Save on Dental cost

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partner
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Save on Dental cost

Post by partner » Fri Mar 08, 2013 11:25 pm

Since I found the information here on this forum that helped me solve my problem, I am posting so that anyone in the same situation can benefit also. In other posts I have explained how my cost for a crown went up from ~$900 to ~$1400. While I was content to pay $900, paying $1400 was such a rip off that I started looking for a way to save money. While reading a post here someone mentioned the website "dentalplans.com". It is a consolidator for multiple dental discount plans. I picked out one of the plans and called a local dentist that was listed. I talked to the office manager and asked if I could use my regular insurance for the preventive work that it covered and this new discount plan for other non covered work (crowns). She said sure, lots of people do that. Bottom line is that I just got a new crown that cost $600 . Add the $110 cost of the discount plan for a year and I'm still paying less that I was with my previous dentist. I like the new dentist better too.

sport
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Re: Save on Dental cost

Post by sport » Sat Mar 09, 2013 2:05 am

I have a friend who is a dentist. He once told me that when you go to a new dentist, you will know within 5 minutes whether or not you like the dentist. However, it will take 5 years before you know if the new dentist is a good one.

All dental work is not of the same quality, and I have learned the hard way, that the patient cannot tell how good the work is. My present dentist is much more expensive than my old one. I feel he is worth the price. IMO, the quality of dental work is the most important consideration. The price, not so much. If you can get quality dentistry at a lower price, sure that is better. Just make sure the quality is there.

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Re: Save on Dental cost

Post by 2comma » Sat Mar 09, 2013 3:22 am

However, it will take 5 years before you know if the new dentist is a good one.
I think that's the delemma, we really won't know until we have problems later but I doubt we should assume that high price equals better quality. Consumers are really at a disadvantage here because we have no objective means on which to base our decisions. I've had a few unfortunate incidents which caused me to change providers and doubt the skills and business practices of some in the profession. Hopefully, my current dentist of 5 years will be the one; so far so good!
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Bfwolf
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Re: Save on Dental cost

Post by Bfwolf » Sat Mar 09, 2013 1:13 pm

After reading this and the other thread on how it is impossible for laypeople to tell if they have a good dentist, it really feels like there is a business opportunity here: some sort of 3rd party certifying authority that utilizes true experts to randomly audit a dentist's patients and actually examine the work that's been done. If the work is above average, they can receive this special 3rd party certification (for a fee). If not, they can't.

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Re: Save on Dental cost

Post by LadyGeek » Sat Mar 09, 2013 1:16 pm

This thread is now in the Personal Consumer Issues forum (dental costs).
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Re: Save on Dental cost

Post by Fallible » Sat Mar 09, 2013 1:42 pm

Bfwolf wrote:After reading this and the other thread on how it is impossible for laypeople to tell if they have a good dentist, it really feels like there is a business opportunity here: some sort of 3rd party certifying authority that utilizes true experts to randomly audit a dentist's patients and actually examine the work that's been done. If the work is above average, they can receive this special 3rd party certification (for a fee). If not, they can't.
An interesting idea, but I see some obstacles. How would "true experts" be determined? How would it differ from, or be an improvement on, getting a second opinion from another dentist? How could even an expert determine the quality of, say, a deep filling once it's done, i.e., whether all of the decay is removed?
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Jerilynn
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Re: Save on Dental cost

Post by Jerilynn » Thu Mar 21, 2013 3:22 pm

partner wrote:Since I found the information here on this forum that helped me solve my problem, I am posting so that anyone in the same situation can benefit also. In other posts I have explained how my cost for a crown went up from ~$900 to ~$1400. While I was content to pay $900, paying $1400 was such a rip off
Depends on who does the crown and what lab/materials are used. With some docs, $900 is a rip-off, with others, $1400 is a bargain.

that I started looking for a way to save money. While reading a post here someone mentioned the website "dentalplans.com". It is a consolidator for multiple dental discount plans. I picked out one of the plans and called a local dentist that was listed. I talked to the office manager and asked if I could use my regular insurance for the preventive work that it covered and this new discount plan for other non covered work (crowns). She said sure, lots of people do that. Bottom line is that I just got a new crown that cost $600 . Add the $110 cost of the discount plan for a year and I'm still paying less that I was with my previous dentist. I like the new dentist better too.
You can certainly evaluate if you like the new dentist. You have no way to evaluate the quality of that $600 crown. Not all crowns and not all dentists are equal. Just like not all paintings and not all painters are equal. That $600 crown may have been a piece of junk.

