New Dentist - what to watch for financially

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills
Post Reply
User avatar
Topic Author
dm200
Posts: 22965
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

New Dentist - what to watch for financially

Post by dm200 » Tue Mar 12, 2019 8:40 am

I am switching dentists because our dentist for the last 20+ years does not take the "extra" discounted Medicare plan that I have. I found a participating dentist (individual practice) in the same building where I work part time. I have been "lax" is taking care of my dental situation in recent years, so I now need a lot of work - probably several crowns, several fillings, etc.

Even with the higher discount plan I have, I do expect to pay quite a bit to get my dental situation back in good shape.

Any tips or things to watch for in keeping the costs within reason - without sacrificing needed work? I do plan to get an itemized bill every time I pay and try to verify that I am paying the correct amount for each procedure code that he does.

User avatar
lthenderson
Posts: 4456
Joined: Tue Feb 21, 2012 12:43 pm
Location: Iowa

Re: New Dentist - what to watch for financially

Post by lthenderson » Tue Mar 12, 2019 8:51 am

Like anything medical, get a second opinion before spending a lot of money on dental procedures. I took my mother-in-law to a nationally advertised chain dentist and they immediately wanted to pull her remaining teeth, put posts in and make new dentures for lots of money which they wanted me to pay up front or create some sort of payment plan with them. I took her to another dentist who simply treated the tooth that was bothering her allowing her to keep her current set of partial dentures. That was five years ago and she has been getting along fine ever since.

terpdds
Posts: 7
Joined: Fri Sep 28, 2018 6:54 pm

Re: New Dentist - what to watch for financially

Post by terpdds » Tue Mar 12, 2019 9:06 am

You get what you pay for. With heavily discounted plans, they will most likely cut corners. Cheap labs from China, cheap supplies, double book patients and rushing procedures. It is just the reality of medicare dental mills. They may also recommend more costly procedures which your plan may not cover. For example, instead of a three surface filling which is covered, they may recommend a crown. It may end up costing you more in the long run.

IlliniDave
Posts: 2321
Joined: Fri May 17, 2013 7:09 am

Re: New Dentist - what to watch for financially

Post by IlliniDave » Tue Mar 12, 2019 9:18 am

My long-term dentist sold the practice at the end of 2017 and I've been a couple times to the dentist who took it over. One thing I've noticed that I'm initially leery of is this new dentist is very big on products, almost to the point I would call "pushy". I don't know enough to judge whether these product recommendations are good or bad, but I'm uncomfortable with healthcare service providers marketing products to me. Maybe that's the future of dentistry, dunno.

I'd agree that getting a second opinion on any major/expensive procedures is wise. Not only could you wind up spending a lot of money you don't need to spend, but there are times when the cure is worse than the original problem.
Don't do something. Just stand there!

User avatar
Topic Author
dm200
Posts: 22965
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: New Dentist - what to watch for financially

Post by dm200 » Tue Mar 12, 2019 9:24 am

terpdds wrote:
Tue Mar 12, 2019 9:06 am
You get what you pay for. With heavily discounted plans, they will most likely cut corners. Cheap labs from China, cheap supplies, double book patients and rushing procedures. It is just the reality of medicare dental mills. They may also recommend more costly procedures which your plan may not cover. For example, instead of a three surface filling which is covered, they may recommend a crown. It may end up costing you more in the long run.
OK - educate me!

Let's say the dentist's "list price" for those paying full price in cash for procedure X1234 is $1,000. My plan (for which I pay monthly premiums) schedule says I pay, say, $450 for procedure X1234. So, I pay $450 and the dentist gets additional payment from the "plan". Seems to me that, from the same dentist, I would get identical quality work and materials. The financial benefit or incentive for the dentist to get a total of somewhat less than $1,000 is increased business. if this dentist did not participate in my plan, I would not see him.

My schedule in my plan goes on for many, many pages. I could be wrong, but the way I read it is that the plan covers the listed procedure codes and done by the dentist.

