know but they wanted to make sure that the hygienists are having as much productivity as  possible they're monitoring how much that doctor is producing per hour how much that hygienist is if they're not hitting that number then they're ready for release late and you get to the point where I have seen some s RPS come in where they'll come now too your practice where you guys are not a DSO or corporate and though you guys will look and say you were just SRP two weeks ago and you're looking at it like how did this happen but because these hygienists are rushing because they're worried about their jobs and you know there's always there's always plus and negatives to everything there's plus and negatives to paying people off percentages there's plus and negatives to you know running a productive schedule but the whole thing about it is you have to run a productive schedule but you have to run it ethically and the plans did what they did to protect the patient it had nothing to do with them saying oh well we don't agree that all four quads you know can't be down the same day because I can actually tell you how to get those claims face you don't have to do that so yeah after the show but their reason and really behind it was because they were asking for copies of the schedule and a lot of providers know this that when you are an SRP utilization right before you get that letter you're gonna start seeing your claims coming back tonight saying they want to see a copy of your schedule well the pillars inside the office don't know what that means so what do they do they print off that schedule and it shows them we did those two pods in 40 minutes or we did you know four quads in an hour and 10 minutes or an hour and underneath the standards that's not long enough

Howard:  well what I don't understand is um it's dollars per hour but I mean if when they need for quarters are playing here toes and you numb up all four quadrants and you're doing all that cleanings and you know they need an occlusal here in an mo here yeah I mean it's what a lot of times we always did is um say you had an hour say  you Thursday you had an opening hour at a twelve to one and then your lunch is one to two then you had opening one to two man there's just three hours you could sit down and do all four quadrants replaying curettage do the four or five fillings but you're it's it's it's like Chipotle I mean you go in there or hungry and you leave and yeah you lunch and you're done and whenever you decide with a complicated human that we're gonna break this up into six appointments over the next six weeks well you just designed a treatment plan acceptance lowering procedure because now this person has to jump over six turtles to get this done and uh and so anyway so that that's crazy so so continue um and 

Danielle Ischelson: we teach to on how to treatment plan properly to be cost efficient you know and that's something else that we do teach our clients cuz we do pay attention we want to see our clients hit their average growth of seventeen eighteen percent above you know we do see offices go from starting with us at two fifteen a month to now they're doing three forty five a month without having additional providers and they're doing that because we teach them how to productively schedule and you know when I was with my dad I was trained pride and then when I was you know gym pride yes so I was training pride with my dad my dad was always rocks and water you know that's the thing goes out okay jump right okay that was the woman

Howard:  oh my gosh i podcast her Jennifer  St. george but yeah hers was the rocks and water what that meant is uh in fact it was funny do you think and eighty seven she lectured in tucson and I took my assistant Jan and all the whole team there's like six of us back then we drove down to Tucson and she asked the first question goes huh wind she said when do you want to do you know there's rocks and you got to fill up your schedule first of the rocks then you can add sand like fellas and cleanings whatever but then you can still pour almost whole glass of water exactly and said it means because when when do you like to do rocks and how I was 25 I said I like you rocks all day long that me and she's so funny she goes yeah you're 25 you won't when you're 55 but anyway so Jennifer Jason or so continue your

Danielle Ischelson:  yeah so we take that you know that aspect we take the scheduling institute verbage you know because I had learned scheduling institute at one of my first clients here locally in Scottsdale dr. Clark's office at Four Peaks Family Dental they're a great practice they're an old town but you know I was lucky that he taught me to scheduling Institute and I was able to with lots of providers because they all go to all these different seminars take from it but I don't believe that only one system works I was able to take from everything and learn how to manage the billing hit that 98 percent or above every time you know in the production not break up the treatment crazy monitor the treatment follow through on the treatment and get these patients done in two points two appointments or less you know because of the fact we do have to break up those s RPS so I do have that whole process of they go and they get now and do the rest party then they come over to your side you finish it if we have to break it up if it's a plan we're allowed to do all four quads in the same day because some plans still allow that well you know that with this which plan of the member 

Howard: I am a selfish bastard on the which plans I'll let you sing let's do all four quads and very good you know

Danielle Ischelson:  so a lot of plans have where when you're doing the scaling route planning you have to wait 30 days to be able to do the follow-up prophy or pair of minutes however the office does theirs and you have to wait that 30 plus one day Cigna is one of the more lenient plans they don't require that you can do that the next day and clean them up they don't make you wait that 30 days but everything's gonna be based on that eligibility and that's where I told you when we had discussed things before was you know the reason why so many Villiers can't get hired with us is because they don't do eligibility anymore so you  forget the rules you hear one time that you know Delta doesn't require you to take that FMX to go with the SRP when you send that claim next to you know you've got providers doing it on every plan and you can't do that or you have where one time they heard that you know limited exams share frequency with the regular exam but if you're doing with the Cigna patient that may not be true well