Typically, the types of dentists that participate in the 'dental plan gizmos dot com' are the ones that are trying to charge low fees do poor work and LOTS of it so they can make a ton of money. Either that or they arent good enough to get fee for service patients in a traditional way. Note: I said 'typically', not ALL.
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Jerilynn
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Re: Save on Dental cost

Post by Jerilynn » Thu Mar 21, 2013 3:29 pm

jsl11 wrote:I have a friend who is a dentist. He once told me that when you go to a new dentist, you will know within 5 minutes whether or not you like the dentist.


True!
However, it will take 5 years before you know if the new dentist is a good one.
Unfortunately that is not true. You (a lay person) will probably NEVER know if they are any good or not. As a matter of fact, some of the WORST dentists have patients that absolutely love them and have been seeing them for decades. Typically these patients think their dentist is a good one. Typically, these patients are incorrect.
All dental work is not of the same quality, and I have learned the hard way, that the patient cannot tell how good the work is.


Exactly.
My present dentist is much more expensive than my old one.


That means nothing.
I feel he is worth the price.
Well, that IS the name of the game. Convince (or con if that is the case) the patient that he/she is getting what he is paying for. MUCH of the dental continuing education courses try to teach dentists how to make the patients think they are receiving good quality care. Course the patient can't tell for sure.

IMO, the quality of dental work is the most important consideration
.

Yep. But, you have no way to know the level of quality.

Just make sure the quality is there.
If only patients could make that assessment. Maybe some day, who knows.
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Jerilynn
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Re: Save on Dental cost

Post by Jerilynn » Thu Mar 21, 2013 3:38 pm

rickmerrill wrote:
However, it will take 5 years before you know if the new dentist is a good one.
I think that's the delemma, we really won't know until we have problems later


Even then you won't know. To answer more completely, I guess you would need to define 'problems'.


Often times when I would introduce myself to friend or a friend, I would ask them what dentist they used. Then I would ask the person if their dentist was 'any good'. They almost always said yes. Then I would ask them how they new. Typically, the answer was something like...'because he is so nice' or 'because he talks to me' or 'because he has new shiny expensive gizmos'. Never did they answer...'because his crown preps have a spot on perfect 6 degrees of divergence and not 5 or 7, and also he makes sure there is a 2mm ferrule all the way around the tooth with at least a 4mm wall on one side of the prep, while not violating the biologic width'.

Someday, I'm going to start a web site that educates consumers about ....'how to spot shoddy dentistry on radiographs (x-rays)'
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Jerilynn
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Re: Save on Dental cost

Post by Jerilynn » Thu Mar 21, 2013 3:44 pm

Fallible wrote:
Bfwolf wrote:After reading this and the other thread on how it is impossible for laypeople to tell if they have a good dentist, it really feels like there is a business opportunity here: some sort of 3rd party certifying authority that utilizes true experts to randomly audit a dentist's patients and actually examine the work that's been done. If the work is above average, they can receive this special 3rd party certification (for a fee). If not, they can't.
An interesting idea, but I see some obstacles. How would "true experts" be determined? How would it differ from, or be an improvement on, getting a second opinion from another dentist? How could even an expert determine the quality of, say, a deep filling once it's done, i.e., whether all of the decay is removed?

There are ways to evaluate the quality of dental tx. Heck, they did it all the time in dental school. Students got A's, B's, C's, D's and F's depending on how well they followed the ideal protocol and procedures. There was also a defined set of criteria to evaluate the finished result. It was spelled out and pretty cut and dry. I wish they would publish these criteria so that patients could use them to evaluate their own dental tx. But, of course, they don't make it public. Most dentists (especially the sloppy/shoddy ones) would have a WALLEYED FIT if patients got their hands on such data.
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Paul78
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Re: Save on Dental cost

Post by Paul78 » Thu Mar 21, 2013 4:20 pm

Jerilynn wrote:
rickmerrill wrote:
However, it will take 5 years before you know if the new dentist is a good one.
I think that's the delemma, we really won't know until we have problems later


Even then you won't know. To answer more completely, I guess you would need to define 'problems'.


