Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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805 Medical Billing Solutions with Dr. Olya Zahrebelny : Dentistry Uncensored with Howard Farran

805 Medical Billing Solutions with Dr. Olya Zahrebelny : Dentistry Uncensored with Howard Farran

8/11/2017 10:22:17 AM   |   Comments: 0   |   Views: 318

805 Medical Billing Solutions with Dr. Olya Zahrebelny : Dentistry Uncensored with Howard Farran

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805 Medical Billing Solutions with Dr. Olya Zahrebelny : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #805 - Olya Zahrebelny

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AUDIO - DUwHF #805 - Olya Zahrebelny

Dr. Olya Zahrebelny (pronounced Zara-bell-knee) graduated from the Faculty of Dentistry at the University of Toronto, Canada, then completed a General Practice Residency, focusing on oral surgery, oral medicine, and oral pathology. She has practiced in both hospital and private practice environments for the past 39 years. Dr. "Z", as she is fondly called by her patients, is a former consultant to commercial and government insurance programs. She has also taught at three dental schools, in the Departments of Restorative Dentistry and Oral Medicine/Diagnosis, as well as holding the position of Attending Physician at Swedish Covenant Hospital for 19 years, and also an Attending Physician in the General Practice Residency program at the University of Illinois, Chicago Medical Center.


Selected for four years in a row by Dentistry Today as one of the Leaders in Continuing Dental Education, and for each of the last eighteen years as a Leader in Dental Consulting, she is featured on their web site and in the December 2016 issue of the magazine. Dr. Zahrebelny has lectured extensively throughout the US and abroad at all the major dental meetings, including the ADA, Hinman, Chicago Midwinter, California Dental Association, Academy of Osseintegration, AAP, and AAOMS, as well as for state and local societies and study clubs, continuing education programs, and hospital general practice and oral surgery residents. She is a former Guest Columnist for Inclusive Magazine, Dental Economics, Dental Equipment and Materials, and Insurance Solutions. Her book, "Accessing Medical Benefits in the Comprehensive and Surgical Dental Practice" has now been in print for 18 years, with yearly revisions, edits, and updates.

Dr. Z is a comprehensive general dentist, with special interests in cosmetic and implant dentistry, and a Principal in The Z Group, a practice management consulting company.

Howard:  It is just a huge honour for me today to be podcast interviewing Doctor Olya Zahrebelny. She graduated from Faculty of dentistry of the University of Toronto, Canada. Then completed a general practice residency focusing on oral surgery, oral medicine and oral pathology. She has practiced in both hospital and private practice environments for the past thirty-nine years. Which means she graduated from Dental School when she was two.

Doctor Z, as she is formerly called by her patients, is a former consultant to commercial and government insurance programs. She has also taught at three dental schools in Departments of Restorative Dentistry and Oral Medicine Diagnosis as well as holding the position of attending position at a Swedish Covenant Hospital for nineteen years. And also as an attending physician in the general practice resident program at the University of Illinois, Chicago Medical Centre.

Selected for four years in a row by Dentistry Today as one of the leaders in continuing dental education and for each of the last eighteen years as a leader in dental consulting.  She is featured on their website and is in the December 2016 of the magazine. She has lectured extensively throughout the US and abroad at all the major dental meetings including the ADA, Hinman, Chicago Midwinter, California Dental Association, Academy Osseointegration, AAP, AAOMS. As well as for state local societies, city clubs, continued education programs and hospital general practice and oral surgery residence. She is the former guest columnist for Inclusive Magazine, Dental Economics, Dental Equipment and Materials, Insurance Solutions.

Her book ‘Assessing Medical Benefits and the Comprehensive and Surgical Dental Practice’ has now been in print for eighteen years with yearly versions, edits and updates. Dr Z is a comprehensive general dentist, with special interest in cosmetic and implant dentistry, and a Principle in The Z group. A practice management consultant company.

My God your bio is like a… should be in the Guinness' book of World Records.  How are you doing today?

Olya: I'm doing very well. I just got back from Europe. I'm a little jetlagged. So, bear with me here.

Howard: So where were you in Europe?

Olya: I was in London for a week, right after the bombing there. And then I was there during the elections and after that I was in Spain for a week.

Howard: I tell you what, I love Spain. Barcelona on the Mediterranean. If you are on the Mediterranean it doesn't matter what it touches. It could be Portugal, Spain, France, Greece, Albania. The Mediterranean is just a fun place to hang out in, isn't it?

Olya: Absolutely. Absolutely a fun place. And I was there during gay pride month and I was staying at an Airbnb with a gay gentleman and we had a blast.

Howard: Wow. So Airbnb. That's… you're the first person I've ever met that… did that work out well?

Olya: It was a great experience. I did Europe last year for two weeks. In Germany, Austria, and Italy and stayed there in Airbnb's during that visit. And Airbnb in London and in Barcelona. Excellent experience.

Howard: Wow.

Olya: I can't say enough great things about it.

Howard: That is funny how Airbnb has turned the hotel industry upside down and my favourite economist was Joseph Schumpeter and his book ‘Creative Constructionism’. He said ‘If you don't destroy the horse and buggy business you can have the Model T Ford’. And so many governments in the old world protect all the old industries. So you have to destroy the old to create the new, and people don't realise that that's the ugly side of the truth of growth, is creative destructionism.

And Uber… I can't believe when I was New York, I had to go to the airport and I had to wait like 45 minutes because the banned Uber from the airport. Like they’re I going to save the old taxi driver. I mean, why don't they go save horses and goats and horse and buggies I mean it's just crazy.

Olya:  I use Uber all the time. I use it wherever I travel. I used it throughout Europe and Spain. Uber is banned. But everywhere else Uber is allowed in Europe, so I've only been using Uber and staying at Airbnb's and it's been an awesome experience.

Howard: And whenever a country tries to protect the old world, like Spain banning Uber. That just means that the country is going to go nowhere. It reminds me of the historic society. I always call them hysterical society, because if they had it their way everything would still be a cow town with the saloon.  They want to preserve everything but notice they never want to preserve it with their own money. They want to go to the government and pass a law that bans them from tearing it down. They can’t find… they can’t find individuals to part with their cash so they just go to the government and steal my cash to protect their wooden barns and their green silos.

So, what are you most passionate about and why are you… why did you get into insurance billing, dental insurance? Why is that a passion of yours?  Medical billing solutions for the dental office. Which your website is The Z group, LLC.  And the Z is for Zahrebelny.

Olya: Yes, it is. Yes it is. Well you'll notice first of all, and this was pointed out to me a couple of years ago and it didn’t even occur to me. In the middle of the name, my last name, you see the word rebel?

Howard: Oh nice.

Olya: And everybody says, ‘no wonder you're doing what you're doing. You’re out there on a limb, you started with the medical billing twenty years ago and outside the box thinker.’ So many people in dentistry are so afraid of medical billing. They think it’s illegal. They think they’re going to get in trouble. And I'm still here. I’m not in jail. I’ve never been audited. No problem there. None of the clients that I worked with have ever been audited.