Howard:  um like say I was with I'm Alan Ford the CEO of Delta at the St. Vincent DePaul deal and I was telling those guys that what's really discerning for me is you know the government is that they've I mean I don't know really what they have ever done in history were they were good at it except delivering the mail right and when you look at the cause Obamacare was so disheartening to me because when you look to the cost of health care you know he wanted more more money for more health care it's like dude 30 percent of the money we're spending his shoveling paper round and so here's what it comes down to the real world the good guy comes in yeah I'm here for my cleaning oh did you cut down a tree make some paper and bring in a head yeah no I forgot damn it and then I have to pay human to call verify the insurance and talk to their him and in fact I was talking to the president of the Arizona Dental Association Kevin early a big fan of the show has been on the show and they're there to the point out where they're they want to pass a law that insurance companies have to make an app I mean Jobs came out with this happen 2007 the smartphone yeah which  made podcasts and podcasts so we're getting really big in 2007 then they hit a wall because Facebook and Amazon and YouTube and Google came out and that enamored everybody right and now that they're kind of getting over themselves on post and bathroom selfies you know in the mirror on Instagram Facebook they're starting to go back to podcasts and I told him I said it should just be your Danielle you walk in and I said you have Delta don't you open up your damn map and I scan it and there it is you're verified and then the Holy Grail I was telling Ellen is you send a check I got it I have to have a human host that money pulls that money and then go post it and Jesus and they post it right for a software goes you know we know dendrix an eagle softer closed system so they're dead so that only leaves us open dental it's the only open system I know I said the Holy Grail is you pay you electronically enter into my open dental and Chase Bank and then that syncs with I'm QuickBooks Pro and of course my accountant you know I mean my  accounting team Stacey but about had a heart attack and fell over dead when I said that I said Stacey I know there's gotta be checks and balances on that's the Holy Grail capital letters that that's what the the church always said was where are we going I mean we're in Phoenix are we gonna walk to New York or LA I need to know where the Holy Grail is and that's where the Holy Grail is that we the only way you can increase the wealth of world is  we were the whole world's population to people on earth and every day we got up and put your bottled water over here we each made a bottled water and the government only printed $2 in circulation so we have two people or total years productivity was to bottled waters and the government put out $2 so the price that water would be $1 melton Friedman got a Nobel Prize in Economics proving that inflation is monetary policy if the government went and spent 2 more dollars which they're spending a trillion dollars a year dad and people don't understand that they say oh no they borrowed the money yeah you borrowed the money from yourself you printed it you went and bought a trillion dollars with the stuff so that caused the inflation and then to rub salt into your eyes now you got to pay back that dollar with interest to yourself I mean it's just so stupid so so the only way so all inflation and monetary policy so the only way is if you said to me coward how could we double the wealth of our planet well we have to figure out how to make two bottles each and if we figured out how to go from you and me making one bottle water each to bottle water to four-day we just doubled the wealth so it doesn't matter if you're cutting here making sandwiches or fixing teeth it all comes down to productivity and I don't want my humans entering checks yeah I know I don't want them doing something that should be an automatic function because then she can do something else or I don't need her can let her go my overhead goes down and and and all throughout history people say well that that's a bad idea no the answering machine kill more jobs than anybody ever and I always think it's funny that people that always want to save the jobs there are always government people and I would say well do you want your daughter to be a secretary to some guy doing something real right and they got no not my dog oh so it's this isn't good for your daughter but it's good for the little daughters of the world yeah yeah the same thing with automatic truck driving do willed you you have two kids I do do you want one to drive a semi from LA to Tampa back and forth I'm carrying a cars because the ship doesn't want to sell down the Panama Canal and come the other side do you want him doing that no so a driverless semi-truck so you don't want to do that job so that's the Holy Grail how close are we before just the initial where I don't have to have a human at $20 an hour and healthcare and 401k and all that crap calling Delta how close are we to where they'll just have a nap and he'll come in and scan it and I'll be there

Danielle Ischelson:  the problem with that is they haven't even figured out how to get their fax fax to be accurate so if you pass nobody hears a fax no no here's the kicker you go through the automated system on Delta Dental okay you're talking to California let's say you're like ins calm down settle ans calm and you are going into your provider portal you've logged in you go to your eligibility you know and you look there that patient could say active or not active but then if you go through the automated system because a lot of us are trained when we do eligibility that you like pre mark your scalp your schedule pull all your deltas out in one call go through the automated on the phone click click click type your fax over let them all come in your eFax and then you upload them into your system the problem with that though is the eFax or the regular fax of your plans benefits for your patient do not update on the first of the month so that's why we all get those wonderful letters stating your patient turns out they weren't active we need you to mail that check back and that's a huge controversy on 88 where everybody talks about why can't we say no you made that mistake you guys eat it because you told us this patient was eligible well of course that's why they had that disclosure that says this is not a guarantee of coverage or benefits and all that but a lot of the plans they don't update until the 7th to the 10th of the month so think about the beginning of the year or think about January 1st because we've got a lot of patients that just went through renewals with their companies they might have chose different plans they walk in for it to your office to get a pro fian January 3rd your front desk gets a fax fax for that eligibility that patient may not actually be active and they could actually be out Humana and you don't know because until you now get that letter saying that it's either a denied claim or they pay it and they want the recoup you didn't know what you received from the plan was actually inaccurate

Howard:  and you know you can tell I mean this would benefit them I mean if you pull up delta dental insurance on linkedin they have twenty eight hundred and thirty one employees on linkedin so if you got three thousand employees on linkedin you get five thousand employees well that that's cost and what delta and where you know the logo to see this correctly is a snake if you ever seen that snake swallowing its tail every once while you'll get a drunk Irish snake that starts swelling in its own tail and so the dentist here's I see the whole industry the dentist might remember they do nothing wrong and you know that's why we all hate dental labs because if that cron comes knockin doesn't fit it was a lab it couldn't have been my proper impression right could that be right I wasn't anything you see me say mistake and so they blame all their current bridge problems on lab yeah and then on Delta they'll sign up for these you know six other plans like I have I read mine out and they're lower fees so then the first year Delta lowered the fee because they're out here in Arizona and they go to your deal and they say hey you want to buy our plan for a dollar and they say well we can get a cheaper one for ninety five cents because you signed up for that so then Delta has to lower the fee and then who's the dentist get mad at  oh and  it's like why you lured your fee you scumbag you dirtbag is like yeah they lowered the fee to match the other six you accepted and then the dentist says well my over it's going up well so is Delta's overhead going up yeah and there and they keep lowering their fees and their overhead keeps going up and it's like it's like dude the dentist you know the dentists are made out of people so they're they're gonna always shoot themselves in the foot but I said one of the things you can do is automate all this labor I'm trying to get your company bankrupt and I'm trying to get you fired you know I

Danielle Ischelson:  I do believe that eligibility should have an automated I think Trojan there are abilities

Howard:  yeah Trojan I believe they're about seventy four dollars what was the next best idea for their name I mean I just got like that's seriously your name look confused I'm like you really don't know that's the name of a condom

Danielle Ischelson:  so what's it called Trojan dunno Trojan eligibility services name of the company chosen yeah so I believe they're like seventy four dollars a month don't quote me on that I just know that they're under a hundred dollars but if that plan like let's say you are an office that sees primarily Delta Dental or Delta Dental MetLife and a lot of your real time processors you can do your eligibility through them and it in depending on what software you are it will incorporate it into your software and it pulls it automatically for you and it does everything so they have developed a system even dental exchange claim connect they've developed an eligibility system are they flawless no do they do every single plan no but do I recommend them for your regular popular plans absolutely because if you can decrease the amount of workload anyone's doing in the front office the idea that I had when I developed dental accounts at ease was I wanted the front offices to be like a concierge you established that patient rapport you welcomed the patient you ask them if anything's changed you get them checked in and then check out they do the treatment planning and then they take the money but nothing else should really occur in the office it should be all outsourced whether it's a physical company like us doing it or like James Anderson over at eAssist and his model or whatever you know those work James and I are probably two of the biggest companies in and all of it I know James is the largest and you know we talk I love James so hi James if you're watching right you know James is awesome yes this is awesome we have a very similar model then we just do it a little bit differently and of course I'm cheaper but you know whether it's us doing it or whether trojan continues to get bigger and they figure out how to do it all there's still too many kinks even with open dental the way that those er a.s incorporate in your system and you apply them to the claim we're now finding as we're auditing patient AR because a lot of our clients are now signing up for us to go to the patient side because originally outsourcing was all big about you go take care of the insurance side we'll take care of the patient in-house then we found all these providers say no one's sending my statements no one's following up with mrs. to miss vallens so now they're coming to us we're going back through I'm doing it open dental office right now that we're doing an audit on and we're finding out the way the ER ace came in they didn't post right so without having that physical yo be in front of you to compare what is coming through an open dental you could potentially be posting wrong in your office right now so they haven't figured it out and because dentistry is so far behind yeah I think medical medical zaiba is transcribing they've been sending their billing out hospitals been having other billing companies do their stuff for years they've figured it out a long time ago on the medical side and their systems and their software's and the way that they do the eligibility automatically right there on their computers is way far past where we have come as dental and not anyone has come up with a perfect flawless software that does it all that can bring it all in that you know does that beautiful single liner kind of accounting schedule it's kind of like I always say if I could develop a software I'd take a little bit from anywhere I'd take a little bit from dentrix sand eagle soft and an open dental and dental con which is my favorite you know remote software if you're gonna use a non server base you know and I could take from there take from care stack tape from everyone you could develop a great system that would possibly do some of that if not all of it but no one's been able to figure it out yet

