Dental practice billing

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tenkuky
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Dental practice billing

Post by tenkuky »

Not asking for health/dental advice here, but was curious about boarders opinions about the following (esp those with dental background)
1. Recently had to change dentists as employer dental insurance plan changed. Went with an in-network office that had been highly recommended by a colleague. They were extremely accommodating/professional in scheduling with excellent patient portal reducing paperwork and time.
2. Arrival: excellent hospitality, gave a "tour" of the facility, introduced all personnel, very clean and welcoming office.
3. Process: here is where things get interesting. Having had many dental visits over 4 decades, several startling things: taking high resolution photographs of my face in profile and frontal, having me manipulate retractors while taking interior photos (note, this is not a cosmetic visit). Regular AND panoramic Xrays.
4. NO cleaning/prophylaxis despite this being a new/annual prophy visit
5. Dentist was knowledgeable and courteous but appeared to be trying to upsell (can I whiten your teeth, need braces?), which I politely declined. Then, instead of telling me anything after the exam, asked staff to schedule a "review of findings" (ROF) separate visit, where apparently dentist will go over the Xrays and photos and findings (I will be checking with my insurance if this is covered).
6. Billing: WHOA, they charged for total amounts, while acknowledging there is insurance payment pending. I challenged that, asking why they cannot first charge me only out of pocket so I don't have to chase my insurance for reimbursement. They were not forthcoming if the photos or ROF is covered.

Is this usual nowadays? Should I revert to my old dentist (even though they are out of network and I need to confirm costs)?

Thanks!
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gwe67
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Re: Dental practice billing

Post by gwe67 »

Did he ask, "Do you want fries with that?"
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123
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Re: Dental practice billing

Post by 123 »

It sounds unusual. It would seem that they have a mostly one track service model which goes to braces and/or teeth whitening. The only time I've ever heard of a visist to "go over things" has been when we've toke the kids in for photos and panoramic xrays and the orthodontist met with us later on a seperate visit about the braces we wanted for them. If you're not in the market for braces they may offer you implants or some gum work.

For a time I had a dentist who would always schedule the cleaning on the last visit if xrays or exam found other work needed, like cavities or a crown, I think the idea of holding off on the cleaning is to get you to return for the other work in the interim.
Last edited by 123 on Tue Sep 22, 2020 3:21 pm, edited 1 time in total.
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alpenglow
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Re: Dental practice billing

Post by alpenglow »

I had a similar experience. There was a new office on the corner about 2 minutes away, so I tried them. Everything very upscale. Pano xrays. Various measurements were taken and recorded on wireless headsets - kind of bizarre. Then they said I needed a bunch of work, so I sought a second opinion. The next dentist more or less said it was a money grab. I've been with that dentist for about 6 years with no tooth or gum issues. I totally trust him.

EDIT: The corner guy also billed full payment upfront. My current guy takes nothing upfront. Both are in-network.
Topic Author
tenkuky
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Re: Dental practice billing

Post by tenkuky »

alpenglow wrote: Tue Sep 22, 2020 3:21 pm I had a similar experience. There was a new office on the corner about 2 minutes away, so I tried them. Everything very upscale. Pano xrays. Various measurements were taken and recorded on wireless headsets - kind of bizarre. Then they said I needed a bunch of work, so I sought a second opinion. The next dentist more or less said it was a money grab. I've been with that dentist for about 6 years with no tooth or gum issues. I totally trust him.
Agree completely, dentist also compared my teeth staining to a perfect teeth model (asked me to hold up a mirror and said see the difference, "shaming" me about my tea staining).
This ROF is unnecessary IMHO. And I forgot, also tried to sell me special mouthwash that was better than Listerine, I declined.
My spouse was offered a "pathogen identification panel" for $190 that was declined.
I am returning to my old dentist even if out of network.
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TexasPE
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Re: Dental practice billing

Post by TexasPE »

My current dentist is in his late 50s, has an established practice, and has achieved the income level and workload he wants (closed Fridays). He accepted my employer dental insurance, but doesn't participate in the individual policy marketplace. He continues to give me the insurance discounted price for procedures (cash).