Often times when I would introduce myself to friend or a friend, I would ask them what dentist they used. Then I would ask the person if their dentist was 'any good'. They almost always said yes. Then I would ask them how they new. Typically, the answer was something like...'because he is so nice' or 'because he talks to me' or 'because he has new shiny expensive gizmos'. Never did they answer...'because his crown preps have a spot on perfect 6 degrees of divergence and not 5 or 7, and also he makes sure there is a 2mm ferrule all the way around the tooth with at least a 4mm wall on one side of the prep, while not violating the biologic width'.

Someday, I'm going to start a web site that educates consumers about ....'how to spot shoddy dentistry on radiographs (x-rays)'
Same thing with MDs. Maybe they do not diagnosis you early enough, maybe they prescribe you less then ideal medications (ie do not stay up to date with best practices), ect. You will not know if they made a mistake until it is too late.

But it does seem very possible to create a statically database to rank doctors (especially dentist).

Diogenes
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Re: Save on Dental cost

Post by Diogenes » Sat Mar 23, 2013 12:02 am

It is a tough guess for sure. I smiled when I noticed the Dentists that apparently posted here. Going to the Dentist is becoming like buying a used car - you never know what you are getting, or what you are paying. Having this week tried a new dentist, for a basic cleaning, I can tell you some ways I figured out they were not best quality:
1. Office staff was more interested in vetting my insurance plan before discussing my need for care.
2. Dentist tried to up-sell me on cosmetic treatments before conducting the exam
3. Dentist recommended removing existing dental work, including crowns that I have had trouble free for 20+ years and replacing
4. Dentist was clumsy and caused a fair amount or pain in a general exam
5. Dentist repeated said 'I don't know' while looking at the xrays
6. Office staff told me how great my insurance was and presented me with a pre printed plan including removing the long existing and trouble free crown for $1400
7. Office did not forward my xrays they took to me as I requested.

I too wish there was a way to easily compare the many, many dentists out there. By the way, perhaps the Dentists reading can advise why a crown should cost $1400 and how much it really costs the dentist. Seems these are a huge profit center, along with the cosmetic treatments.

_D_
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jaekwilson
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Re: Save on Dental cost

Post by jaekwilson » Sat Mar 23, 2013 11:52 am

I don't think $1400 is unreasonably high. Just like any product or service, there will always exist a wide range of costs. The reasons are varied, but here is my attempt to "break down the cost"

1. The level of training of the dentist is important. There are dentists who go to school 3 years after dental school just to become specialists in making things like crowns and dentures. These specialists (prosthodontists) generally are much more exacting through all steps of treatment, resulting in extra chair time and laboratory time. I can assure you, however that there are many general dentists who are just as meticulous and can deliver an exceptional product, but in both cases, the extra time for making the crown must be included in the fee.

2. As with anything, the cost of goods vary according to the region of the country or the world. $1400 for a crown in Manhatten or Beverly Hills would be considered bargain basement prices, but in Sioux Falls, SD may be considered on the high end. Even within cities, location of the practice may require a higher fee. The fixed costs of the practice must be accounted for in every procedure.