Howard:  so um you said Trojan a couple is Mark is Mark still the CEO did you work with Mark done

Danielle Ischelson:  I've never like actually worked with anyone on their executive team they're just my go-to the minute someone talks to me about eligibility and cutting their costs and they want to drop a person in their front office and you know because we do reek air too I don't believe that reek air should be by text message anymore I think days of demand force and solution rates they're great to remind you of an appointment but to get someone to schedule anymore you know you talk with me or you I'm sure you get a lot of text messages in a day I get hundreds because I have fillers across the nation and office is texting me you send me a text and it's not an appointment reminder I just swipe that thing off my screen so if you're telling me I need to come in for my hygiene you are less likely to get me as a young person to schedule in a way that I would have scheduled probably 10 years ago or eight years ago when we weren't so much on our phones like we are in this day and age and so like even for ours company we took that back we have a physical person calling 40 hours a week for your office dedicated so when we take all this out of your office we can cut your overhead in the fry you can be underneath that model where your total overhead for everything you know is keeping it underneath that 30% mark you can do all that but a lot of offices aren't doing it and they continually I see the worst as I continually see them hire more people because their own team's not cutting it 

Howard: right because when you look at overhead um a couple things real quick on overhead is to set um if you do $1 a month in sales and you have $1 a month in overhead then your overheads on a percent the way you get the only way you're gonna get your overhead down to 50 percent is you need to take the same people and do $2 a dentistry and all the fortune 500 companies measure collected revenue sales not adjusted production while I build a thousand but you signed up for a PPO and they downgrade it's a 700 and you know forget its revenue coming in the door what actually made in the door so if the money coming in as a dollar and you do $1 dentistry your overheads hundred percent you take the same people and you get them to produce two dollars now your it's fifty percent and when you try to lower your cost the first thing you try to do is uh oh I'm paying my assistant 20 I'm gonna try to get her down to ten well her fee set by supply and demand so she'll quit and get a job across the street you can't call the electric company and say I'd like to lower my electric bill to lower my overhead your tax are you so almost everything that you pay for is set by a very efficient supplying to Mandel so the only thing you got left is productivity and so anything so when you go to buy something I always hold up my hand will it make you go faster easier higher quality lower cost will it be smaller and if you can if you answer all five of those questions then then you do it so but if you were on Shark Tank when you were time I Trojan the first thing Mark's gonna ask the smartest County Shark Tank is obviously mr. wonderful it's always the bald guy in the room have you notice that mr. wonderful would say is is who are your competitors is Trojan online your competitor no 

Danielle Ischelson: yes this would be my competitor who would be yest over James O ESS yes yeah okay so so these kids are probably wondering on they're still stuck on the Trojan on what does what do you use Trojan then I do I mend officer sees chosen for for any eligibility that they can obtain through them if you are in Texas sorry it does have some issues in Texas but if you are in Arizona or you're in California or Nevada Washington New York whatever it does have a great system that does work but you have to evaluate your  office to if you are in office that is using UFCW well there's a million different labor union offices you're gonna have to get on to get that eligibility or if they have a portal some of them have started to come out with portals in the labors union you might go to pull that but if you're talking about your at like my dad's office where he typically always saw you know he was in network with delta only that was it he did not go in network with anyone else right here in fees in Albuquerque New Mexico Albuquerque that's right so he was delta o me and 

Howard:  your dad was dr. james assaults the third DDS 1965 to 2019 Albuquerque New Mexico yeah I still can't spell Albuquerque 

Danielle Ischelson: so he only did was Delta Dental only in network his reasoning behind that was you know Delta will mail those checks to your patient if you're not in network with them so you're really kind of stuck being in network unless you've got patients that want to cuff up the money in full and realistically it's hard enough to get them to pay for fluoride let alone sit there and say I'm gonna give you $300 from miry care visit that's your exam you're cleaning your x-rays and all that and go from there and then say give me that and we'll send the check back from Delta it does people shouldn't don't want to do that you know and so a lot of providers you know will always tell them you know it really should be a network with Delta because your own teams not collecting that money I walk in to offices that are donors or something of what I think is abusive and that is I'm

Howard:  and they burn me several times in this they mail that if you're not patient and what is the chance that when you mail the check to the patient they will not send it to you so if you're using a billing company we're gonna catch it because we're following up on claims three days old and old over 

Danielle Ischelson: okay so I do see for like for instance Jupiter smiles they're with me a long time so we'll talk about them for a second they're in Texas they have constantly where a lot of times they're Delta checks will get mailed to that patient my biller ashley is the first one on that phone calling that patient saying I show a check was just issued to you as soon as you get it please sound and bring it into the office or mail it in that's a good system and that works because the patients experience an America there's two hundred eleven thousand Americans a live license to prime streamer what percent of them call them three days later after they're not you're using a villainess so then what percent of those patients would just cash the check and never turn it cash on when they throw them away there's a lot of times they think it's a notice so they're like oh just Delta give me another notice toss it in the mail do any times that I have called a patient and said well you actually received a $3,000 check I did this help you

Howard:  to say I hate the government is an understatement I mean I know it's a necessary evil but god they're evil so I told the postman III don't want this junk mail 99 cents thrown away I don't want it I said I want it I'm gonna take out my post box and they said well you can't I said well how cool is that that not only do I have to do with you yeah I can't not do business with you yeah so I just said okay so here's here's a deal I'm just never gonna check the mail again so he just left a permanent note in my deal you know all your mails forwarded to you know the government mafia and because because it's a digital yeah and sending a letter I see that because if someone sent me a check in the junk mail you assume it's a it's a joke it's a it's a you know it's some marketing thing so I can see I mean I mean when you have the business where 99% of your product is throwaway it's not a very high trust route to go the same way we get so much from you know the the I call them the annoying postcards from every dental office 