I found him by asking my previous dentist (who was retiring) who HE recommended after giving the young dentist who bought his practice a chance. The young dentist trotted out a list of recommended high-dollar procedures, including cosmetic, on my first visit-issues the retiring dentist never raised.

I assume he has a large student debt to retire. :moneybag
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Big Worm
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Re: Dental practice billing

Post by Big Worm »

You are being scammed.
hnd
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Re: Dental practice billing

Post by hnd »

our dentist retired and he referred his patients to a new dentist but it was way across town. my wife got a flier for a free consultation and xrays for a new dentist office much closer and decided to take herself and our 3 children to this establishment for free consultations.

She described it very much like you did. they all get xrays they all had cavities. like a lot of them. My wife OCD with her teeth and has never had a cavity and this dentist said she had 3. When she came home with the estimates (we'd paid these people nothign at this point) she was in tears as it was thousands of dollars. and on the estimate was all these other options or addons. She called my SIL and was like does any of this make sense. My SIL gave us the name of a different dentist. Called the dentist and told them the situation. He was like come on down, we'll see whats really up.

my oldest did have a few cavities, nobody else did. The lady called from the other place to see about scheduling the bloodbath. I told that lady what for (i don't do it often) and spoke to the office manager and they were like whaattt???

long story short? find a new dentist.
toofache32
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Re: Dental practice billing

Post by toofache32 »

Tough to say.
The photos and data gathering are not a bad thing and are actually smart. This is called taking records. It serves as a snapshot of where you are at that time. You would be amazed how many patients say "your filling came out" when they filling was already there the first day you were seen.
I would simply ask them up front what the costs will be for every step of the way. Dental "insurance" does not cover much.
quantAndHold
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Re: Dental practice billing

Post by quantAndHold »

I had that happen at a fancy place in one of those wealthy towns where everyone putts down to the village in their golf carts.

I found a new dentist in a part of town where the patients care how much stuff costs.
Yes, I’m really that pedantic.
brcase800
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Re: Dental practice billing

Post by brcase800 »

You never “have to” change dentists bc of insurance. If you were happy with previous dentist than stick with them. In and out of network is very confusing for patients but typically it averages out. (It’s a business so in network can easily find ways to increase costs by adding all allowable codes).
The new dentist is using one strategy that a few consultants recommend. I never personally liked that strategy and felt it was out dated.
Basically, my advice is to go to the office you feel more comfortable at. Don’t let cost be only factor.
rich126
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Re: Dental practice billing

Post by rich126 »

I've gone to dentists like that and never go back. I also have tried telling them no about the photo stuff. I just want cleanings, xrays and an exam.

When I go into a dental or dermatologist office and see a lot of ads and brochures involving questionable procedures I don't go back. They just aren't for me.

I would look for a new dentist.
Kelrex
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Re: Dental practice billing

Post by Kelrex »

toofache32 wrote: Tue Sep 22, 2020 9:47 pm Tough to say.
The photos and data gathering are not a bad thing and are actually smart. This is called taking records. It serves as a snapshot of where you are at that time. You would be amazed how many patients say "your filling came out" when they filling was already there the first day you were seen.
I would simply ask them up front what the costs will be for every step of the way. Dental "insurance" does not cover much.
Agreed.

Some dentists practice this way, it's very by-the-book as taught by some of the top end continuing education schools, and believe me, a lot of the dentists who practice this way make *less* money because it takes a ton of time.

It may cost the individual patient more, but cleanings and fillings are more lucrative per unit of time, so some of those dentists who keep it quick and simple are actually way more profitable.

It really depends on the dentist, but don't assume extra cost to you actually amounts to a cash grab, because it isn't necessarily.
Redlion
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Re: Dental practice billing

Post by Redlion »

You have to be selective. Dentists are like Mechanics, they will make stuff up to get more business. Thorough research, word or mouth and sometimes getting a second opinion you can find an honest Dentist.
DebiT
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Re: Dental practice billing

Post by DebiT »

I have rarely had dental insurance, and only very rarely wished I had (root canal,maybe). I picked a new dentist in my old area a few years ago, and just now a new one in new area. Both first visits were similar,even though one office was large and the other was husband wife and smaller.