So medical billing is such a huge secret. And I think a lot of it has to do with the fact that people are under the misconception that it is only for physicians, or in the case of traumatic injury. And I think the reason for that is because it’s not addressed in the dental schools. It's not addressed for the most part by organised dentistry and I think that’s a huge disservice to our patients, because so much treatment is not being done on patients that need it. But they can’t afford it, and I always laugh at practice management people’s… you have to explain the benefit of the treatment to the patient.

They have to understand the benefit and then they'll sign up for it. Well, I understand the benefit of driving a Lamborghini. If I can’t afford it. I’m not going to buy a Lamborghini. So it has nothing to do with understanding the benefit or very little to do with it. It has everything to do with the bottom line.  And what are you going to pay? Your mortgage, your rent, your food or you're going to pay for your teeth? And that's what it boils down to.

I started with the medical billing because I was exposed to it when I first moved to the US from Canada. I joined a hospital-based practice. And people are under the impression that hospital-based practice patients are only medically compromised and that's not true. You see normal patients as well as physician's nurses, and patients who require a hospital monitoring and oral dentistry. And when I joined the practice coming from Canada, which is a single pair system medically. And my brother is a physician in Canada, so he keeps me up to date with what's going on there.

But, dentistry in Canada, only twenty percent of patients have dental insurance. So, for the most part, it's a cash system. And when I moved to the US, I was exposed to medical billing. Because of the fact that the majority of what I was doing... the procedures that I was doing as a general dentist, were being billed to the medical insurance. And I thought, ‘how is that possible? I’m a general dentist. I'm doing general dentistry procedures. I'm not a physician. How is this being billed to medical?’

And that was my first exposure to medical billing. And as I spent more time with the hospital-based practice etcetera, I became very proficient at it. And I thought, you know what? It's time to also learn the inner workings of insurance companies, because there's so much going on behind the scenes that people kind of guess and assume. And they kind of try and work the system but they don’t really know what's going on.

And so, I did consulting work for insurance and that was quite the eye-opener.  Quite the eye-opener in the processing and how things are approached and what's required documentation wise etcetera. And how medical reviewers look at our claims and our documentation that are sent to… is sent to them.

And most dentists, when they bill medical, are approaching it as if they're billing dental insurance. And that’s completely the wrong approach. You have to think like a physician. You have to put your documentation together like a physician would, and present the material like a physician would. And then it would be processed. You have to keep in mind who your audience is. And it’s a physician or a nurse that is going to be reviewing your documentation, and not a dentist.

Howard: That is very interesting. I like… I like the… the saying that the first Chinese medical text was found two thousand six hundred years ago. And it said, ‘superior doctors prevent the disease, mediocre doctors treat the disease before evident, and inferior doctors treat the full-blown disease.’

And basically dentists are doing the… treat the full-blown disease. They're used to just billing cavity, root canal, crown, extraction. And so what is the… how do they start thinking like a physician?

Olya: Well you have to… first of all, when I speak with dentists I'm amazed at how many of them say, ‘I’m just a dentist’. You are a physician of the mouth and you have to conduct yourself accordingly. And patients will treat you that way.

And I think a lot of the problem is the fact that the ADA is separate from the American Medical Association. I think it should be a subsidiary of the American Medical Association. And that way the population… the general population would not perceive us as second class citizens. That's the first issue.  

The second issue is, dentists have to approach the patient from looking at the total picture, the whole body and then zeroing in on the mouth. Just like a physician does when examining a patient. So, you have to look at the whole head and neck area, ask a lot of detailed questions about the patient's medical history. Get down to the nuts and bolts.

And ask a lot of detail and explain to a patient, ‘in order to get a total true picture of your condition, we need to know what is going on behind the scenes. Not just what you think we should know, but these are other issues that we have to know about that may impact your oral and dental condition.’ Because patients only give you the information that they think is relevant to what you're treating and their perception of dentistry in general is very narrow.

Howard: I no longer believe you that you are born in Toronto because you've been talking for ten minutes and you haven’t said ‘A’ yet.

Olya: I lose the ‘A’. I only pick it up subconsciously when I’m back in Canada and I haven’t been there for a while. So…

Howard: My favourite movie accent is still Fargo because it's a North Dakota.  Have you ever seen the movie Fargo?

Olya: I have. I have.

Howard: And when you get that far North in Minnesota or North Dakota, their actually sounding like they're Canadian. I know whatever he's thinking is, ‘what is covered by a medical plan?’ You have your doctor Z's top 10 list. What is that?

Olya: Doctor Z's top 10 list, lists all the billable procedures that are covered by medical plans to one extent to another. Starting from exams, consultations, appliances, surgical procedures, implants, bone grafts, tissue grafts, periodontal treatment, biopsies, excisions, prosthetics. I mean, when you look at the list of the procedures that are listed on the website and in my book. You can see why, as a general dentist, literally eighty-five percent of what I was doing, was billable to medical insurance. And the coverage is excellent.

Howard: So, where is the best way to find your book?  Is it on The Z Group or on

Olya: It is on The Z Group website under the product's heading.

Howard: Okay. I like that. I just learned recently that those three little horizontal bars, everybody is supposed to know that's the menu. I think that they told all the millennials and forgot to tell all the grandpas. I did not remember getting that letter in the mail. So, what products do you have? And do you recommend that the dentists actually buy this and reads this and all this, or is this just something that you buy for your office manager? Or your dry-hand admin staff?

Olya: Well one of the things that's critical to medical billing, and to the success of medical billing in an office. Is that the clinical end and the business end have to have a symbiotic relationship. In other words, each has to work in partnership with the other because the biller on his or her own cannot bill medical insurance without the information coming in the right format from the clinical end.

So, as far as the book goes, the book answers about ninety-eight percent of the questions regarding medical billing. However, I find that most people learn best visually, the learn best by asking questions. And when I do my seminars, my one and two-day programs, they're very interactive. I keep them to a very small size, typically under twenty to thirty people at most. Because I find that no question is stupid when you're learning.

And people have a lot of questions about insurance. A lot of questions in particular about medical insurance. Because it is such an unknown to them. And such a mystery and always the thought to be illegal, if you will, for dental to bill medical. And that could not be further from the truth.

Howard: Now when you said it answers ninety-eight percent of the questions. Were you talking as a Canadian talking the metric system, or are you now an American speaking imperial math?

Olya: No, I've been here longer than I was in Canada. So I’m speaking as an American.

Howard: And how much is… is it one book that you sell or is there multiple books?

Olya: It’s one book. It's one book it's got six hundred and thirty-five pages. It's got everything I mean, from A to Z regarding medical billing. It's got over two hundred pages of claim examples and each example has the letter of medical necessity. It has the claim form itself, it has the codes explained. It has everything that you need to know about billing medical. It has an awful lot of detail.

The book initially started as a handout. When I first started teaching medical billing, about twenty years ago. It started as fifty page handout. And it has now grown to being five pounds and six hundred and thirty five pages. Because every year I add to it as people say, ‘can you can you put this in it? Can you put that in it?’ And I keep adding to it.

Howard: And how much money does the book cost?