What are the characteristics of a medicare dental mill?

mantoof
Posts: 1
Joined: Tue Mar 12, 2019 9:58 am

Re: New Dentist - what to watch for financially

Post by mantoof » Tue Mar 12, 2019 10:09 am

I am a dentist practicing in midwest. Your example of procedure x1234 has a fee of $1000 and your insurance schedule says you pay $450. Your assumption is that the dentist gets additional payment from the plan. Generally speaking lots of these plans are negotiating a fixed price for the services. Many of the plans have no additional reimbursement from the plan itself. It is "sold" to dentists by saying "if you take our fee of $450 for service x1234 you will have access to our large group of subscribers thus increasing your total patients." The difficulty for the provider is that if typical overhead in a dental office is around 70-80% and your typical fee is $1000 for procedure x1234 that means the provider had to write off $550 of the typical fee. The way providers try to get around this is to lower the overhead. That means seeing more patients per hour, using less expensive materials, less expensive labs. Another user noted many of the crowns are sent to China to be fabricated bc the cost is so much cheaper than in US. I know in my geographic area and using my traditional materials and labs I am unable to do a crown for $450 without it being at a loss. I choose not to compromise on materials or time to get it right. In the end each patient chooses what level of care is best for their needs.

quantAndHold
Posts: 3622
Joined: Thu Sep 17, 2015 10:39 pm

Re: New Dentist - what to watch for financially

Post by quantAndHold » Tue Mar 12, 2019 10:42 am

One thing to be aware of. When I switched from my employer to individual dental plans for wife and me, the new plan has something like a 2 year exclusion on a lot of the more expensive work. We both had healthy teeth at the time, so I didn’t worry about it. Then six months later, wife needed a crown, and insurance paid nothing. So make sure you check for that on your insurance, and act appropriately.

The other thing is, our long time dentist, who we really like, isn’t on any of those cheap plans. We asked him what to do, and he volunteered to lower his rates for us as longtime patients. It ended up being about the same to just go to him without insurance as it is to pay for cheap insurance and go someplace else.

sport
Posts: 8757
Joined: Tue Feb 27, 2007 3:26 pm
Location: Cleveland, OH

Re: New Dentist - what to watch for financially

Post by sport » Tue Mar 12, 2019 10:58 am

A dentist friend (not my dentist) once told me that when you go to a new dentist, you will know within 5 minutes whether or not you like him/her. However, it will take 5 years before you know if that dentist is any good.

In my experience, the cost of dentistry is much less important than the quality of the work. My dentist is a perfectionist and does the highest quality work. The problem is that he knows how good he is, and he charges accordingly. He is not in any insurance plan. Since I can afford his prices, I am willing to pay that cost to avoid the complications caused by having lower quality work. My previous dentist was not as concerned about quality and I had to have several root canal procedures on teeth he had repaired. Getting root canal procedures followed by the required crown will cost much more than you can save with a less expensive dentist, plus those procedures come with discomfort and inconvenience.

User avatar
Topic Author
dm200
Posts: 22965
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: New Dentist - what to watch for financially

Post by dm200 » Tue Mar 12, 2019 11:01 am

quantAndHold wrote:
Tue Mar 12, 2019 10:42 am
One thing to be aware of. When I switched from my employer to individual dental plans for wife and me, the new plan has something like a 2 year exclusion on a lot of the more expensive work. We both had healthy teeth at the time, so I didn’t worry about it. Then six months later, wife needed a crown, and insurance paid nothing. So make sure you check for that on your insurance, and act appropriately.
The other thing is, our long time dentist, who we really like, isn’t on any of those cheap plans. We asked him what to do, and he volunteered to lower his rates for us as longtime patients. It ended up being about the same to just go to him without insurance as it is to pay for cheap insurance and go someplace else.
I have tried to read (and understand) all the details and fine print. I do not see any restrictions or limits on the various procedures initially. I will watch for that, though.

Yes - the "basic" Kaiser medicare dental coverage is a slightly discounted schedule. Our longtime dentist honored this for many years. When inquiring about his Kaiser coverage and my being enrolled in the greater discount plan, I learned that he is not in either Kaiser plan - BUT for longtime patients he honors the basic Kaiser charges. That works fine for my wife - since she is not paying extra for higher discounts.

User avatar
Topic Author
dm200
Posts: 22965
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: New Dentist - what to watch for financially

Post by dm200 » Tue Mar 12, 2019 11:07 am

sport wrote:
Tue Mar 12, 2019 10:58 am
A dentist friend (not my dentist) once told me that when you go to a new dentist, you will know within 5 minutes whether or not you like him/her. However, it will take 5 years before you know if that dentist is any good.
In my experience, the cost of dentistry is much less important than the quality of the work. My dentist is a perfectionist and does the highest quality work. The problem is that he knows how good he is, and he charges accordingly. He is not in any insurance plan. Since I can afford his prices, I am willing to pay that cost to avoid the complications caused by having lower quality work. My previous dentist was not as concerned about quality and I had to have several root canal procedures on teeth he had repaired. Getting root canal procedures followed by the required crown will cost much more than you can save with a less expensive dentist, plus those procedures come with discomfort and inconvenience.
Yes! Over the decades, I have had good and not so good dentists. Two dentists back, that dentist (we had for 15+ years) - as he grew older - let his equipment go somewhat out of date and stopped doing some procedures that he used to do (and most general dentists do routinely). The last dentist (I am leaving but my wife will still see) is in his mid to late 70's (individual practice) and has slowly cut back his hours. As a patient, my belief, observation and opinion is that he is up to date on his equipment and I do not and did not perceive any deterioration in his skills doing dental work.