Initial visit cleaning, x rays, and dental exam. Watch an area or two, fine with leaving my slightly chipped tooth alone. Both fine with my stated preference of x rays only every 2 years, both required them at minimum every two years for standard of care. One was all digital, other not, both seemed excellent. I have always had cleaning each visit, dental exam yearly, never been up sold.

Definitely pick carefully, and ask questions on the phone first.
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cheese_breath
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Re: Dental practice billing

Post by cheese_breath »

tenkuky wrote: Tue Sep 22, 2020 3:06 pm ...taking high resolution photographs of my face in profile and frontal...
Mug shots? Better pay your bill unless you want your pictures displayed in the post office. :P
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Topic Author
tenkuky
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Re: Dental practice billing

Post by tenkuky »

cheese_breath wrote: Wed Sep 23, 2020 12:06 pm
tenkuky wrote: Tue Sep 22, 2020 3:06 pm ...taking high resolution photographs of my face in profile and frontal...
Mug shots? Better pay your bill unless you want your pictures displayed in the post office. :P
:P
What is worse, I had to pull my mouth corners into a Joker-like smile and hold it there with retractors myself for the pics.
Very uncomfortable and weird.
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8foot7
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Re: Dental practice billing

Post by 8foot7 »

I think the photos are moving pretty high-tech and those are normal. Every dentist needs a baseline from which to work and judge decay and other changes.

Not to put too fine a point on it, but if your dentist's office is super nice (not just comfortable and well-appointed, but super high-tech, all the pamperings, fine stuff) then you have to know who's paying for that.
J295
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Re: Dental practice billing

Post by J295 »

I’d be principally concerned with quality of care, which I can’t help you evaluate online.

I sense many medical and non-medical businesses are frequently looking for cross-selling opportunities.
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FIREchief
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Re: Dental practice billing

Post by FIREchief »

Is this really a dentist's office? Yikes!!
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Topic Author
tenkuky
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Re: Dental practice billing

Post by tenkuky »

J295 wrote: Wed Sep 23, 2020 5:36 pm I’d be principally concerned with quality of care, which I can’t help you evaluate online.

I sense many medical and non-medical businesses are frequently looking for cross-selling opportunities.
I agree. I think the dentist is super competent, however the upselling and general philosophy is a poor match for me. I need cleaning/Xrays/check-up and nothing unusual.
My previous dentist can/will do those, and I am resigned to going out-of-network if for peace of mind and not feel I'm being scammed.
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William Million
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Re: Dental practice billing

Post by William Million »

My experience is, there a great range of opinion among dentists as what needs to be done and when. Range is greater than with other medical professionals.

In general, I prefer conservative dentists and do most of my dental work when outside the U.S. Don't mean to offend any dentists on the board, but for me, as someone without dental insurance who frequently travels abroad, I feel I get better service for a fraction of the cost by avoiding U.S.-based dentists.
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tenkuky
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Re: Dental practice billing

Post by tenkuky »

William Million wrote: Wed Sep 23, 2020 6:01 pm In general, I prefer conservative dentists and do most of my dental work when outside the U.S. Don't mean to offend any dentists on the board, but for me, as someone without dental insurance who frequently travels abroad, I feel I get better service for a fraction of the cost by avoiding U.S.-based dentists.
COVID is putting a damper on your care then. I know several people who do dental tourism to Mexico, India and other countries for complex stuff that would cost a jaw out here.
newyorker
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Re: Dental practice billing

Post by newyorker »

tenkuky wrote: Wed Sep 23, 2020 6:26 pm
William Million wrote: Wed Sep 23, 2020 6:01 pm In general, I prefer conservative dentists and do most of my dental work when outside the U.S. Don't mean to offend any dentists on the board, but for me, as someone without dental insurance who frequently travels abroad, I feel I get better service for a fraction of the cost by avoiding U.S.-based dentists.
COVID is putting a damper on your care then. I know several people who do dental tourism to Mexico, India and other countries for complex stuff that would cost a jaw out here.