Danielle Ischelson: you know because you guys send these postcards I get five of them from local dentists every day they work and cuz 99% are thrown away but if you mail to a hundred houses one still comes yeah one older lady but then believe it or not doctor Mercia love doctor Marissa he's a big part of why dental account cities is here today dr. burr shows discovery dental in Las Vegas he used to do the review journal and I never understood when I went in there and I went to go manage one of his practices when I you know first was launched in deadlock on cities I needed some more money I needed to work - and dr. Marsh I was like why would you advertise five oh you know five hundred hours and six hundred crowns and then reviewed only goes to Cassini I'll most of them only have that very small Humana Medicare plan where they're only allowed to one crown and the two fillings and one extraction per year or whatever the guidelines are and or they don't have any at all and the only enrolled in the Medicare on the medical side he goes so and they still read newspapers and believe it or not hands down signature smile discovery dental in Las Vegas every single day there was a call 

Howard: so the young dentists they come out of school and the biggest base you're ever gonna have yourself is you're gonna project yourself on all your thinking okay and you have to remove yourself from the data at large and yeah and they're like well I don't like direct mail okay well you're 30 years old hello and and I can give you the name of I donno $25,000,000 practices where they do the same thing they advertise a $99 extraction yeah why well you're 30 you just got a dose go how many extractions do you need how many mm extractions are going

Danielle Ischelson:  for the big case they're going or the person that still reads those or that reads the newspaper that gets those Flyers but they don't have insurance and they see that and they come in next thing you know that one extraction is actually four crowns eight extractions a partial and SRP we can't even start without the scaling and root planning and get all this treatment and it works it does you know but I'm not saying person I get millions of stuff in the mail and I'm always like oh just give me my money you know and and it's one of those things where you have to remember that what works for my age group your age group getting out of school you Orion it's not all the same but you do still have to go back in dentistry we went back to making phone calls and rhe care because it worked people wanted to hear someone from the office again you know putting stuff back in the review-journal yes people still read the newspaper if they didn't they wouldn't be standing outside Starbucks selling that newspaper on Sunday still because it still works too much you guys come out of dental school you go and you take your 110 thousand dollar you know a year job at whatever corporate you got on with you're like well they made it they have 25 offices and this is what they do and you take that and you go off you buy your single practice and you think it works you didn't study your demographics you didn't study the image groups of your area what works in Gilbert which we all know is  very you know more of a religious city we're saying yeah it's very morbid you know what works in Gilbert will not work in Moon Valley you know here in Phoenix that's for David Spade once ya seventh Avenue and underground the affluent Mac yep it won't work we're used to see her house but you know it won't work we're uptown is versus what works in Gilbert you have to study and every single time I was just on the phone with true Karen Albuquerque's my client they've got several offices and love the owners there and on the phone with them last night working on their accelerated dental assistant that's gonna help now with the doctors because that's now allowed in New Mexico and we're developing their plan but a lot of things we do every time I don't care about to talk to my owners that are my clients on time to three hours a night to figure out to how to make them more money because that making more money means I'm making more money you know but you know I will tell them let's study things let's look at that-air radius what is working in your area what is this practice doing what's this practice doing what age groups are coming to your practice what marketing have you done that failed what marketing worked I still believe in Pido that you need to be at every single Health Fair you need me out in front of the Rancho markets you if you're a Medicaid driven pediatric office cute smiles for kids I started there in their first year at the end of their first year they did like 1.1.2 for I don't know I was lower in the 1 million scale and the year that I you know the second year I was there we did 3.2 you can see Peter though 

Howard: I forgot why but the pediatric dentists hate dentists also say oh my gosh I should have chose a different one this talk about affordable dentures got to a hundred locations off one ad and it was the $99 extraction because the CEO said do you know anybody who needs one tooth extracted and nothing else and 

Danielle Ischelson: they do the 495 arched dentures what they get you on is they get you in that door and they say let me show you the difference of what these look like here's what it looks like at a 495 model right but if you take this model at $800 an arch look at the difference in the esthetics this one looks so real is your son Annie the IVA Claire has the low-cost denture teeth yeah and then they have the what is it the blue line they have like that it's like a blue is a higher line yeah you know there's notice we better yeah better look and you can look at her Reyes products like I love her ASI think they're a great product you know and you look at their practice products of their teeth that they use in the labs and it's night and day but you're gonna pay for it because

Howard:  our train so when I was getting my man International Congress or open ecology and my fellowship in the mission stood 30 years ago at University of Pittsburgh now go back 30 years later who made the most money I thought people who got their fellowship in the missions to then went back and bought denture world in their community yeah and who had the 495 denture and yes you could upgrade him to maybe an 800 with a the premium teeth and then upgrade some more to just two little ball and hooks snap down all the way to an all on four and these guys would go back and buy these um these big brand legend removable places in the middle of the biggest trailer park community retirement centers and this guy had this pride this denture world for sale for like five years and he bought it for like four hundred and they could convert you know the majority half were getting this much buy low-cost denture so it's a great service and but the upgrade deal they were over about three out of a hundred would convert to an all on for $25,000 an arch and then your first thought will be well where do they get that money oh I don't know in America the average American buys thirteen new cars between age sixteen and seventy six and the median price that new car is thirty three thousand five hundred but no they would never want to spend that on their teeth by the way on you if you left hair fell down the stairways and knocked out your very front teeth yeah would you just tell everybody here from Apache Junction not care your front to go to be like yeah whatever or would it be a crisis it would be a crisis yeah so so so why why do these kids oh and then another one was the implant the biggest implant producers I know bought the denture world and they're upgrading you know low-cost ceinture nicer teeth onto maybe on four on four are and a lot of the on four guys after MIT are now doing you know all on six and they're not but anyway that that's all another subject but um the they built it by just a dollar bill sighs ad in the local newspaper just says dental implant 99.999 yeah so they're so everybody's going to the oral surgeon Prospera das they're all getting these bills for look at these bids for like 1200 1400 1600 and his just 999 and oh he's just placing 50 implants a month on that 999 and then a lot of people say well I need twelve or fifteen hundred well then then you don't understand cost because if your cost is a dollar a day you need to do a dollar and having one person come in and pay a dollar versus two people come in to 50 cents it comes down to dollars per time you pay you know your fixed cost rent mortgage equipment bill like computer insurance malpractice professional dues those are costs you pay on the first a month for the whole month whether you see one patient or 100 variable cost or your cost similar people lab and supplies and those are costs to go up and down with the number of people you see but but marketing's everything but I catch of the chase I'm how do you make money what do you actually I mean give give give me give me your pitch I got a dental office right up the street have you met my team I have not who d 2d from Gilbert no we're both trained right and but at least we're not Apache Junction right but so give me your ear spill what would you do for me what would the cost be what would the price your website is dental billing calm dental billing company comm 