Olya: The book… I think right now, the hard copy… there's a hard copy and a digital version. The millennials love the digital version. Most offices, what they do, they get the hard copy office. And then the digital version they can access from their laptop, their tablet, their phone, whatever when they're not in the office.

So a lot of doctors, at the end of the day, the last thing they want to do is stay in the office. So they go home and after they've had a martini, sangria, whatever. They sit down and they do there their patient charts, or documentation in the evening. And they're able to access all the information in the book from their laptop or tablet.

But there's also all the templates that are in the book for the letters of medical necessity, for the operative reports. For everything are also on CD so that you're able to use that, and edit it to modify it for your patient's specific situation.

Howard: And the dentist always… you’ve got to think of the cost or fixed cost. You've got to think of the total cost over a lifetime. So you're talking about a four hundred and fifty dollars book. How much… what percent are these companies taking that do your medical billing for you which goes on and to  perpetuity? What is the average?

Olya: I don't recommend that you use a medical billing company.

Howard: I know but the ones that do, what is their cut of that?

Olya: Typically between thirteen and fifteen percent of the…

Howard: I know. So fifteen percent of all this stuff. Month after month, year after year. And they will balk at a four hundred and fifty dollar book? They'll say, ‘I don't know if I want to spend four hundred and fifty dollars.’ So then they will go and spend forty five thousand dollars in the next decade, having someone else do it.

Olya: And that's why it’s important. And I say it's actually better for you to have somebody in your office trained to do it, and cross-trained with different people in the office doing the medical billing. So should you lose one person for one reason or another, others can pick up the slack. And it's well worth the investment for that person's training, with the doctor, rather than paying a billing company.

Howard: And you walk the talk when it comes to cross training because you cross train between a martini and sangria. I like that about you. You don’t just do one sport.

Olya: Depends on my mood.

Howard: Depends on your mood? Yeah. So do you see this… you've been teaching this for twenty years. Is the medical billing… would you say it's flat, would you say it's growing, would you say it's contracting? Where is it better from twenty years ago, ten years ago to now?

Olya: What I've found has happened. Is as dental insurance has become more and more pathetic in its benefits, more and more strict within its benefits, medical has picked up the slack. So when you think about it, and I don’t know, why this doesn’t occur to people.

First of all, when I started practicing, a pro-fee was twenty-five dollars, a crown was two hundred dollars. And this is when I started practicing in the US. Okay. You look at the premiums. You look at the calendar year maximums. The premiums have skyrocketed. Calendar year maximums have stayed the same, benefits have diminished significantly.

When I started practicing you could do an OrthoMax every year. You could replace fillings every two years, crowns every five years, prosthetics removable and fixed every five years as well. That's not the case anymore. You don’t see that. So what has happened?

A lot of these procedures, especially the surgical procedures, exams, appliances, whether it's for sleep apnoea, night guards, TMD appliances, surgical stents, diagnostic stents, biopsies, excisions. All of that have been picked up under the medical plans. And people… patients don’t know. They don’t even know what they're dental benefits are, let alone their medical benefits. And dentists don’t know either. To them it's such a huge mystery. And again I think a lot of it has to do with the fact that it is not addressed in dental school. And well... A lot is not addressed in dental school.

I mean my education began when I left dental school pretty much. And you know, when I look at the dental education model… think about how physicians are trained and how dentists are trained.

Howard: Yeah.

Olya: Physicians are trained in real-life situations in hospitals, treating real patients under the direction of the best of the best in the hospitals. How are dentists trained? They are trained in dental schools. Most of the patients they have are patients that can sit for three hours for a simple filling.

When you look at the faculty in dental schools, the full-time faculty. They are either dentists who have never practiced, dentists who have failed in practice or ex-military people. All of whom, again, they've real life experience with real patients. Finger dentistry and the real world is not realistic. And I've found that, in my experience, teaching in the dental school and as a student, that students tend to go with their real-life questions to the part-timers.

The ones that are practicing and are teaching because they enjoy teaching. And whenever a student would say to me ‘how would you handle this?  How should I handle this?’ I would say to them, ‘well, how did the full-time person tell you to do it?’ And they'd say… they'd give me an answer… a textbook answer and then they'd ask me how I would do it, and they'd say, but… but… but doctor, so and so said do it this way’. I’d say ‘tell you what, if you want to be called on Thanksgiving morning, at three o'clock in the morning, that's how you do it.  But if you want to have a pleasant holiday with your family, this is how you do it.’ That's real life. That's how you handle it.

Howard: See I would want an emergency during a family holiday. Just an excuse to get the hell out of that room. I also want to say something about… you have taught at a hospital residency for nineteen years. A lot of kids as they're getting to be juniors, seniors. They start asking about residencies and this sounds pretty crass, and bad, and rude. But the key to the best residency is to be in the biggest city.

When you… KU has moved their hospital training from Laurence, Kansas of thirty thousand to Wichita, Kansas of three hundred and eighty thousand. And you know what's better than three hundred and eighty thousand? The three point eight million metro of Phoenix. Chicago is probably what? A five million metro? And you need five million humans to get a lot of these examples of really rare stuff.  And I think… I think the best residency is the biggest city you can find. I don’t care if you have to go to China to get there. You just want to be in a really, really big city.

Olya: I think residency is now… my opinion of residency is that they should be mandatory. Because that’s where I got the majority of my knowledge and experience from. In treating real-life situations and rare situations. I trained in three different hospitals in Toronto in Canada, and it was an unbelievable experience.

And I compare that to my colleagues that had no residency training and there's no comparison. And I look at the kids that are coming out of residency programs, the dentists that have been through them. Night and day difference between their demeanor, their professionalism, how they handle themselves, how they handle patients, their communication skills with physicians and with patients. Night and day difference. I absolutely recommend a residency to everybody. Absolutely. But yes do pick your residency very carefully.

Howard: Just picking on straight out demographics. I’d just go to the largest city you can go to. And that's where… I mean sometimes you just need nine million people in Manhattan to see that one oral cancer on one side of the tongue. You know what I mean? And all the rare stuff. Seems like the people that I know had the best residencies were in New Orleans, Manhattan, Los Angeles, Chicago, Houston. They were never in Parsons, Kansas with the VA.

Olya: Very true.

Howard: So when you go to the VA in some small town of fifty thousand. That's good. That's great. But it could be a lot better. So there's nine specialties recognised by the ADA. Does medical billing apply to some of those specialties a lot more than others? And are some of the specialties, do not even apply? I mean, does it not work for say Orthodontists or Endodontists or…?

Olya: Well for the most part when you look at for instance paediatric dentists. A lot of the situations they're treating, a lot of those children are management issues because of their medical issues. They’re management issues because of their age etcetera. All of those situations are medically billable.

Endodontists that are treating patients with periapical pathology with abscesses, facial cellulitis etcetera. Any type of infection, inflammation is billable to medical insurance without a doubt. It's a covered benefit.

When you look at periodontists, the surgical specialties as well, the majority of what they're doing is covered under the medical. Whether it's a oral surgeon or a periodontist, anybody who is placing implants.

