debridement/irrigation?

[cynic]

I had the same dentist for twelve years. He's seen me through fillings, braces, jaw surgery and pulled my wisdom teeth. He only took the more expensive insurance, but I had a bad experience with a cheaper dentist and willingly paid the higher price. During that time I always had regular cleanings that were fully covered by my insurance. These cleanings seemed thorough to me. The hygenist would even ask if it was okay to go as deep under the gums as she could, because it might hurt a bit. I paid out of pocket for extra visits when I had braces because my gums got swollen, but even those were still considered regular cleanings.

Unfortunately, my dentist retired. I procrastinated about finding a new one for about a year. I finally signed up with an HMO dentist. At my first appointment, I was told that my gums were in bad shape and that I needed a deep cleaning that wasn't covered by my insurance. I tried to question them about it and it seemed like they just got irritated with me. It was coded a debridement and cost about $200. It actually seemed faster and less thorough than the cleanings I was used to. I also felt like he was being kinda impatient and rough with me. I was put off and didn't make another appointment for a year.

I went to a new HMO dentist last week. The first thing she asked me upon walking in was if I had ever had a deep cleaning. When I said yes, she told me that I would probably need another one because of my gum condition and she recommended that I come in 4 times a year for cleanings. This was before doing a exam or looking at my x-rays. During my exam, she told me that my gums actually looked pretty healthy with my measurements mostly in the 2's with a few 3's. At first, she said I could probably just do a regular cleaning, but then she said since I apparently had a gum problem in the past, she'd like to give me some type of rinse as a precaution. I asked for an estimate which came to $240 for the debridement and irrigation and is not covered by my insurance. It is not optional. I can't get a regular cleaning or even just the debridement, because the rinse was recommended.

This just doesn't seem right to me. I'm being told that a regular cleaning is just a basic polishing of the teeth. Has something changed? What was my old dentist doing? I probably would have just gone ahead and done it, but I had a few cavities as well, so I couldn't afford to get everything done that day. I had my cavities filled figuring that was more important. I'd go to another dentist, but I can't pay for a new exam and more work. I probably won't be able to afford the debridement/irrigation for a few months and by then I'll be in my new plan year anyway. I don't want to forgo a cleaning in the meantime. Is it possible to go somewhere else and ask for a cleaning without an exam? Am I risking my teeth if I wait? Am I wrong in thinking it's possibly not even necessary? I hate feeling like I have so little control that I can't even tell if I'm getting good work or being dealt with honestly.

 

[letsconnect]

Hi cynic (I don't blame you for being cynical ),

the way HMO plans work is that contracted dentists are paid a fixed amount (usually on a monthly basis) per enrolled family or individual. This amount is quite pitiful. The dentists in turn provide some types of treatment to the patient at no charge, while for other treatments, a co-payment is required. As it is difficult to make a good living and pay back those loans for dental school, some dentists may resort to encouraging treatments which require co-payment even though they are not indicated. This is not to say that HMO dentists are bad, but that for some dentists, the system can sometimes encourage unethical behaviors.

Now, it may be that your HMO dentist is perfectly correct in her treatment suggestions (who's to say over the internet?), but you've also got to trust your gut feeling on this one. In the long run, it may not be that much more expensive to see a dentist that has been recommended as good and honest by other people instead, even if it means paying out of pocket. If a dentist who has been recommended to you concurs with the HMO dentist's opinion, you could always go back there.

I hope this helps

 

[cynic]

Thank you for your reply, letsconnect.

Your explanation makes sense. My gut is telling me the behaviour you described is what is happening here. I suspected my change to HMO insurance was contributing to my disatisfaction, but I didn't know why it would. I do feel for the dentists that believe they aren't getting paid enough, but there has to be a better way of dealing with it. Now I can't get a cleaning at all. I lose out. The dentist also loses out. Instead of a cheap billing, she gets no billing. She also loses me as a patient since I don't trust her.

You know, I wouldn't have been nearly as suspicious if she hadn't told me I would need the debridement and more frequent cleanings PRIOR to doing my exam or looking at my x-rays. The kicker is that I was thinking that next year I'd like to start getting extra cleanings again like I did when I had my braces. I had some unusual expenses this month, but she would have made more money off me long-term.

I'm going to go back to the better insurance when my job opens enrollment. In the meantime, I'm going to try to see someone else as soon as I get the money. The debridement and irrigation aren't covered anyway so if I really do need that done I guess it doesn't matter if I go out of network. I just wish I didn't have to pay for another exam and lose out on a covered cleaning.

 

[brit]

You know, I wouldn't have been nearly as suspicious if she hadn't told me I would need the debridement and more frequent cleanings PRIOR to doing my exam or looking at my x-rays.

Yes that bit was blatant wasn't it? Sure you're making a wise decision .