Danielle Ischelson: we are dental billion company comm we are one of the nation's only flat-rate dental billing companies that has a reputation that's known that stands by their work I can vouch for her reputation she's in my hood I don't know dad was a dentist Albuquerque by okay so you flat billing was great so it's great if your and we do it based off of how big your office is so a lot of people go to our website and they're like but I'm only collect this we don't do it that way and the way that it comes out is if you are doing you know the average PPO practiced as 65% insurance base if you're in network you're doing 65% insurance base if you're taking Medicaid you're gonna close that gap up to that eighty five percent mark so if you're using one of my competitors they say so though again the average in office is what they see five percent insurance based okay but does that mean 65 per well it can't be 65 out of a sense of dollars coming from an insurance company that just means 65 percent of your patients yes all right 

Howard: so two thirds yep so your average practice two out of three customers have dental incorrect okay so your average the average 65 percent has insurance correct

Danielle Ischelson:  so and I can use an example you know from eligibility terms if your practice is doing you know about 145 to 160 and insurance or I'm sorry in production a month you know typically we're doing about 120 to 150 eligibilities per week on patients so that kind of sees where you are on your hygiene and your production side and that's not including the fact that we're not gonna pull eligibility again on someone that's already been seen in that current month that would have already had that eligibility so when you think of it in that aspect if you're using one of my competitors or you know you're using dental claims clean up does a tear price pricing or using es su does three and a half percent if you are producing two hundred thousand dollars and you're 65 percent insurance based and you know let's say of that two hundred thousand you know a hundred and twenty thousand of that came in and insurance and of that 280,000 was your cash in and cash patients or whatnot in your co-pays and you do it at three and a half percent you're well in you know what almost four thousand dollar bill a month with my competitors or whatever at that point why even outsource you might as well have it in-house you might be able to get a really good biller for fifteen to seventeen dollars an hour but with me you could be $23.99 to $27.99 a month flat rate no additional fees no charges for us to cross co2 medical we don't charge more to Bill Medicaid we don't charge more to bill medical we don't charge more for you know anything we don't charge you for postage we don't charge you for any of that and that stuff that you will see in my competitors we don't do it we are that's what you pay that's all you pay that's it no matter what you need us to bill and that's why our system works is cost-efficient wise it does bring your overhead down we have seen offices that have actually you know let their bill or their treatment coordinator go and then we've retrained the front staff to operate on two people instead of the original three so you can cut overhead we have offices that are doing 60,000 to 75,000 a month in production that are now down to one person in the front because they've outsourced everything else to us 

Howard: so why so she's young she's in dental school she's uh why would she outsource

Danielle Ischelson:  so the point of it is if you're gonna come out of dental school and you're gonna go buy your practice you need to keep your overhead low so we do startups we're doing a start-up right now in Texas where he wants just his wife to work in the front but just checking in patients he wants us to do everything else so we're gonna be putting the co-pays on the schedule he would rather pay for that service that he can manage his overhead not pay overtime not pay workers comp not pay payroll tax and he can keep his cost down because you really as a dentist practicing in your own practice wanna be 30 percent or below for your overhead and if you're you know have associates you want to be you know whatever your associate pay is on addition to that but you know we do see it I'm sure you've seen it in all your years of practicing where those girls in the office or gentlemen they want to hit that forty hour mark there may not be patients but they're gonna find something that's that they're in sterile and pretend they're doing to hit that and even in the front office you'll see them your last patient have 4:45 why did they take till 5:30 to clock out oh well I was feeling her how to finish my EO B's well now you can be into a position of overtime so that is really why we encourage offices Towe source it does keep your overhead low if you're paying attention to what you're outsourcing and what the overall costs I get providers call me all the time and they're like oh well I feel like if you build off percentage-based your girls would work harder and I so obviously didn't mean me as the owner because my girls work very hard because they know that I will be right on them going hey why is my practice I monitor every single office around on a dashboard that I monitor every day as soon as those girls are updating your guys's numbers in the office for your production and collection I'm seeing your percentage it's kinda like a stock market board and it's constantly giving me where you guys are if I'm watching your office and we're dropping in percentage I will make my girls hand type in your claims to make sure that we're hitting that 98 percent or above for the end of the month so how much is it then we start at $14.99 unless you're a start-up if you're a startup we do a per claim probation type price about $14.99 a month that's the starting rate and they go up to I mean I have offices that do 400,000 a month so you know an office for instance how much more affordable we are if you're an office that's doing three hundred thousand a month in production I'm gonna come in at around 3,500 to build that office a month whereas if you're doing but

Howard:  what does the average what is the average dental office in America collect a month in money yeah it varies like you could use just saying the average so the average is it be seven eighty five right so divide that by 12 so the average would be 65,000 a month 

Danielle Ischelson: so if they're doing 65,000 they're gonna be more of our $14.99 a month and what would you say your average client does a month in revenue you know we're pretty raised I would say lately we're getting a lot more bigger offices we are getting DSOs inquiring now that are actually saying that what do you think your average client collects a month anywhere from [Music] 60,000 is what their collections are all the way up to 430 but  is that's what I've been telling you consistently for four years so you you look at the 80s assessing and say what does an average dental office make general dentists don't say 

Howard: well there's two hundred thousand license dentists 150,000 work 32 hours a week as a general dentist thirty thousand specialist this average general dentist does you know 780 it's you know 65,000 a month then you go ask a dental consultant well what does the average dental son make oh I'd say the average in America is about I don't know 1.2 to 1.5 million see that's their world because the smart people have dental consultants the smartest Dennis I know use all the dental consumnes a Oh every user don't they'd say I've used five I've used Jennifer juicing George Sally McKenzie sandy Purdue I you know they name a whole list here so people that are outsourcing to her see what the average was 65 so that's the median so half the dentists make less than that have to decimate more and when I asked her that was the low number and then she all the way to you know three or four hundred thousand and that's why I'm that that's why when companies come on the show and they're trying to do something I say well don't don't go after dentists they're chasing bone grafting and the ultimate implant go after DSOs because if you have a decision that's obviously business makes sense go talk to do so cuz they'll listen my homies my god they just want to go up to Sedona and buy a magic crystal so um so the big dog so now DSOs are contacting those are contact and a lot of them do their boss yeah and a lot of them are doing this in India what if and that's and that's something