A general dentist who is treating patients with sleep apnoea with TMJ issues, with implants, restoring implants, trauma patients. I mean, across the board all the specialties have medically billable procedures without a doubt.  

Orthodontists, we tend to see them with skeletal problems, not just dental problems. Something as simple as a high palatal bolt, a narrow arch. Your approach when you're dealing with medical has to be to look at things from a medical standpoint. So, for instance, if I were to describe to a dental insurance in my documentation that the problem is between six and eleven. If I did the same thing, and reported it that way, to a medical insurance, medical reviewer, they wouldn’t know what I was talking about because between six and eleven, to them refers to the vertebrae. It has nothing to do with the teeth.

So, you have to keep in mind who your audience is.  Who's going to be reading your documentation. Similarly, if your documentation says the problem is in the lower right quadrant. The lower right quadrant to the physician is the lower right quadrant of the body. It is not the lower right mandible. So again, they're going to say, ‘well why are you treating the mouth if the problem is in the lower right quadrant?’ Because they are not connecting one to the other because that's their training, that's their background.

If you say the left joint. Well there is a lot of joints down the left side. You have to be very specific and say, ‘the left TMJ’. So, your approach, your examination, your documentation, your clinical notes, all you have to do is tweak them. They will still be acceptable to dental insurance. But they will be that much more acceptable to medical insurance, because now the physician or nurse will understand what you're talking about. Where you're coming from.

And the medical history of the patient. If they have a medical history also, you want to use that to your advantage and bring that into the equation. Any medications they’re taking. Look at all the baby boomers now, it's a huge segment of the population. And when you look at the baby boomers and the medical issues they have.

With the Medical Association reporting that seventy percent of Americans are overweight and of that number, forty-one percent are obese. So that brings in the issue of diabetes, and cancer, and heart disease, and all of that. You have to bring that into the equation because the medications they're on, the treatment they're receiving is going to impact their oral health, their dental health. You've got the patients that are the meth addicted patients, bulimics and anorexics.  All of these issues are critical. And I find so many times the history taking, that the physician, that the dentist does is not addressing a lot of these issues. And that becomes critically important to the success of medical billing and the office.

Howard: That is amazing. Not to get political, but I have to ask. Since your brother is a physician in Canada, and you are a dentist in America. And you've been doing medical insurance billing for so long. Healthcare has always been a political hot button forever. I mean… and now it’s… I mean it’s just now it's so huge. Who do you think has the better system?  Do you think Canada with the single payer or…

Olya: No.

Howard: Is America and the (inaudible 28:45).

Olya: My brother, on a daily basis says to me, ‘I wish I had been a dentist.’  Because he said the medical system in Canada is an absolute disaster. Single payer is a disaster. That's why you see patients coming to the US for their treatment. He said to me, and I found this to be absolutely unbelievable, because this was not the case when I left Canada.

He said, ‘if you need an MRI, or an angiogram, or a mammogram, you cannot have it done at your local hospital’.  Canada has set up regional health centres that do these tests. Diagnostic and screening tests. And you have to… the radius, obviously in a larger city is smaller than it is in a rural area. However, you have to make an appointment at one of these regional health centres. It takes you anywhere from twelve to fifteen months before you can actually get the test done’. And he said, ‘the way that the healthcare system saves money, is that patients die before they actually get the treatment. Because they are not even diagnosed for twelve to fifteen months’. He said, ‘if I want my patient to get an MRI, or a scan ASAP. I go next door to my vet's office, he has the machines. I have the patients scanned there’.

Howard:  My doctor told me if I gain ten more pounds he's going to have me get a mammogram. I think one of the problems with Obamacare and all the medical dealers that, seems like Americans don’t realize that, about a third of that cost is admin and you go into almost any dental office, when they do dental billing, forget medical billing. When you do dental billing, almost all your practices that are at a million-dollar level say, ‘you know what, I have got to talk to a human.’  They have to call someone at the intern’s company and be on hold. They have a full-time employee at the front desk in a room, getting somebody on the line because the… I mean… why isn’t that just automated? Why isn’t that… why do you have to have your number one expense, labour, talking to their number one expense labour?

And that is where I think Obamacare fell the most they did a lot of noble stuff like got rid of pre-existing conditions, and let you keep your kids on your insurance plan. But they did nothing to address the unnecessary cost of admin.  And man, just a few changes in admin they could've cut the admin cost in half with hardly even trying. Why is that not so obvious to government?

Olya: Well first of all. Let me address the issue of precertification, preauthorization with medical. Okay. For a CT scans, when you pre-certify a CT scan you get transferred to an RN immediately and you get an authorization within two minutes. Okay. If you're doing surgery, which requires a precertification, elective surgery requires precertification. You are able to do it online. You get a response between twenty-four and seventy-two hours later.  max. Max, twenty-four and seventy-two hours. Not like dental insurance, where it's six to eight weeks to wait for a response. Okay.

The other issue with the medical is the single-payer system, very inefficient.  You look at Medicare. Horrible. A lot of fraud because Medicare does not require any documentation. And there's a lot of fraud in the system. With the traditional insurance, the commercial plans, you have documentation that you have to submit in order to be paid. And that obviously has to go through a  medical review. So there is that hang-up. However, like I said twenty-four to seventy-two hours later. When I see cheques twenty-five, thirty-five, fifty thousand, ninety thousand dollars coming from medical insurance. That timeframe for processing that claim and getting that cheque is from four to six  weeks. We're talking big cheques. With dental insurance, you’re talking these pathetic little benefits of under a thousand dollars and it takes that long.

Howard: So right now. What percent of dentists, general dentists, do you think bill medical? What percent right now?

Olya: A very low percentage. Only because they are not familiar with how it works, or they've tried it on their own because they think it's just like dental billing. And it's nothing like dental billing. So they submit a few claims. They get rejected, because they approached it like they approach dental insurance.  They get rejected. They get a denial and they say, ‘medical billing doesn’t work’.

Well it works but you have to understand how the process works. And you have to understand how to approach with the documentation. You don’t submit radiographs, you don’t submit periodontal charting. None of that. You submit your claim with medical codes, with a letter of medical necessity. And that's not a letter from the physician. It is a letter from the treating dentist that explains, in medical terms, what needs to be done. And the mindset and the thought process behind it. And then you also submit the head and neck evaluation of the patient.  It's a comprehensive head and neck evaluation and I actually have it on my CD.  Where all you do is you follow the check boxes, check, check, check, check, add in the general medical history, added to the patient's health record or print it out and off it goes to the insurance company.  

Howard: Well tell your brother I'm going to move to Canada so I'd like to meet him. I figured out that if I just moved from Canada, my weight in pounds would be cut in half in kilograms.

Olya: Yes it will.

Howard: And that's how they should solve global warming. Stop measuring in Fahrenheit and measure in Celsius. We're all there. Right on track. So what could… so we both agree almost nobody else does this. But if they start doing this like what percent of revenue could it be? I mean is this something where when dental offices get involved in this, it's now three percent of revenue, five percent, ten percent. What could this be?