Not defending some aggressive dentists out there, but please dont go to Mexico or India for complex stuff. I saw so many cases in residency where it did cost them a jaw “literally”
toofache32
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Re: Dental practice billing

Post by toofache32 »

newyorker wrote: Wed Sep 23, 2020 6:31 pm
tenkuky wrote: Wed Sep 23, 2020 6:26 pm
William Million wrote: Wed Sep 23, 2020 6:01 pm In general, I prefer conservative dentists and do most of my dental work when outside the U.S. Don't mean to offend any dentists on the board, but for me, as someone without dental insurance who frequently travels abroad, I feel I get better service for a fraction of the cost by avoiding U.S.-based dentists.
COVID is putting a damper on your care then. I know several people who do dental tourism to Mexico, India and other countries for complex stuff that would cost a jaw out here.
Not defending some aggressive dentists out there, but please dont go to Mexico or India for complex stuff. I saw so many cases in residency where it did cost them a jaw “literally”
I encourage dental tourism. It's sending my kids to college.
Kelrex
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Re: Dental practice billing

Post by Kelrex »

newyorker wrote: Wed Sep 23, 2020 6:31 pm
tenkuky wrote: Wed Sep 23, 2020 6:26 pm
William Million wrote: Wed Sep 23, 2020 6:01 pm In general, I prefer conservative dentists and do most of my dental work when outside the U.S. Don't mean to offend any dentists on the board, but for me, as someone without dental insurance who frequently travels abroad, I feel I get better service for a fraction of the cost by avoiding U.S.-based dentists.
COVID is putting a damper on your care then. I know several people who do dental tourism to Mexico, India and other countries for complex stuff that would cost a jaw out here.


Not defending some aggressive dentists out there, but please dont go to Mexico or India for complex stuff. I saw so many cases in residency where it did cost them a jaw “literally”
Funnily, my issue with it is that it's overpriced. For the quality of care and materials used, it's too expensive. Some of the stuff coming out of Mexico that people pay a quarter to a half of US prices for and really, they shouldn't have paid more than 10-15% for what they got. They're over paying several times what they should.

I really don't judge people for being willing to take the risk when they can't afford high quality dentistry, but what pisses me off is that they're getting ripped off by predatory companies, on top of the risk of horrific damage. Why take the risk for a bad deal?

A lot of locals in Mexico are getting great work done, but they're not going to bloody Los Algodones with a tour company and getting shafted on the price and quality where the dentists there don't own the clinics, they work under insane pressure from the companies that own the clinics and don't have a ton of control over how they work. That makes a huge difference.

It's not that the dentistry is necessarily always bad in some of these dental tourism countries, it's that the dental tourism industry tends to attract really sketchy practices. The same way that cosmetic surgery tourism does...like practitioners who've lost their licenses in other countries, that kind of thing is common in medical tourism.

If someone wants to get cheap work in Mexico or India, I recommend they go spend many months there and make friends with Mexicans or Indians who can help them find higher quality care from caring independent practitioners, for very low prices.

If there's some kind of tour company involved and a hot spot destination where a lot of foreigners go...um...well...

Anyway, that's as much as I can say while keeping this post as focused as possible on the economic cost-benefit of dental/medical tourism.
bampf
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Re: Dental practice billing

Post by bampf »

toofache32 wrote: Wed Sep 23, 2020 7:36 pm
newyorker wrote: Wed Sep 23, 2020 6:31 pm
tenkuky wrote: Wed Sep 23, 2020 6:26 pm
William Million wrote: Wed Sep 23, 2020 6:01 pm In general, I prefer conservative dentists and do most of my dental work when outside the U.S. Don't mean to offend any dentists on the board, but for me, as someone without dental insurance who frequently travels abroad, I feel I get better service for a fraction of the cost by avoiding U.S.-based dentists.
COVID is putting a damper on your care then. I know several people who do dental tourism to Mexico, India and other countries for complex stuff that would cost a jaw out here.
Not defending some aggressive dentists out there, but please dont go to Mexico or India for complex stuff. I saw so many cases in residency where it did cost them a jaw “literally”
I encourage dental tourism. It's sending my kids to college.
Are you really a doctor that celebrates people going to places that are going to harm them so they can fix it and make money? If you are being sarcastic, it falls flat as this whole thread is about dentists harming their patients for money.
toofache32
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Re: Dental practice billing

