The cost of dental care is rising along with everything else. Lately, several patients and even some dentists sent or posted concerns to the author regarding dentists who appear to be charging more than reasonable, charging for services that are more expensive that what the patient feels necessary, and even planning treatments that subsequent dentists feel are not necessary. Another side of the coin is that dentists and patients are upset that insurance companies do not cover some procedures or pay less than is reasonable. These are valid concerns.
Most people understand that dentists charge fees that reflect their estimation of the value and cost of the services they provide. Dentists are doctors who provide an important service to their communities. Dental offices are small businesses that employ tens of thousands of people in Massachusetts. Dentists must charge fees that allow them to pay their staff and expenses, and support themselves.
Another factor driving up dental fees is that the cost of dental education is very high in the United States. In the 1980’s, new dentists were in debt less than 100,000.00 on average. Today the figure is nearly three times that. It is not surprising that the cost of dental procedures rose by a similar factor in that time. Of course, dentists who finished school in the 1980’s do not have this debt, but we do employ young dentists. These new dentists need to earn tens of thousands of dollars each year after taxes only to service their education loans.
Patients have the right to choose their dentist based on their own criteria. Patients may choose the least expensive dentist, the dentist that is closest to their home, accepts their insurance, or the nice doctor that they have known since childhood. This is a hard choice for everyone.
Dentists have different opinions on treatments. For example, thirty years ago, most dentists would never use tooth colored composite to treat a cavity on a back tooth. Now, many do. Fillings are great for small cavities; crowns are great for cavities that destroy large portions of the tooth. Patients need to rely on their dentist to determine the best treatment for a medium size cavity. It is important for patients to speak with their dentist about treatment options. When a dentist recommends an ideal treatment, they should discuss reasonable options including the option to do nothing. Patients should know what to expect if they choose the no treatment option.
Second opinions are very useful. Recently, one patient found that their dentist felt that they needed treatment for gum disease. The treatment was very expensive. Later, another dentist may have told the patient that treatment was not necessary. It is not possible for a dentist to look at gums months after treatment and know that a completed treatment was or was not necessary. It may be that the patient misunderstood the second dentist or that the dentist misspoke. Second opinions are very useful before treatment; after treatment, an opinion is second guessing.
Dentists and patients often complain that insurance companies may limit coverage for treatments in a seemingly random way. For example, one plan will cover half of the cost of replacing a single tooth with a dental implant, but not two teeth. The dentist and the patient may feel that this rule is arbitrary. Insurance companies would like for patients and dentists to understand that this coverage is chosen by the employer from a menu of available benefits. Employers may choose plans with or without coverage for a variety of procedures such as dentures, tooth colored fillings, and dental implants. Patients must choose plans that their employers offer. Dentists may choose to accept particular plans or not.
Dental offices can help patients avoid high fees and understand what their out of pocket expense will be. Insist that your dentist provide a written or printed list of the procedures they recommend. Always ask for alternate procedures. Most dentists offer the best treatment first to every patient regardless of cost, income or level of dental education. Patients should be aware of alternate treatments and what they can expect if they prefer no treatment. Ask what the advantages and disadvantages are of each treatment. For example, what would a tooth colored filling cost versus a silver filling, gold filling or a crown.
It is not the dentist’s responsibility to figure out exact co-payments for every treatment. However, many dental offices offer that service with varying levels of accuracy. While it is useful to submit a treatment estimate to the insurance company, the printed insurance company estimate includes caveats such as pointing out that the benefit package may change or that the estimate does not account for how much the patient will have to pay after charges exceed the annual maximum coverage.
Some offices may prefer to estimate coverage, take a payment at the time of service and settle the difference when the insurance explanation of benefits arrives. Some offices expect payment in full from the patient. Then the insurance check will go directly to the patient in a few weeks. Even offices that are able to figure the exact co-payment are not able to guarantee insurance coverage. There is no way for the dental office to know if other dental offices are awaiting payments or if the insurance company and employer change the employee’s benefits.
Communication is a very important component of successful oral health care. If you feel that you do not understand the need for a treatment, the costs or options, discuss your future treatments and expenses with your dentist and dental office staff. Remember that second opinions are very useful before treatment and less useful after.