Olya: The offices over the years have told me that it has increased their bottom line by anywhere from thirty to fifty percent. I didn’t think it would be that much. I thought it would be more like twenty-five to thirty percent. But the offices that are doing it, that are proficient at it, that have put in the time to learn how to do the process correctly. Are telling me that's what it… I just got out of office yesterday, a prosthodontists office, that told me that they are already thirty-two percent ahead of last year in their gross earnings because of medical billing.

When the recession hit in 2008 the offices that were doing medical billing, these are general dental offices, were telling me that they could not fill their schedule fast enough. That they were booked out six to eight weeks and offices around them said, ‘we're at fifty percent. We're scared that our practices are going to go under, how are you doing it?’ And they said, ‘it was because of the medical billing’.

Two things. Patients were either afraid of losing their benefits because they are losing their job, or they were using the medical benefits that they had in order to pay for treatment that they needed, that they didn’t even realize medical covered. Patients talk to other patients. That’s your best… you don’t even have to do any marketing. Patients talk to other patients. They talk to colleagues, they talk to people at work. People have told me that their patients will be sitting and having a cigarette outside, or having lunch with a colleague, or a co-worker and they'll say, ‘Isn’t this great. Our insurance is so good. I just had two implants placed and our insurance covered it’. And their co-worker will say, Wait a minute. I just went to my dentist for implants and my dentist said it was going to be this much, and it's all out of pocket. How on earth? What's your dentist's name? Let me go to your dentist’


Howard: So you've taught at three dental schools. What’s that like? Did you do it for the money, for fun, because you love teaching? And what are your thoughts on the current state of dental schools?

Olya: I think that the dental school's, first of all, so much of the curriculum now is very similar to what you and I went through. And so four years is not enough.  It's no longer enough, and you need that extra year. And that's why either extend dental schools for five years or make that residency program mandatory. Because there's so much to learn. There’s been so many advances in dentistry, four years is just not enough.

Practice management is pretty much non-existent as far as the dental school curriculum goes. And so I use to have lunch and learns with my students every Thursday, teaching them practice management and the real world. They would come to me and this was… I remember distinctly one situation in 2001, when I was teaching at Northwestern before it closed. A student came to me and said, ‘I’m going to be coming and looking for an associateship. And the practice management course that we had here told us that we should ask for a minimum of a hundred and fifty thousand dollars as an associate’.

This is in 2001. And I said, ‘you've got to be kidding. Who is telling you that?’ ‘Well doctor so and so who is teaching practice management’.  I said, ‘Look. Nobody is going to hire you. You have no experience. You're slow, you don’t have the knowledge, the background. You're not up to speed yet. There is no way you're going to get a hundred and fifty thousand. You'll be lucky if you get seventy-five to ninety thousand. But you have to prove yourself. You have to start at the bottom, work your way up.

Howard: I want to ask you a question. I hope it's not sensitive or anything but you graduated from the University of Toronto in ‘78. So you're coming up on forty years of practicing. Would you say, when you graduated from dental school, dentistry was a ‘man's’ profession and now that's changed to women as well. Did you feel like an outsider in a man's profession in 1978? Or was it really gender equal back then?

Olya: You know what? My year out of a hundred and thirty five students, there were nineteen women. The year before me was twelve, the year before that was six, and the year before that was two. One of the things that I found is that we were expected to be as good, if not better than the guys. They basically watched us all the time. Our fellow students, we were using our feminine wows to get ahead and all of that thing. So the expectations were higher. I never felt I was treated differently by the staff. I never felt I was discriminated against. Never in my career have I felt that, I think a lot of it has to do with how you conduct yourself.

The respect you command is the respect that you get from people. And if you conduct yourself appropriately, professionally etcetera, that's how you're going to be treated by patients, by colleagues etcetera. I've never felt unequal. I've never felt a problem. I've never felt my pay is any different, my income… never.  Never.

Howard: Nice. Any advice… You've been in three dental schools. You've seen this rodeo for a while. We just had sixty-five hundred kids graduated from dental school in the last two weeks. They just left. You've taught at three dental schools. What advice would you give to all these kids who just walked out of dental school? And I'll give you a heads-up. Do you think their coming out of school humble and hungry? Or do you think they are coming out of school, they know it all, they learned it all, they got their diploma and they’re ready to go?

Olya: I'm seeing a lot of them have this entitlement issue that, ‘I've got the diploma, I deserve a huge salary’. That's not going to happen. That’s not going to happen. I think that the one piece of advice I would have to them is, take as much continued education as possible, number one.

Really be careful about the continuing education that you select because all continuing education is not equal. And I would say about… in my estimation about thirty percent of the continuing education is something, that I would say is of great value. The other seventy percent tends to be fluff and self-promotion and that kind of thing. So ask the seasoned dentist that you trust, that you respect in practice what they would recommend.

Howard: Yeah. I think when you come out of dental school with three hundred and thirty thousand dollars in debt. I mean I can’t believe how many dentists, even ten years out. They'll call me up and they’ll be talking to me about advice, or I’ll be lecturing, I'll have lunch with them and they're having all these financial problems. Say they’re going through a divorce and they’re putting two kids through college and all this stuff. And then you go to their hours. And they work Monday through Thursday, nine to five. And I'm like, ‘dude, you're going through a crisis and you're on three day weekends?’

They have that Monday through Thursday, nine to five. I never did nine to five.  I did ninety-five hours a week. That was my nine to five. I mean my God, my office hours the first decade with me, was seven to seven, Monday through Saturday. And you could just work through… I mean you've got massive experience. I mean the best way to get good at endo, and crown, and bridge, and fillings is do a thousand more of each one of them.

Olya: Yeah. Just…

Howard: When you do a thousand more fillings you start figuring out how to do a damn filling, nine to five should be ninety-five.

Olya: Yeah. I mean my first few years were eight to six, 6 days a week. You've got to put in the sweat equity without a doubt. You have to put in the sweat equity to get the rewards and, you learn the most from your mistakes. And I think the best lectures I've ever been to, also, as far as CE goes were where the dentists showed all the mistakes they made. And then how they handled them. Because all of us have perfect crown preps that we've done, perfect situations that we've treated, perfect fillings that we've done. But we've learned the most from when things go wrong and we screw up. That's when we learn.

Howard: And here's… when you know someone's old-school. So old-school… which is funny the people with all the money, they buy textbooks for like two hundred and fifty bucks and that's what you said… the scripts, avoiding complications of oral pathologies. Here's eight hundred pages of dental implant screw-ups and… but the millennials, the won’t buy a two hundred and eighty textbook. They'll buy a two hundred and eighty dollar airplane flight one-way to some course on the other side of the country, drop three grand, come back and they'll have like three pages of notes.

Olya: It's all in your priorities without a doubt. God bless Carl Misch because he was an outside the box thinker and he left his imprint on dentistry.  Unbelievable.

Howard: And would you say he worked nine to five, Monday through Thursday?

Olya: Never. Never.

Howard:  Oh my God. And not only would… he would… not only would he work like seven to seven, Monday through Friday. But then Friday after work he'd fly to Rome and lecture in Rome then… I mean, you know how many times that guy even landed at the airport at six a.m and had a full schedule of patients at seven?

