Getting a second opinion/How do I know if dentist is overprescribing or overtreating?

[Susanne]

Any thoughts/suggestions on how to go about seeking a second opinion when a proposed treatment plan seems excessive? And what might indicate to a patient that the dentist was overtreating or overprescribing a particular procedure/therapy?

My regular dentist looked at my teeth today, took bitewing xrays and mapped out a treatment plan that involves 8 crowns, among other things. My insurance will only cover a very tiny fraction of that and the office manager said something about the way my insurance is set up means they won't give the policyholder discount until the new year because crowns are considered a "major" dental procedure (can't remember the exact terminology). The total cost of all this proposed work for me would be around $9,000.

I knew I would be needing a fair amount of dental work, but 8 crowns seems unbelievably excessive. It's not what I was led to believe when discussing things with the dentist after my appointment today. I was given the impression that 3-4 crowns would need to be done, not 8. It wasn't until the office manager gave me the treatment plan printout that I discovered how many they were proposing.

 

[Paige2018]

If you have almost reached your max for the year, dental plans start over on January 1 with new deductive and max. Yes, crowns are considered major dental procedures, and depending on your dental coverage, your insurance would possibly only pay 1 or 2 depending on the Destists fees.
On average, dental plans pay between $1250-$1500 max per year total for minor and major work. This does not include cleanings, as those are usually included at 2/year (6 months apart)

Regarding a second opinion, I would call another local dentist that is also in private practice and request another evaluation and tell them it is for a second opinion. If you can get a copy of your most recent X-rays, take those with you, and it may save you some money not having to have them taken again for the second opinion (they might or might not charge a fee if you pick them up, but should not charge a fee if you ask them to send them directly to the dentist) as well as your treatment plan from the initial dentist. If your current dentist had a problem with you getting a second opinion, then I would change dentists immediately! No dentist should EVER have a problem with you getting a second opinion over such extensive treatment!

 

[LittleLynnie]

The only way I found to get around such doubt, was by finding friends, neighbours, family, etc., who had a dentist who quite often found that they didn't need any work at all. To me, that indicated honesty, which otherwise, is a very hard virtue to determine. I finally found a dentist I trusted, and could therefore accept any treatment that she determined was necessary. Ask around. Find a second opinion that you can trust. And while I don't like to disagree with the poster above, I would not let them know what the previous dentist said was needed to be done. Let the new dentist come up with what's wrong on his or her own, to see where they agree or differ.

 

[Enarete]

Hi Susanne,

I think this has to do with trust. The fact you are asking this question makes it clear that you have doubts in which case seeking a second opinion would be a good thing.

Another things to watch for:

Did the dentist explain to you every single tooth that needs a treatment and told you why?
Did the dentist actually show you why the teeth need treatment, for example on x-rays, pictures made with intraoral camera, using a simple mirror?
Did the dentist explain to you what your options are for every treatment, including pros, cons, consequences and what happens if you decide against the treatment?
Did the dentist discuss with you the reasons for needing so much treatment and how to prevent it in the future?
Did the dentist discuss options to deal with the costs for you, such as starting with the most urgent tooth or using materials that are more affordable?
Did the dentist explain to you what the suggested procedures involve and what to expect?

It sounds like the treatment plan surprised you and the dentist didn't communicate clearly what will be needed. This alone would be a reason for me to seek a second opinion if I was in your shoes. Clear and transparent communication is relevant not only when it comes to treatment plan and costs, but for all interactions between you and the dentist / the practice and from your brief description it sounds like they failed at this.

All the best wishes and keep us posted

 

[Sol]

Have to agree with what others have said. It sounds like they did not completely explain the treatment plan to you, go over alternatives, or ask what you wanted. I'm also wondering if some of the new crowns they are recommending are to replace any existing crowns and, if so, did they give you reason as to why they needed to be replaced?

As far as insurance goes, this will vary a bit since dental plans are not standardized. Many dental plans have a waiting period of 6 months to a year for major services. That waiting period usually applies to things like crowns, periodontics, prosthodontics, tmj, etc. Typically those types of services are covered at 50% after the waiting period ends, until you hit the plan annual maximum (usually $1000-$2000). The other benefit to insurance is that if your dentist is in the plan network you usually get an additional 10-15% off of their normal charges since they accept the lower price offer by your insurance plan. Hopefully they go over with you how to break up your appointments so that you get the maximum use out of your insurance. Most insurance companies also offer a way to get a "pre-treatment" estimate. The office can submit their proposed treatment plan to your insurance to get a clear idea of what your out of pockets will look like.

If you decide to get a second option I would suggest also going to your dental plan website or calling the insurance company to get an overview about how your plan works so there are no big surprises about how the plan works. Hope things work out in your favor. ✌