3. One of the most variable costs associated with a crown is the laboratory that actually fabricates the crown. 99.9% (just a guess - no data to support this) have dental laboratories make the crowns. I have visited a number of labs. Some are small operations with extremely skilled craftsmen. These labs usually employ technicians who have achieved designations such as Master Ceramist, etc. These artists can carefully layer porcelain to exactly mimic the shape, color, translucency, and yes, even imperfections of adjacent teeth. On the other hand, there are dental lab equivalents to factories. These are usually the labs that advertise in throw away journals for very low prices. Usually a mail order system. Not a sweeping indictment of all large labs that accept cases through the mail, but most often, it is a case of "you get what you pay for"

4. The crown itself has inherent costs. Basically there are three different types of crowns: all metal, all porcelain, and a combination (porcelain fused to metal) All porcelain crowns can be the most esthetic, but technically the most demanding. They can be pressed into molds, stacked (built up by hand, using different types and shades of porcelain) or milled (cut CAD/CAM style from a block of porcelain - requires high end milling machines) The time and expertise required to fabricate an exceptional all porcelain crown may be in the range of $500 dollars. All metal crowns are usually the easiest to make, and take the least skill. But there may be a high cost associated with the metal itself. Precious metals are usually a portion of the alloy used to make crowns, and with the cost of gold higher than in the past, this may be causing crown prices to increase. Cheaper metals (base metals) can be used, but as I recall from my days as a general dentist, the fit is not as ideal as crowns with high amounts of precious metals like gold.

5. Finally, the time associated with crowns is greater than other procedures. After diagnosis and planning, there is a minimum of two appointments. At the first appointment, the dentist will usually numb the area, and carefully prepare the tooth for a crown. Usually a small cord is placed in the gums to make the soft tissue shrink temporarily. An impression is made of the prepared tooth and the surrounding teeth (this material is not cheap). Finally, a "provisional" crown is fabricated. This may be delegated to a trained assistant, or done by the dentist. As a periodontist, I have to say this step is the one that is often rushed or done poorly and can have detrimental effects on the surrounding tissue. The bite is adjusted,and the patient leaves. The impression is sent to a lab (see above) and a crown is returned to the office. At the second appointment, the crown is fit to the adjacent and opposing teeth. Again, depending on the practice, this may be done by the dentist or an assistant. Once adjusted, the crown is carefully polished and cemented on the tooth. I am not writing this to bore anyone,but rather to point out the steps involved, keeping in mind that any one is a potential area to cut corners - thus saving time and money for the practice. I cannot tell you how many times I see crowns that fit like a sock on a rooster, are about as polished as sandpaper, have gobs of excess cement around the edges, hurt because they don't fit well, and look like monochromatic chicklettes.

I'm not sure this helps answer your question. I've seen a number of threads related to the costs of dentistry, and just want to make the case that excellence in any field generally costs more. In the end, it comes down to value. Ask some questions - what materials will be used, is the lab local or across the country, what training does the dentist have, what does the dentist do/what will the assistant do. Ask to see some photos of previous crowns done in that office. Make sure the dentist is willing to redo the crown at no cost to you if it does not look or feel like a normal tooth.

By the way - I completely agree with the previous poster regarding up-selling cosmetic procedures and recommending replacing old work without clearly defining the problems with the existing restorations and the risks associated with not replacing them. These should be huge red flags.

Thanks for letting me vent a little.

John

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Re: Save on Dental cost

Post by protagonist » Sat Mar 23, 2013 1:03 pm

Jerilynn wrote:
jsl11 wrote:I have a friend who is a dentist. He once told me that when you go to a new dentist, you will know within 5 minutes whether or not you like the dentist.


True!
However, it will take 5 years before you know if the new dentist is a good one.
Unfortunately that is not true. You (a lay person) will probably NEVER know if they are any good or not. As a matter of fact, some of the WORST dentists have patients that absolutely love them and have been seeing them for decades. Typically these patients think their dentist is a good one. Typically, these patients are incorrect..
Correct, and true regarding physicians (and I would imagine attorneys, accountants, car mechanics and others) as well. These professionals are judged by the public based on primarily two parameters:

1. Clinical outcome. But since most procedures and therapies are routine, the worst professionals will still have positive outcomes most of the time. So unless you are unfortunate enough to have a screw-up, and can directly connect it to bad treatment, you will think your clinician is competent. On the other hand, the best doctors also wind up having bad outcomes, and it is very common to wrongly attribute good doctoring with a bad outcome to incompetence.

2.Interpersonal interactions.

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Re: Save on Dental cost

Post by travellight » Sat Mar 23, 2013 1:52 pm

appreciate the details, jaekwilson... it does help understand all the factors involved.

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