Olya: I know it. I know it. He was one of a kind. No doubt about it.

Howard: Yeah. He was an intense dude. And I think… and I think he was totally down to earth.

Olya: He was.

Howard: I mean he'd sit at the bar with eighty dentists from anywhere and talk until three in the morning about anything dental implant related. He was so approachable. You go to so many of these lectures a day and as soon as the lecture is over they just like disappeared. It's like they went out some back hidden door and you’re standing like, where the hell did he go?’

Carl would get done lecturing at five and he'd stand in the room holding court until eight PM, then go to the bar and hold court until one in the morning.

Olya: Yeah. I mean that man obviously, dentistry implants were his passion and you can always tell the difference between somebody to whom dentistry is a… or for whom dentistry is a job versus somebody for whom dentistry is a passion.

Howard: Yeah, I call it… when I was little we were… as a Catholic family went to mass every day, and they always called it… are you going to go into an occupation or vocation. And when you into a vocation and you've got passion and purpose into it, you seem to be… if your purpose-driven in a vocation… I mean like Carl Misch, implants was his entire life. It was his passion. It was a vocation. It wasn’t some nine to five job he did so that he could go home and watch ESPN.

So yeah… so on that note. How would you help these little kids who just come out of school, find their passion? How does she find her dental passion? And I want to tell you why I'm asking this, because the one thing that scares me is half of them… I mean what are the endo requirements in all schools, three teeth? And half the class comes out says, ‘I hate endo, I don’t want to do endo’. Eighty percent of the boys, what was your pulpotomy requirements? ‘I did one and I hated it. I never want to treat a kid again’.

So they walk out of school and they already hate endo and then another thing with these millennials, half of them tell you they don’t like, they're not apical barbarians and they don’t like blood and guts. They don’t want to pull teeth, gum surgery, implants. They just want this white fluffy stuff. Bleaching, bonding, veneers, sleep apnoea and invisalign.

Olya: How do you…

Howard: It's like, ‘dude, are you a doctor?’

Olya: Yeah.

Howard: I'm pretty sure that… and then they say that they don’t like blood.  I'm like, ‘then why aren’t you graduating with a degree in electrical engineering? I mean how the hell do you go to dental school, and didn’t know humans were filled with blood and guts?’ Are you a blood and guts apical barbarian or are you a white, soft, pretty, fluffy, bleaching, bonding, veneer, sleep apnoea and invisalign girl?

Olya: You just reminded me of an assistant that I hired when I was working at one of the hospitals. And she worked with me for a day and then the second day she didn’t show up to work. So we thought, ‘oh my God something happened to her’. So we’re calling her, calling her, calling her and finally we reach her and she says, ‘well I quit. I didn’t realise it requires so much suctioning’. I said, ‘what? You’re a dental assistant that's part of your job. What do you mean?’ It’s like, ‘no, I didn’t realise that I was not cut out for suctioning’. So it’s…

Howard: Well you should've just bought her an icelight.  Because… I think icelight’s are better than a dental assistant. I mean it retracts the tongue, the cheek, it does better suctioning. But more importantly when you’re all 54 years old and can’t see. It floods the area with light. And then while you're doing that with better suction, better light. Jan is entering the notes.

Olya: Right.

Howard: Setting up the next room, all that stuff. But back to the passion. I’m afraid of this girl because she's already made up her mind. She just graduated with three hundred and fifty thousand dollars in debt. And she's already decided she hates endo, she doesn’t like blood, she's not going to pull a tooth. And I just think she's so young, she might not know that when she's as old as us that, that might have been her total passion in life. So how does she find her passion?

Olya: I think mentoring is critical. I think mentoring is underrated in dentistry.  And it's the kind of thing that… that… that's the other thing that I would add to the dental curriculum. Is to have shadowing programs, if you will, with dentists.  And I know several dentists that actually do shadowing programmes. But somebody doesn’t know what is exactly involved in dentistry, when they've only done one or two procedures. They don’t know. And the reason they may have gone into dentistry they said, ‘oh, dentist live in nice houses, they drive nice cars, they may dress well, whatever it is. They see the external part. They don’t see the day to day grind. What's involved.

The things that float our boat and why we're actually happy in our profession.  And my profession… my personal career has taken a lot of turns here and there.  I've done hospital dentistry. I've been in private practice. I've been in group practice where there were seventeen of us. General dentists, all the specialists, physicians as well. And it was an outstanding relationship as far as interaction and all of that goes.

But I think mentorship is critical. And finding a good mentor, spending a lot of time with that person, and learning about what floats their boat. I think is very, very important. Doing it on your own. It's like you’re a boat out to sea with no destination. You have no direction. You really don’t know what you don’t know.  And until you find out what your goals are and set your goals, you're going to be floating. And you're going to be very unhappy with your choice in career.

Do a lot of e-blasts as well and we get a lot of response from that. Most of the time what I find, as far as the courses and all of that, it's word of mouth. Because a lot of people have now jumped on the medical billing bandwagon.  And again, this is where I caution people, there's courses and then there's courses. You want to make sure that you learn from somebody who has been there, done that on both sides of the coin.

Both internally, processing in insurance companies so that they know how insurance companies operate. Their mindset and they have their connection within the insurance industry, as well as on the outside practicing and clinical practice. Not just teaching it because, like they say, ‘those who can’t do and those who can’t teach. Especially if they're doing it full-time. So, I think it's important to select your course, whether it's a clinical dentistry or practice management, select the right course and make sure that you put the time in to learn it.

Because medical billing, there is a learning curve of about four to six  months. I'm not going to lie about it. To get things running smoothly and being paid on a regular basis and seeing those three, five, ten, twenty thousand dollars and more cheques coming in is well worth it. Well worth it. You’d think of the time that you spend in dental billing and providing all those narratives, and this and that and the other. And then you get a cheque for three hundred and fifty dollars  after jumping through all those hoops. Is it worth it? Heck no.

And you look at… I tell patients, ‘drop your dental insurance’. Get better medical insurance. It's so much more worth it because of the procedures that are covered under the medical plans.

Howard: This is so fun. I'm actually… because I’m podcasting you I’m adding… we need to add a medical billing category.

Olya: I think it's even more critical, Howard, than dental insurance because you look at dental insurance. Okay. When I started practicing, when you started practicing what were the calendar year maximums? A thousand dollars, twelve hundred, fifteen hundred dollars, they're still the same. It's ridiculous, absolutely ridiculous. You look at the benefits of medical insurance, there are no calendar year maximums, there are no procedure limitations. If you need to do five, ten exams a year, they'll all going to be equally covered. There are no lifetime maximums.  

So for those three reasons alone, medical billing is essential to any dental practice. People say, ‘what about high deductibles?’ Okay. Only Obamacare Plans do you have to come up with the deductible upfront, in full. Now that's the other downside of the Affordable Care Act. Is people who… eighty percent of the people who are on the Affordable Care Act have their premiums subsidised by you and I, the tax payers. Okay.