My manager had used my new dentist a few years ago. She went to another dentist because she felt that he was a bit "rough" and his large hands caused a degree of unpleasantness as a patient. She had no negative opinion about his overall skill and competence. That aspect (being a bit rough) does not bother me since I am very tolerant of medical and dental procedures. We shall see.

As was/is common, while I had somewhat above average teeth, as a teenager - I had a lot of cavities and fillings. Our family dentist back then did not use Novocaine when I had drilling and cavities filled. I did not even know about Novocaine when being drilled, etc. until I was in my 20's.
Last edited by dm200 on Tue Mar 12, 2019 11:13 am, edited 1 time in total.

User avatar
HueyLD
Posts: 7362
Joined: Mon Jan 14, 2008 10:30 am

Re: New Dentist - what to watch for financially

Post by HueyLD » Tue Mar 12, 2019 11:11 am

If you think you may have thousands of dollars of dental expenses coming, you could consider having the procedures done in another country. Medical tourism is popular because there are plenty of well qualified dentists in this big wide world.

However, not everyone wants to be far away from home.

User avatar
Topic Author
dm200
Posts: 22965
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: New Dentist - what to watch for financially

Post by dm200 » Tue Mar 12, 2019 11:14 am

HueyLD wrote:
Tue Mar 12, 2019 11:11 am
If you think you may have thousands of dollars of dental expenses coming, you could consider having the procedures done in another country. Medical tourism is popular because there are plenty of well qualified dentists in this big wide world.
However, not everyone wants to be far away from home.
No - happy to get the work done right here -

terpdds
Posts: 7
Joined: Fri Sep 28, 2018 6:54 pm

Re: New Dentist - what to watch for financially

Post by terpdds » Tue Mar 12, 2019 11:36 am

dm200 wrote:
Tue Mar 12, 2019 9:24 am
terpdds wrote:
Tue Mar 12, 2019 9:06 am
You get what you pay for. With heavily discounted plans, they will most likely cut corners. Cheap labs from China, cheap supplies, double book patients and rushing procedures. It is just the reality of medicare dental mills. They may also recommend more costly procedures which your plan may not cover. For example, instead of a three surface filling which is covered, they may recommend a crown. It may end up costing you more in the long run.
OK - educate me!

Let's say the dentist's "list price" for those paying full price in cash for procedure X1234 is $1,000. My plan (for which I pay monthly premiums) schedule says I pay, say, $450 for procedure X1234. So, I pay $450 and the dentist gets additional payment from the "plan". Seems to me that, from the same dentist, I would get identical quality work and materials. The financial benefit or incentive for the dentist to get a total of somewhat less than $1,000 is increased business. if this dentist did not participate in my plan, I would not see him.

My schedule in my plan goes on for many, many pages. I could be wrong, but the way I read it is that the plan covers the listed procedure codes and done by the dentist.

What are the characteristics of a medicare dental mill?
Let's use a real example. What is your fee for D2740? What percentage will you owe?

As far as the percieved financial benefit of the $1000, overhead will greatly impact whether the $1000 in your example is actually a benefit. A real life fee and percent will make this easier to explain.

Dottie57
Posts: 7567
Joined: Thu May 19, 2016 5:43 pm
Location: Earth Northern Hemisphere

Re: New Dentist - what to watch for financially

Post by Dottie57 » Tue Mar 12, 2019 11:57 am

Watch for good care. You can check other dentists for their prices. But bad care is not worth a cheaper price. I’ve tried cheaper and it did not work out well.

User avatar
Topic Author
dm200
Posts: 22965
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: New Dentist - what to watch for financially

Post by dm200 » Tue Mar 12, 2019 12:43 pm

[quote]Let's use a real example. What is your fee for D2740? What percentage will you owe?
As far as the perceived financial benefit of the $1000, overhead will greatly impact whether the $1000 in your example is actually a benefit. A real life fee and percent will make this easier to explain.[/quote]
Under the "basic" Kaiser Medicare plan I had (and my wife still has), D2740 (Crown - porcelain/ceramic) is $741.
Under my added/enhanced Kaiser Medicare plan I have now and am paying an added $23/month, D2740 (Crown - porcelain/ceramic) is $531.
I conclude that I would save $210 for just one such crown by paying the slightly higher premium. I do not know what this dentist would charge to a patient who had no coverage and paid cash. I am assuming that the recommendation/decision would be pretty much the same for most patients, and that just about any choice or decision to spend less and get less quality results would primarily be the decision of the patient (without any coverage).