Post by toofache32 »

bampf wrote: Fri Sep 25, 2020 6:55 am
toofache32 wrote: Wed Sep 23, 2020 7:36 pm
newyorker wrote: Wed Sep 23, 2020 6:31 pm
tenkuky wrote: Wed Sep 23, 2020 6:26 pm
William Million wrote: Wed Sep 23, 2020 6:01 pm In general, I prefer conservative dentists and do most of my dental work when outside the U.S. Don't mean to offend any dentists on the board, but for me, as someone without dental insurance who frequently travels abroad, I feel I get better service for a fraction of the cost by avoiding U.S.-based dentists.
COVID is putting a damper on your care then. I know several people who do dental tourism to Mexico, India and other countries for complex stuff that would cost a jaw out here.
Not defending some aggressive dentists out there, but please dont go to Mexico or India for complex stuff. I saw so many cases in residency where it did cost them a jaw “literally”
I encourage dental tourism. It's sending my kids to college.
Are you really a doctor that celebrates people going to places that are going to harm them so they can fix it and make money? If you are being sarcastic, it falls flat as this whole thread is about dentists harming their patients for money.
Of course I don't celebrate poor care. I was making the point that if you think US dentistry is expensive the first time you need it, it's even more expensive the 2nd time when redos are much more complex. I have seen good and bad work from Mexico, and good and bad work from the USA. But in the USA at least you have legal recourse.
S4C5
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Re: Dental practice billing

Post by S4C5 »

OP,

Be wary of practices that have visibly high overhead. Expensive buildings, landscaping, coffee bars and arcade games in the lobby, elaborate aquariums, expensive furniture, etc. They have to pay for all this somehow.

Do not let them sell you on a "deep cleaning" unless they can prove that you actually need it. I went to an office a few years ago like the one you describe and they sold me on a deep cleaning (planing and scaling). I believe that I actually needed it as I have had issues with my gums for many years. However, I had no doubt that they are trying to sell it to everyone they can.
rich126
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Re: Dental practice billing

Post by rich126 »

tenkuky wrote: Wed Sep 23, 2020 12:31 pm
cheese_breath wrote: Wed Sep 23, 2020 12:06 pm
tenkuky wrote: Tue Sep 22, 2020 3:06 pm ...taking high resolution photographs of my face in profile and frontal...
Mug shots? Better pay your bill unless you want your pictures displayed in the post office. :P
:P
What is worse, I had to pull my mouth corners into a Joker-like smile and hold it there with retractors myself for the pics.
Very uncomfortable and weird.
Yeah, when one doctor tried to do that, I said nope. And never went back. I don't make my living based on my looks. I simply want quality dental care and not teeth whitening or fancy expensive stuff. Treat the teeth.

Some doctors are just well strange. I didn't realize it at the time but I went to one that had a large practice with another doctor and things seemed ok. Then he gave me a root canal and didn't use the plastic dam thing to keep the area dry. From a patient perspective it was like "wow, this is much more comfortable". Unfortunately not doing it properly led to an infection and a second root canal. I've learned to always see a specialist for root canals.
jucor
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Re: Dental practice billing

Post by jucor »

toofache32 wrote: Tue Sep 22, 2020 9:47 pm Tough to say.
The photos and data gathering are not a bad thing and are actually smart. This is called taking records. It serves as a snapshot of where you are at that time. You would be amazed how many patients say "your filling came out" when they filling was already there the first day you were seen.
I would simply ask them up front what the costs will be for every step of the way. Dental "insurance" does not cover much.
So the photos, etc. are more of a CYA for the dentist against possible claims from clients in the future than they are an actual benefit for the patient? Do you charge your patients extra for protecting you? What percentage of your patients make claims that work you did not do was actually done by you? In my case dental work I've had done is always documented by written records that both the dentist and I have a copy of indicating tooth number and work done -- seems it would be pretty easy to counter a false claim with those simple records without the need for costly photos, etc.
toofache32
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Re: Dental practice billing