When you look at the deductibles that they have to satisfy before their benefits kick in, they have to come up with that money. For a single per individual that's around three thousand dollars. For a family of four it is now ten thousand dollars. Now, if these patients can't afford the premiums, how on earth are they going to pay the deductible upfront? The deductibles are not subsidised by taxpayers and that has been the other failure of the Obamacare system.  Hospitals are now requiring Obamacare individuals with those policies to pay upfront before they will treat them for elective procedures. If it's a non-emergency procedure you have to pay your deductible upfront. Physicians as well. So you find physicians are not taking Obamacare patients, because they know they’re not going to be paid until the patient's satisfy their deductible. The insurance is basically useless.

Now with commercial insurance, non-Obamacare insurance that's not the situation. The deductible is eaten away gradually. So each claim that you submit, a portion of it goes to the deductible then there's the code pay and then there's the physician gets reimbursed as well.

Howard: When we say we're physicians of the mouth, I mean, we're really not.  I mean when people say well a dentist… Your brother is a physician.

Olya: Yeah.

Howard: When people say to you, ‘well you're not a real doctor, you're a dentist, you're not a physician’. I almost think it's true because like, look at dental insurance. Imagine all the oral cancer technologies that were available in dentistry really came from female cancers downstairs.

The swishing, the toluidine blue, looking that valscope, all that technology and health insurance paid for that. I mean Delta, the biggest dental insurance doesn’t pay for an oral cancer screen. And imagine the uproar if they medicate Medicare, quick-covering female cancer screenings. It would be outlandish but no one covers it in dentistry today. Another thing is outlandish is...

Olya: You're right. It's not covered under the dental insurance, it's covered under the medical.  

Howard: Yeah. And the other thing outlandish is dentists… I mean our biggest nightmare problem that we have isn’t a cavity or gum disease or occlusal. It's oral cancer and now it's exploding from HPV, yet dentists aren’t even allowed to give an HPV shot. Dentists aren’t even fighting for the chance to give an HPV shot. And look at the influenza. I still can’t believe eight thousand to thirty-eight thousand Americans die each year from the flu and their always elderly grandma's. And when they go back and say, ‘where was the last entry point into the US healthcare system?’ The dentists are always in the top three and the hygienist got a four year degree and she's looking for gingivitis? Why doesn’t she give a flu-shot in the arm? And it's now only legal in Tennessee? I mean...

Olya: Dentists have been pushing for cosmetic things.  The Botox, the this, that and the other with the cosmetics rather than the medical issues. And I would disagree with you about the physician of the mouth thing and maybe it has to do with my training.

My first two years in Canada in training were identical to my brother's. We both went through our schooling at the same time. And in addition to that my training also involved learning oral pathology and all of that stuff.  In addition, we were taught in the medical school by the same professors that were teaching the medical school students.

The other thing when we graduated… my brother was always testing me, always. And when we graduated he said, ‘I have to hand it to you. Dentists know more about the body than physicians know about the mouth’. And I found that in my training, not just in dental school but also in my residency training.

Howard: Nice.

Olya: It's absolutely true.

Howard: Yeah, I agree. You can find individuals going for it. But the fact that there are two hundred and eleven thousand Americans alive right now with an active licence to practice dentistry, hundred and fifty thousand would be general dentistry thirty hours a week or more, thirty thousand would be specialists thirty hours a week or more. But the fact that none of them are giving flu shots, none of them are giving HPV shots, none of them are getting reimbursed from dental insurance for oral cancer screenings.

And I mean you're talking a lot of oral cancer deaths a year and all that stuff like  that. And then when I hear the nitty-gritty details that when a board voted on whether or not dentists and hygienists can give flu shots… There was a damn dentist on the board voting it down. It's like are you out of your mind? I mean it would’ve made sense if Walgreens voted it down, because they want you to go to them to get a flu shot or maybe your family physician. But it's like the dentists are their own worst enemies.

Olya: They are absolutely. And I find organised dentistry, when they complain about membership declining especially with the millennials and all of that.  Hello. Let’s look at what you're doing for us. What you're doing for the profession. You're more worried about being in bed with the insurance companies, and not offending the dental insurance companies. Than you are being on the side of the dentists and fighting for flu shots, HPV shots, all of that. Why aren’t you fighting for that?

Howard: Here's another weird thing about the dentists, especially in the South.  They won’t even talk about HPV, and sex, and oral sex, like that is not an appropriate discussion. Well, if you can’t have that discussion with your patient, then where do they go when they need a doctor?

Olya: Absolutely.

Howard: I mean are they going to go to their minister? I mean what do you think it states of the profession when many parts of the country, they can’t even mention HPV, sex, oral sex. And you're working on a mammal that reproduces, and has ulcering, and gives birth to live young and nurses them?

Olya: It's ridiculous. And when I was teaching at the university of Illinois, a student came to me and said, ‘I see this lesion on the pallet and it's a 16-year-old boy and I don’t know what it is. Can you come and take a look at it?’ And my first question to him was describe the lesion.  He said, ‘it's red and it's circular’. I said, ‘did you ask the kid whether he's had oral sex?’  He said, ‘Oh I can’t do that’. I said, ‘you’re a doctor, you can do it’. He says, ‘I can’t do it’, he says, ‘are you going to do it?’  I said, ‘watch me’. He trailed behind me as we walked in, I looked at the kid and I said, ‘have you been having oral sex?’ He said, ‘oh my God, don’t tell my momma’. This was a male.  He was having oral sex with another male. Okay. And he says, ‘just don’t tell my momma, don’t tell my momma’. I said it's critical for me to know because of what we're seeing on the roof of the mouth, and the back of your mouth, and that's exactly what it was.  It was from oral sex, a circular red lesion just like the old school hickies and all of that, that nobody even knows what they are anymore. But that's exactly what it looked like on a soft pallet and that's what it was.

And I said, ‘without addressing those kind of issues, without asking questions about the patient's, about their history, their sexual history, their drug use etcetera’. Whether a child is eight years old or a grandma is ninety-eight years old, I am surprised when I ask that question. And again, it's how you ask the question but I'm surprised at how many of them are choking up. And when I say ‘how you ask the question’, you know too many times I find dentists also are turning red, looking down at their shoes when they're asking the question.

Well the answer is not on the tip of your shoe. Ask the questions, be a professional, you're a healthcare provider, you're a healthcare professional.  Conduct yourself accordingly. Let the patient know why you're asking the questions and why it's critical that you have an honest answer.

Howard: And it's part of our culture. I mean you have a movie where Rocky, or The Rock, or Schwarzenegger has a hundred people showered with a AK-47 and it's a PG thirteen family movie. But if a mammal shows a mammary gland they all run for the doors, and rate it ‘R’. And it's a very bazar culture that you're a doctor, and you can't talk about bodily functions of eating, and drinking, and reproducing of an offspring. And now the end result of that is patients are dying of oral cancer, who had their teeth cleaned every six months and no one mentioned HPV vaccine.