What do you think and conclude?

Although I know nothing about the economics of dentistry practice, I suspect that one patient with a lot of work and procedures being done is slightly more efficient and "profitable" than five different patients getting the same total work done.

apple44
Posts: 61
Joined: Tue Feb 19, 2019 3:22 pm

Re: New Dentist - what to watch for financially

Post by apple44 » Tue Mar 12, 2019 12:53 pm

I recently switched dentist too because my old dentist is not "in network" of new employer's dental plan.

I immediately noticed some differences:

-- My old dentist is male and old, and perhaps old-school. His office feels old too and he treated me like a non-obedient child (if you don't do this, you are going to lose all your teeth! You don't want that, do you?), scolding me every time I visited him that I wasn't brushing/flossing my teeth and I didn't visit him as often as I should, which are all true! I was so torn whenever I went to see him -- on the one hand, I know that he was saying those things for my benefit but on the other hand, I felt so uncomfortable and almost developed a PTSD about dental visits. This dentist never ever tried to sell me any products! He just wanted me to see him every 6 months so that he could monitor the situation.

-- My new dentist is a young female, very pretty and charming. Her office is bright and shiny. She did tell me to floss more often but not in a scolding way, just smiling. BUT, this is a big but, she tried to give me stuff without telling me that it would cost me extra -- I went in for a routine teeth cleaning and after that, she said do you want fluorite which protects your teeth? I thought that was part of the routine, so I said sure. Then it turned out that it's essentially just toothpaste which costs me an extra $25 (I'm not mad about the dollar amount, it is small, but it's the principal of things -- I didn't expect to pay for this, no matter how small the amount is)! And then she wanted to sell me night guards. I said I'll think about it.

Anyway I will probably go back (it's close to my home and it's a nice place), but the experience does leave a sour feeling...

User avatar
Topic Author
dm200
Posts: 22965
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: New Dentist - what to watch for financially

Post by dm200 » Tue Mar 12, 2019 1:07 pm

apple44 wrote:
Tue Mar 12, 2019 12:53 pm
I recently switched dentist too because my old dentist is not "in network" of new employer's dental plan.
I immediately noticed some differences:
-- My old dentist is male and old, and perhaps old-school. His office feels old too and he treated me like a non-obedient child (if you don't do this, you are going to lose all your teeth! You don't want that, do you?), scolding me every time I visited him that I wasn't brushing/flossing my teeth and I didn't visit him as often as I should, which are all true! I was so torn whenever I went to see him -- on the one hand, I know that he was saying those things for my benefit but on the other hand, I felt so uncomfortable and almost developed a PTSD about dental visits. This dentist never ever tried to sell me any products! He just wanted me to see him every 6 months so that he could monitor the situation.
-- My new dentist is a young female, very pretty and charming. Her office is bright and shiny. She did tell me to floss more often but not in a scolding way, just smiling. BUT, this is a big but, she tried to give me stuff without telling me that it would cost me extra -- I went in for a routine teeth cleaning and after that, she said do you want fluorite which protects your teeth? I thought that was part of the routine, so I said sure. Then it turned out that it's essentially just toothpaste which costs me an extra $25 (I'm not mad about the dollar amount, it is small, but it's the principal of things -- I didn't expect to pay for this, no matter how small the amount is)! And then she wanted to sell me night guards. I said I'll think about it.
Anyway I will probably go back (it's close to my home and it's a nice place), but the experience does leave a sour feeling...
Yes - common type issues, I am sure.

To me, in your scenario, an important factor (perhaps the most important) is whether the young, female dentist does as good or better job in the quality of the dental work. While I have mostly had female Primary Care Physicians for the past 40+ years - and have been almost always very pleased, I have not had a female dentist. Today, I cannot think of an objective reason to prefer either male of female dentists.

carol-brennan
Posts: 277
Joined: Thu Dec 27, 2018 3:19 pm

Re: New Dentist - what to watch for financially

Post by carol-brennan » Tue Mar 12, 2019 1:12 pm

lthenderson wrote:
Tue Mar 12, 2019 8:51 am
Like anything medical, get a second opinion before spending a lot of money on dental procedures.
Can't second this firmly enough.

Did anyone see that Canadian investigative news program on dentists? A woman took her x-rays around to 19 different dentists to ask their opinion. Guess how many different treatment plans she got?

If you guessed 19, wow, you're right!