Danielle Ischelson:  I have an issue with any company that's outsourcing overseas they're billing shouldn't be going over there nothing should be going over there it didn't write it is she why though because if there's a violation if there's something where there's a breach in security HIPPA has already published that they're gonna come after you as the provider so they don't care that you outsource they're coming after you the problem is I'm 

Howard: the problem is I'm yeah I've lectured hell on New Delhi Phoenix Arizona five-hour flight to New York two hour fifteen hour flights in New Delhi tak take up on her people 15 hours back to New York fibers I New Delhi is straight on the other side so right now it's 10:30 in the morning so New Delhi it's 10:30 night so there they're working claims and trying to call customers and dental offices you know it's so it's a timezone it's it's a mess up so if this dentist is is the average and she's doing you know she's doing a because eighty three three  a month okay so she's a million dollar collection she did collects eighty three 333 and for a million dollar practice she's probably got three girls up front too much so if she gave you and II and III you should change it to 1500 months he really cuz you know what you're perpetuating at $14.99 um people believe that when you say $14.99 that it's psychologically it's not fifteen hundred that's not where that started it was actually your job it was actuarial risk accounting so I had a you have a shop and you would sell stuff and you had a cash register so you come in the morning you break a roll of pennies and put 50 pennies in there and then when you come in there today because everything was charged 99 cents so they'd always give you a dollar so you had to give them one penny back for transaction so that was the transaction count right so if I know my average transaction is $10 I come back there's 10 penny Messing's I should have $100 in the in the cash register so if it's close you know but that's so it's no psychological deal but it but it's hard like I  try to reduce all my math to ones and zeros yeah because then you can do it all in your head so 14.99 man you got a one a four two nines

Danielle Ischelson:  you know what it works with tennis honestly does it really really does if I come to a dentist and I go oh well you're in the next you know you're kind of in between the two tiers so we're gonna do that at 1600 if they're in between that for $2.99 in that 99 tier uh-huh for that $14.99 really sounded better if I cover about 1550 that $14.99 is really sound so much better it really is it works and so when we started we used to be like you know it was twelve fifty for the smaller when we were our old pricing was 1250 and it was 1,600 and it was 1750 and it was 2200 and

Howard:  it was crazy when we went to that business was like okay but let's go back to my homie she's on she collects one millionaire says eighty-three 333 and she's got three girls up front now I give you 1500 and one white

Danielle Ischelson:  so what's gonna change in her world usually if they're coming to us they want to lower their front office she's thinking that at this point when she's coming to me she's saying I think I messed up I think I have too many girls in the front I want to outsource anything I can and then I want to decrease my front and it's really about cost at this point you know she might be five years in this practice raises are coming in affect everything else and she's realizing that she kind of got herself in a pickle by allowing three girls oh where the hell were you born so so so then I want to tell you what she just said

Howard:  um you when you go to dental seminars I was just at one for two days over the weekend the dentists all come alone so they they don't bring your staff so you don't educate their staff then I asked you all the technical stuff how do you do insurance verification billing oh you don't know so then you hire this front desk there's no training and then you you start doing Medicaid sheet as a bunch of mistakes now you're living in Cancun and this is all she does this is their core coma see when I talked to my DSO buddies Steve torn and Pacific Alex Abrams of one three hundred in Dale Rick workman this is a department that they would never ever think the cult the incoming call center on a new patient goes to their call center they want to handle that because like the scheduling in suit which does it for the individuals that they  want a closer trained correct convert this incoming call to a scheduled appointment and after that they only give you like six weeks and it if you can't and then the dentist don't give that girl that can't convert six years 12 years and then they don't train her on all this they can't run any of these reports and then all the dental consultants that I know when they go into an office with questions like this 50% of time they find embezzlement yes residency 

Danielle Ischelson: and then on top of that you know you look at our statistics and you know and I have like a really bad review from a girl who failed an exam with us she's like well I have all this knowledge and in Washington we do this no sweetie there is no difference and there is no such thing as a signal of Washington has a different rule than a signet of Arizona it depends on the group and the policy and what they what the employers selected but you know you look at us so cute that one review you know factor that she failed her exam of course but she went on everything linked it does it does it personally bother you I think it bothers me in this sense because I consider our company very culture and my Director of Operations right right 

Howard: and that's why it buddy but out of the so 1800 we had 1 billion humans yeah and what was it a 19 in any way 1910 we passed 7 billion we're almost coming to a billion ahead of 8 billion people what percent are just batshit crazy okay so that's exactly what's kind of my I'm talking with the planet the planet Earth what kind of crazy are you so when these sapiens look at reviews and you got five reviews they all say oh my god she is the bomb like okay Danielle got her sister her mom or three cousins right but when they see 10 reviews yeah and look at me with movies I mean if all 10 reviews are good I know it's some bubble guns almost every movie I like didn't get good reviews right I go see Ford and Ferrari and if you don't like Christian Bale just move to another country okay even like but the bottom line is uh I think the one review is legit and remember on bad reviews when you stir it stinks people are crazy people know that and reviews are gonna get better because they're gonna turn into video and when you start seeing that lady say in the review you'll know that you know surprise she's probably had some challenges oh no for sure I want to get I want to change it we all have challenges I'm sorry your dad had some challenges again and I don't want to bring that and we're at the end so if that's personal I'm gonna drop in here it's about my book