No one told her that… a lot of people think that if you wear a condom you just need that for sex, but you don’t need that for oral sex because you can’t get pregnant. And nobody is having that conversation. So the result is you have to die. Because the biggest joke in… remember I went to Creighton and it was a Catholic college. The sex talk from your parents. Yeah. There wasn’t one kid at Creighton that got the sexual education talk from their parents, and those were the same parents who don’t want it taught in school. Is they thought it should be taught at home, but not one of my Catholic friends every had a dad or mom sit down and explain the birds and the bees. It's a very crazy deal but it needs to be changed because I think…

Olya: A lot of it has to do with how it's addressed in dental schools, and those who are teaching it to the students coming through the program. And if they're uncomfortable with it, if they're turning red and hemming and hawing and embarrassed about it. Well that's the impression that the student gets, that's the impression the patient gets. That's it somehow taboo to talk about it, and it's not.  You're a healthcare provider, conduct yourself accordingly.

Howard: And the best line of this deal was, that the dentist knows more about the body than the physicians about the mouth. Because every year when I get a physical, I almost can’t quit laughing when he gets to my mouth and he says, ‘open wide’, he puts in a popsicle stick and says, ‘say ah’ and he's got his light and I say ‘ah’ and then he throws the stick away and every other thing.

Okay. I've been a dentist for thirty years. What the hell could you have done pushing down my tongue with a popsicle stick and shining a light in there? I mean… I mean… I mean what was he looking for?  Like a sign sitting on my tongue? A message. I mean talk about the lamest exam in the world. Could you imagine doing a six month recall exam and me walking up to you. The doctor says, ‘I'm going to need you to open your mouth, say ah’. Shine my light, ‘ok, all good’.

Olya: That's it, we're all good. You know it's funny because I’ve lectured to… when I was attending at the hospital, I would lecture to the physician groups and I would show slides of different pathology. And just simple situations in the mouth. And so many physicians would say to me, ‘what's that silver thing around the tooth?’ and I said, ‘that's a denture clasp’. And they're like, ‘I've never seen one’ and I'm like, ‘yeah you have, you just are not paying attention.  You're working with blinders on, looking into the throat, the pharynx whatever.  Everything else around it could be falling apart, you could be having oral cancer, you could have abscess ulcers whatever but you're not focusing on that’.

Howard: And I just want to say one last thing. You promised me an hour of your precious life, and we're already ten minutes over, because I keep babbling and won’t shut up. But when you are young and out of school you've got to run for mayor. And the best marketing, you said it earlier, that you need to find mentors.

And when I was a young dentist out there. I asked every pharmacist to go out to dinner with him, or bring him over to my house. The physicians, the paediatricians. Just because eighty percent of each segment might of said no, the twenty percent that did say yes, those are your extroverts, those are the talkers.  And if you're going back to some town of twenty thousand you should ask every single physician, and dentist, and chiropractor, and everybody out for dinner.  You'll learn the oral systemic link, you'll meet friends and the referrals are crazy.

Olya: Absolutely.

Howard: Every paediatric dentist...

Olya: Your network building is critical. Absolutely critical. And you have to put in the time. That involves a lot of schmoozing, a lot of going out for dinners and all of that. But it pays back in spades.

Howard: And you know your net worth is equalled to the size of your network. And I never went to dinner with a physician, or a pharmacist, or a chiropractor, and didn’t learn something. I mean, I thought it was very fun. But my gosh. It is amazing how when you press the flash, and run for mayor.

In the seventeen percent of the US economy healthcare sector in your own zip code, your own town and I mean if… I've got two of everything and my iPhone, cardiologists, internists, chiropractors, pharmacists. All friends. That just gets so many word of mouth referrals. I mean… so get out there and run for mayor. The best way to learn about the oral systemic link, is go to dinner with everybody who treats any part of the body no matter what way they do it. You know what I mean?

Olya: Absolutely. And I think the other thing that I would say, and what I found really valuable, is whenever I came up with a treatment plan. I would discuss it with my colleagues and say, ‘how would you do it? How would you do it?’ And just getting different perspectives, especially on the comprehensive cases, really opens up your eyes, and your thought process as to the possibilities you may not have thought of.

Howard: Can I just ask you one last overtime question? And I swear I’ll shut up. There’s kind of a lot of bias and negativity towards anything alternative. Whenever you’re with dentists and anyone says the word alternative or holistic. Immediately the quackwatch goes up, the aluminium tin foil hat, all that kind of thing.

But as a businessman, when you’re in the market a huge portion of Americans don’t want to take a bunch of pharmacy pills, and don’t want to take a pill for every problem. They’re always trying to solve things naturally or alternative. And dentists… it’s funny because when a dentist has high blood pressure he doesn’t say, ‘oh that was great. It worked out great, I got a pill. I take a pill every day’. No. They decide they need to lose weight, or quit eating bacon, or something.

So the dentists all act alternative, and all natural, and all holistic. But man is it a racist bad toxic word… what would you say to the young millennials who are going to come out. And all the older dentists, you say those words and you’re a wackjob. But what percent of the people in Chicago would rather try to treat something natural and holistically than just go to the pharmacy and get a pill.

Olya: I think people are a lot more open minded these days. Whether is chiropractic, yoga, pilates, vitamins, minerals, whatever alternative oriental medicine. I think people are a lot more open minded about it. Because traditional medicine. Yes it’s important. But there’s a lot of value in the alternative options as well.

Howard: It’s big marketing words. I know some dentists who just said, ‘all natural. And we practice off the grid. We don’t leave a carbon footprint. Our entire office is run by solar’. And they are people driving gasoline engine cars an hour across town to go to the dentist that’s powered on solar.

Olya: Yes. Celebrities and their private planes. But they’re all about the environment.

Howard: Yeah. Yeah. I know. They fly their Citation Five telling us to walk to work.

Olya: Yeah. Do as a say not as I do. And it’s like the physician who smokes or who’s overweight and says, ‘you have to lose weight and you have to quit smoking’. Okay. I mean, yeah, let’s consider the source.

Howard: I’m pretty holistic. I mean when I get sick, I’m a hundred percent Irish, so I’ll just go eat a bowl of lucky charms with milk or chase it down with some Jameson Whiskey. And it works every time.

Olya: Because it paralyses you inside see. It’s the alcohol. It works.

Howard: Hey seriously thank you so much today for coming on my show. I think you’re just wonderful. You were so informative. In fact you’re such a unicorn that I had to, on DentalTown… I couldn’t believe it, I was going to look at what questions were under medical insurance billing. It’s like jiminy Christmas. We have fifty categories, one of them is insurance. And under insurance we have claims processing, coding q and a, Delta Dental, dental insurance for dentists, disability insurance, dental liability insurance, VPO’s, HMO’s, life insurance malpractice, medicate and medicare, and welfare. It’s like we didn’t even have medical insurance billing.

Olya: I know. I’ve been checking and I said, ‘what the heck?’

Howard: So I’m going to tell everybody, from now on, that I actually met the tooth fairy and she was riding a unicorn in Chicago. And her name was Dr. ‘Z’.

Olya: That’s it.

Howard: Thank you so much for coming on the show today.

Olya: Absolutely. It’s my pleasure. We’ll talk to you soon.

Category: Insurance
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