Estimated costs ranged from, as I recall, just over $100 to well over $10,000.

How many of you think the same kind of investigation done in the U.S. would yield similar results?

Okay, you can put your hands down now.

Dental profession: ripe for fraud for some fairly obvious reasons. Google it.

Be especially wary of "in plan" or "in network" dentists, who agree to accept what the insurance company pays for certain treatments. Guess how they too often make up the difference between what the insurance company pays them and what "out of network" dentists charge?
Last edited by carol-brennan on Tue Mar 12, 2019 1:15 pm, edited 1 time in total.

User avatar
Topic Author
dm200
Posts: 22965
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: New Dentist - what to watch for financially

Post by dm200 » Tue Mar 12, 2019 1:15 pm

carol-brennan wrote:
Tue Mar 12, 2019 1:12 pm
lthenderson wrote:
Tue Mar 12, 2019 8:51 am
Like anything medical, get a second opinion before spending a lot of money on dental procedures.
Can't second this firmly enough.
Did anyone see that Canadian investigative news program on dentists? A woman took her x-rays around to 19 different dentists to ask their opinion. Guess how many different treatment plans she got?
If you guessed 19, wow, you're right!
Estimated costs ranged from, as I recall, just over $100 to well over $10,000.
How many of you think the same kind of investigation done in the U.S. would yield similar results?
Okay, you can put your hands down now.
Dental profession: ripe for fraud for some fairly obvious reasons. Google it.
Maybe this is information I would be happier not knowing. I wonder how much of these differences were due to objective dental competence (or lack thereof) and how much was sales/marketing?


DrGoogle2017
Posts: 2528
Joined: Mon Aug 14, 2017 12:31 pm

Re: New Dentist - what to watch for financially

Post by DrGoogle2017 » Tue Mar 12, 2019 1:29 pm

My kids are not happy with our new dentist, they are not going to him going forward. But we stay put, but have rejected any new stuff they suggested unless it’s absolutely necessary.

User avatar
Topic Author
dm200
Posts: 22965
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: New Dentist - what to watch for financially

Post by dm200 » Wed Mar 20, 2019 3:24 pm

So far, so good.

Had initial appointment yesterday. New X-Rays and evaluation. No surprises because I know I need a lot of work and everything he said makes sense to me.

The office staff is very happy to provide me with detailed billing, including procedure codes, that I can match to my plan documents. My initial bill ($40) had the 3 procedure codes with the charges that matched my plan documents: $0.00, $10.00 and $30.00

Fortunately, not like this: https://www.youtube.com/watch?v=nF_C3bO8WZ0&t=484s

gretah
Posts: 227
Joined: Wed Apr 20, 2016 11:14 pm

Re: New Dentist - what to watch for financially

Post by gretah » Wed Mar 20, 2019 10:13 pm

I had a great dentist in my old state.

Dentists in my new state have been terrible. Failed root canals, failed crowns.

I have been thinking about going outside the US to get higher quality dental care.

Which country has the highest quality dental care? Switzerland? Other? Any one know how to find a great dentist in the country?

btw - I checked out the Mexican town just south of the border below SE California. Implants there have a failure rate of 10% and up according to a Canadian referral agency I consulted. The young owners of the referral company think 10% is acceptable !!!

elainet7
Posts: 387
Joined: Sat Dec 08, 2018 1:52 pm

Re: New Dentist - what to watch for financially

Post by elainet7 » Sun Mar 24, 2019 12:36 pm

If you need lots of dental tmt at a high cost a second opinion is worth every penny
Too many young indebted docs grossly over treating
Get recommendations from family
Discounted plans are junk
Many docs really do unnecessary work more often than you think, physicians ascwell

User avatar
TexasPE
Posts: 246
Joined: Sat Feb 17, 2018 8:41 pm
Location: Southeast Texas

Re: New Dentist - what to watch for financially

Post by TexasPE » Sun Mar 24, 2019 12:51 pm

My long-term dentist sold the practice at the end of 2017 and I've been a couple times to the dentist who took it over. One thing I've noticed that I'm initially leery of is this new dentist is very big on products, almost to the point I would call "pushy".
+1
Same thing happened to me. I asked my former dentist who HE would go to. He recommended a well established, conservative dentist. I am satisfied with the dentist he suggested.

I had the feeling the dentist who bought the old dentist's practice was trying to pay off his student loans - I received multiple expensive 'suggestions' on my first visit to him, even though I had regular checkups and addressed any issues as they occurred.
At 20: I cared what everyone thought about me | At 40: I didn't give a damn what anyone thought of me | Now that I'm 60: I realize that no one was really thinking about me at all | Winston Churchill (?)

Post Reply