Post by toofache32 »

jucor wrote: Fri Sep 25, 2020 2:15 pm
toofache32 wrote: Tue Sep 22, 2020 9:47 pm Tough to say.
The photos and data gathering are not a bad thing and are actually smart. This is called taking records. It serves as a snapshot of where you are at that time. You would be amazed how many patients say "your filling came out" when they filling was already there the first day you were seen.
I would simply ask them up front what the costs will be for every step of the way. Dental "insurance" does not cover much.
So the photos, etc. are more of a CYA for the dentist against possible claims from clients in the future than they are an actual benefit for the patient? Do you charge your patients extra for protecting you? What percentage of your patients make claims that work you did not do was actually done by you? In my case dental work I've had done is always documented by written records that both the dentist and I have a copy of indicating tooth number and work done -- seems it would be pretty easy to counter a false claim with those simple records without the need for costly photos, etc.
It's not CYA as much as just a good practice to have the most complete information possible. Xrays and written notes only tell part of the story. Most dentists don't charge for this unless maybe it's a prosthodontist specifically using this for a full mouth rehabilitation which also includes models and a facebow mounting.
Carguy85
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Re: Dental practice billing

Post by Carguy85 »

A new pt exam/prophy usually takes us an hour. Xrays taken (if none current from elsewhere). If extensive work or deep cleaning needed due to periodontal problems then of course a “cleaning” wont be done that day.. We take intra-oral camera pictures with before/after cosmetic cases, crown/bridge delivery, or if there is decay or something else not evident in the xrays or if there is soft tissue pathology...not on every patient. Is it wrong to cake camera pics on every patient though...of course not. And no, we don’t charge for them. Btw, there is an extremely wide range of what is deemed aesthetically acceptable and important patient to patient..I let patients tell me if something bothers them aesthetically. Just my personality but I hate “selling”..especially hard selling. I feel it’s my job to tell them what’s going on and what to do to fix it. When they are ready they will let us know. As I always say, it’s not hard to treat people right. Probably why we have many from surrounding counties come see us. I hear “shady dentist“ stories and see questionable past work on a daily basis. Usually from the ones that went to an in-network dentist of “terrible“ plans. They tend to have a way to make up for it one way or another at least in my experience. Is this always the case though...of course not. Word of mouth is the best way to find a new provider...sounds like you tried this route.
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tenkuky
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Re: Dental practice billing

Post by tenkuky »

Carguy85 wrote: Fri Sep 25, 2020 4:00 pm A new pt exam/prophy usually takes us an hour. Xrays taken (if none current from elsewhere). If extensive work or deep cleaning needed due to periodontal problems then of course a “cleaning” wont be done that day.. We take intra-oral camera pictures with before/after cosmetic cases, crown/bridge delivery, or if there is decay or something else not evident in the xrays or if there is soft tissue pathology...not on every patient. Is it wrong to cake camera pics on every patient though...of course not. And no, we don’t charge for them. Btw, there is an extremely wide range of what is deemed aesthetically acceptable and important patient to patient..I let patients tell me if something bothers them aesthetically. Just my personality but I hate “selling”..especially hard selling. I feel it’s my job to tell them what’s going on and what to do to fix it. When they are ready they will let us know. As I always say, it’s not hard to treat people right. Probably why we have many from surrounding counties come see us. I hear “shady dentist“ stories and see questionable past work on a daily basis. Usually from the ones that went to an in-network dentist of “terrible“ plans. They tend to have a way to make up for it one way or another at least in my experience. Is this always the case though...of course not. Word of mouth is the best way to find a new provider...sounds like you tried this route.
Thank you so much for your perspective.
They did charge for the photos. Word of mouth referral, and I did gently update my referrer who was horrified and was unaware of the practice specifics.
I will be returning to get my records including Xrays next week and go back to my original dentist for cleaning and prophy.
Forget the "review of findings" visit that my insurance confirmed is not covered separately.
Overall, this has been a $300 lesson (for both family members charged by this practice), but likely dodged an even bigger bullet down the road.
Fascinatingly, my teen has already had orthodontics by incredible clinicians in the past and was discharged with no further issues. This one (who is a general dentist) wants to do "impressions" as she feels that things are not good in that dept and may need Invisalign. Take that in for a second. :annoyed
Carguy85
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Re: Dental practice billing

Post by Carguy85 »

Whenever something doesn’t sound right or make sense ALWAYS get a second opinion. Good on you!
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