Danielle Ischelson:  my book is about my dad and it's called behind the drill it's called behind the drill you know you guys will like chapter two it's actually a quote from The Hangover Stu you're a dentist on a doctor but my book touches on a lot of things that we all face and we see in dentistry or were afraid to speak up about that we see our providers doing and it talks a lot about addiction my dad was an opiate addict and in the end you know contributed to him having passing in his 50s and you know behind the drill focuses on everything that we're doing wrong to deal with the fact that addiction and exists in dentistry and is there reasons behind it is it because you guys come out with massive student loans that you start drowning yourselves in your stuff because you're you guys just can't deal with things is it because your practice fails you know I don't know and I don't think I'll ever really understand why my dad has his problem and and honest to god until the Dental Board incident we never even knew as his family I would have never knew that my dad took opiates and was practicing because my dad the amount of opiates he took in a day because I don't think he truly understand even what being high felt like when he was actually examined by a medical doctor said that it acted as tylenol for him that he could fully practice and this medical doctor in the Supreme Court ruled against the the New Mexico Dental Board they lost against my dad my dad ended up losing his license over not giving a patient x-rays he didn't even lose it / opiates but the Dental Board threw it right out of the book right at him we had a dental board member within a mile of our practice who also worked at my dad's church and you know new insider information that we had spoke about with our local church and and it was really sad it all got used against him but in the end it took a medical doctor examining how much he was taking and whether or not it truly affected him practicing you know I never ever disagree my dad was supposed to be in treatment I'll never disagree that my dad should have probably stayed in a program forever of his life because he did have that circumstance but we're always so quick because we're so oversaturated with you know really trying to strive for that extra patient that you know we we're really just not really dealing with it as a field and that's what the books about that in the book touches insurance it touches everything and you know and even as a person who owns a billing company it does touch on that like how we need to come together as Dentist and I think that in our field we just really need to come together identify when we see a friend that might be acting differently or you know if we're starting to see things weird in an office not just sit there to collect a check you know what I see that that happens and it's the same thing you know with Dentist to deal with embezzlement it's also in my book my dad was stolen from - and you know it really touches everything that we we hide in our field so that's why it's called behind the drill and I welcome anyone's stories - if they want to add it but you know I did take some from some clients two of their stories and it's in the book and you know and I'm really hoping that it's gonna help guide you know students that are coming out that are gonna be graduating as Dentis helped you guys if you do have anything going on and it is much bigger than for a lot of you dental students are probably watching this going oh no never no one in my class I can't tell you how many even dental convinces I've went to where a dentist has invited me to go in and go fight with him oh come up to my room real quick let me go grab my jacket so we can leave and I go in there and I see drugs on the table yeah well I would've just put it in perspective and everything always gets better

Howard:  so every hundred years it gets better when I got out of school in 87 no one had ever even mentioned that opium was a problem I and when I opened up my office the the Vicodin Rupp's I mean they would just go by and give everybody samples yeah and I remember I remember one time we had to throw like 20 30 40 greenbox and samples in the trash get a thousand square foot for office and we didn't have room for all the samples and but China they got into this stuff at 700 AD the opium were ten percent of the Chinese smoked opium the whole world so so a lot of times I just want to remind you that a thousand years from now I mean look the ten commandments they're fight they show up 500 BC you know the thoughts steal kill you know nothing's changed in 2500 years they've been smoking when the Chinese got to Britain different reports the majority report said 10% smoked opium every day every day when the United States became a country in 1776 they they with England you know the opium wars also so it's a it's a problem that's gonna be here a thousand years from now you're gonna have drug addiction and it's a disease and yeah and I'm so sorry but  I do have to say this a time suicides a big disease too in dentistry it is and every year that I've been here I've known of a dentist saying yeah and I've been to some of the funerals and here's what I think is sad is when the staff is really really upset they'll be saying things like we all know we just looked the other way that's right and that's the human thing I mean even when the pitiful thing broke out and in a Penn State everyone knew and then I was like why did we not do anything and like yeah we knew doc was doing that but you know he did good dentistry and the practice was great and we just kept looking the other way then we walk in there one morning and there he is on the on the nitrous thing and he's dead yeah and she's like okay well we gotta been doing that you know several times did that I remember it was at 2000 and 2012 or 13 when he they found him on his nitrous right all right and that's why the nitrous so when I got a school you could turn Knights up on a percent now you can't even do that like my nitrous machine turned up to 70% so I'm you know so but um so it is a disease what I like the most about it is it used to be a moral thing where they wanted to take you to church and spank you and now but-but-but-but-but talk about the Truman you didn't like the the treatment till 

Danielle Ischelson: you know I was I was okay with my dad being in treatment what I wasn't okay with was finding out that people knew and they hid it from his own family you know I wasn't working in a dental office at the time that you know every tool so the Board found out about your dad before his own family knew and the board would you resist so this was 2008 and the reason the board found out and here's the kicker are we ready was because when my dad finally decided that he was done with his own team writing scripts in his name because they were doing that and with them not running his office he cleaned house these same team members that have been with him for 13 years that I guess knew his deepest darkest secrets as a vendetta wet and that's like revenge they went in to the Dental Board and finally took it to them said well doctor salts is doing this where were you over those 13 years went by however long because I we don't even know when my dad actually started using we still don't know you know because it's just one of those areas where it's very sensitive what happened during that time and it's and for us it's like how could you have sat there and taken a check from him how could you have sat there and done all that knowing what he was doing and that was my always biggest issue it wasn't the fact that he got turned in it was the fact that his staff turned him in once he terminated them and that's

Howard:  Harvey Harvey Weinstein yep you know who was who was mad at him the ones that were doing all that abuse for not getting the movie role right you know I mean it's yeah they they look the other way if it's in their own self exactly

Danielle Ischelson:  exactly and that's human things but  you said the board was the new about this they were treating it and board at that time was when you know we just had our own board issues in Nevada recently where everybody knows our board was you know released by the governor but you know in New Mexico at that time we had been violating the board was violating at the time as well they had two providers in the same district which was not allowed to have two members on the board in the same district both those members were in the vicinity of my dad's practice one of them belonged to the church it was Catholic no a Presbyterian yeah well give credit okay you know and you know that doctor in Albuquerque knew a lot about my dad's stuff that we had confided in my parents had confided with the church and it all got to him and so he actually had inside as a board member of things beyond what was even turned in because the church leaked it and to him because he worked for the church as well along with my dad so my dad's case was very crazy like Lifetime movie type level but that's why the books out there but you know when the board came they wanted to throw the book at him they wanted his license taken they didn't even want to help him they didn't want to put them in treatment they didn't even want to give him a chance of saying okay for the next three months you need to go to treatment and then we'll have someone supervise you it wasn't even like

Howard:  so do you do you think it's a in hair okay so I've had some amazing people on the show and that talk about this and it varies a lot and I noticed the older people anyway legit but but a lot of the the younger 55 year olds I'm young well we had on a wind Wendy Gessen okay and she is a firm believer that 95% of the substance abuse users are doing it because they have other mental challenges and it makes them feel better and there's a dentist that we had on here Chris volchok he says that I'm on the homeless population ninety percent of the homeless that never get recycled back into the this of schizophrenia and that if a schizophrenia smells pain sniffs glue drinks a bottle about anything you give them makes them feel better so you hear judgmental people don't get a dollar he's gonna go by Yvonne can slam it well he's gonna do that because he's a human and he'll feel better yeah and but anyway but  the crucible check and Wendy guessed some that convinced me that you're the this is a disease this isn't a moral issue like robbing a bank now this is a disease do you believe it's a disease 

Danielle Ischelson: I do um full disclosure my dad was living a life as a straight man and he was not and that's in my book it was a very sensitive subject to talk about but I do believe that my dad spent his entire life hiding who he truly was that it led to his addiction and he had you know access to what my grandfather was a doctor he was also the mayor of Tucumcari New Mexico for many years and you know growing up with my grandfather was like just a really good looking man and he will your dad was good-looking just looking at you I figured he was a home but my grandfather was that manly man that manly town doctor that mayor that just strong it and my dad was it my dad was a pianist my dad was soft-spoken I've never heard my dad raised his voice in my entire life which is crazy because we're Italian and you know he married an Italian woman and so it's like you would have thought hit when it came out of him at some point it didn't but you know he was that calm guy who's very soft-spoken and they used to always say that when you would fill him in s ties you couldn't feel like because he was just so soft and smooth but he hid who he was and I 100 firmly percent believe that he hid his opiate or he used his opiate addiction to deal with who he was I

Howard:  I don't doubt anything because I think humans are so complex yeah I mean the pyramids were just 5,000 years ago and they didn't put that too writing until the Greeks 2500 years with Pythagoras who they all said they learned this geometry from the guys around the Mediterranean built and building pyramids and I really believe it will be 5,000 more years before we figure out how this noodle exactly works I'm so trying to figure out uses the stuff we see in dental offices you know I got an Italian thing you need to figure out the Italians always brag about their tomato sauces and their sauces no the Incas found the tomato along with the potato and the Italians didn't know what a tomato was so 1600 Italian food you go down to Peru and you see how those Incas work up those tomatoes yeah and I'm Irish so you know a tomato is good because it's close to potato right yeah but my god that's Incan food my gosh you know what um when is behind the drill gonna be back out

Danielle Ischelson:  so I'm hoping that I finished my book I've got a couple more chapters kind of figure out where I'm gonna go with these final chapters but hopefully it'll be released by this summer and I'm really hoping that you know it gets somebody out there to help them it's not about anything bigger than for it to help someone and help guide you that it's okay it's okay to rely on something it's okay to even call us as you know to be honest about what's going on in your practice we have no judgment you know we want to be a support system out there for everyone to be successful and and to also you know deal with whatever challenges they're facing and hopefully behind the gel is gonna help bring awareness and deal you know let people know that you're not alone that's the biggest thing I hear from every dentist who comes to me whether it's because they're in trouble with the board they've got a drug thing they've got you know embezzlement they've got a crazy employee who's trying to be vengeful and do things to them or they had anything going on every one of them has always said to me Danielle I feel like I'm alone in this I feel like I can't even go to my other dental friends that I might have went to school with because I don't want them to judge me or they always want to talk about how you know great their practices and they never feel like they have anyone is there to listen and and I get it there's nothing anyone could show you 

Howard: I want to ask you um specific though so when I get out of school and I know we got to go I can't believe went over an hour and a half is um when I get a school we were the bad guys cuz grandma's dying a cancer and she's in a lot of pain and those evil doctors won't give her any pain mad and they're worried she's gonna addiction she's gonna die anyway yeah so then the pendulum starts swinging it was like man load her up she won't feel a thing and then and then it's always the cycle the business cycle you expand credit you can track credit and I'm telling everybody I don't care what any I just heard a guy from the it's the World Economic Forum in Davos and some one of the smartest guy he said no this time it's new oh my god the kids I mean you know I've lived through for expansion and contractions I'm consolidation when I was in college or thousand beer companies that consolidated and a Budweiser and Coors and Michelob and now it's Dee consolidated back again same with dental supplies I got an 87 there's a dental supply house in every city consolidated the Patterson Ben Cohen and shine and Burkhart and now it's Dee consolidate again so the everything goes to it's just pendulum so don't prescribe anything prescribe everything now its back just real quick final thought knowing how you're an expert your dad's a dentist you're in dentistry all stuff somebody comes in with a root canal and the some old guys are prescribing vicodin some people think that's just the kiss of death what would your thought be on pharmacology in a dental office after you pulled a wisdom tooth or canal

Danielle Ischelson:  I think that every dentist needs to be on the website verifying what prescription history that patient has before they're prescribing because if somebody had done that with my dad earlier on they would have realized that he was a doctor hopper and yep like going to other prior writers to try to get more and I see it all the time in Vegas Vegas dr. Mercer's group you know I like to bring dr. Royster up again because he's so by-the-book but dr. Murray says group they have that website and when I was we have Arizona everyone does it's a national database that you will pull that patients may even murder will you make a post on that on how to do that yeah I believe an email to me I've never been on that yeah so when you have that patient you're about to prescribe a narcotic you know you want to make sure that you're logging in and checking their history especially when you have a limited exam site come in what's the site but will you will say yeah it's a federal database and you guys are actually supposed to have logins for it hint hint if you're a provider out there watching this you are supposed to legally have a login for it you're supposed to be checking your patients checking your limited exams when they're coming in you never seen that patient be prepared for them coming in because they might have already went to three other doctors that day with the same thing they're coming in because you have it on your website at $49 for that exam and that x-ray they're walking in to see you they're walking in to see so and so they're walking out with all these scripts and you know we had a huge DEA a huge thing in what was a 2015 in Vegas they had all those medical providers we got lots of great medical providers actually sitting in jail today because they were busted yeah yeah so it's like you guys have to check these things because they are what we call doctor shoppers or dr. hoppers okay I just sent you an email so we have a course on dental town called appropriate analgesic prescribing tramadol you know you know or yeah terminal but if you can do an on what's not considered a narcotic even though you know it could go either way I've seen even Plastic Surgeons you know prescribed that for surgery you have to remember and I can't even I'm I'm a person who had a little bit of plastic surgery um but it's you know what one of the things that they'll tell you you know you go and get it like oh say a boob job and they give you two weeks of meds well I don't know any girl who's had a boob job that needed two weeks pain meds maybe 72 hours the first three days it might hurt but it's like you have all these meds and this is where our problem is we're so quick to just go oh let's do you know ten through twenty five good then thirty Bulova and you're not really paying attention to how long are they really gonna be in pain for that root canal you know how long are they really gonna be in pain out for that extraction you know what is the healing time because these are things we need to be paying attention before we're prescribing because it is a problem it is an epidemic it's a growing epidemic for hydrocodones and oxys out there and you know people are getting more creative with smoking them and breaking them up and snorting them and doing everything that they're doing and we created it as providers the street did not create this as much as we are creating it as providers 

Howard: Wow okay well on that note Danielle it was an honor thank you today it really was and thank you so much for all you've done and when will the book be out I'm hoping by August in this rumor yep well when you come out you might want to come back on the show and we'll just talk about the book because it's a serious sell we've all been to a lot of funerals that's a tough complicated problem thank you so much.

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