Paying for a longer treatment

[Dr. Daniel]

Hi everyone,

Treating a fearful patient should be done patiently, without any time pressure, to allow: slow injection, slow teeth cleaning, slow extraction, intermitant pauses, and more....

Most dental insurances do not recognise (meaning, they don't have a treatment code for) such extra time. A possible solution would be that the patient pays directly to the practice (with a receipt of course) for the extra time.

Would you consider paying $ 50 extra (out of your own pocket) for 10 minutes longer treatment?

 

[MountainMama]

That is a tough question. In theory it sounds great and I would be happy to pay a little more to help ease anxiety, especially not feeling rushed in and out.
In reality, in my experience, I would be afraid that those extra 10 minutes would be eaten up in waiting time, either waiting in the chair for the dentist or waiting to get to the chair. At my last dentist, it wasn’t uncommon for him to be 30 minutes or more behind schedule. At previous dentists, I would wait an hour or more sometimes just to get to the dentists chair, then wait for the dentist longer.
I would be hesitant to pay more, not knowing that it would actually get utilized or not.

 

[letsconnect]

Or do what my dentist does - charge everyone top dollar and schedule an extra 10 minutes for your fearful patients for free ?

I suppose that wouldn't work in Holland though if the insurance pays a set amount per treatment code?

 

[Dr. Daniel]

I would be hesitant to pay more, not knowing that it would actually get utilized or not.

Good point. It mainly has to do with the fact that longer treatment time or comfortable treatment are a bit vage and obscure.
it would help if this extra payment would be given after the treatment, whenthe patient feels he got special service. It might look a bit like tipping a waitress for good service… a bit weird.

 

[Dr. Daniel]

I suppose that wouldn't work in Holland though if the insurance pays a set amount per treatment code?

In the Netherlands there is a treatment code for 5 minutes extra for treating a fearful patient, it is called U5 and is worth 15 euros and a dentist can use it several times. The problem is that a dentist needs to ask for it beforehand, and it takes lots of bureaucracy and usually not approved for general practitioners.
In the past I used to explain beforehand that I will use that code and the insurance might not accept it but eventually I stopped using that code.

 

[MountainMama]

Or do what my dentist does - charge everyone top dollar and schedule an extra 10 minutes for your fearful patients for free ?

I suppose that wouldn't work in Holland though if the insurance pays a set amount per treatment code?

This is basically what my current dentist does. He is not in my dental insurance network, so I pay more anyway, but he is awesome, so well worth it. I have to wait longer sometimes, but he doesn’t make me feel rushed.

 

[Dr. Daniel]

Or do what my dentist does - charge everyone top dollar and schedule an extra 10 minutes for your fearful patients for free ?

That might not work in all dental practices if they are bound to a specific tariff, for example in The Netherlands or the NHS in the UK. For these practices, it is worth to think outside the box and that is the purpose of this thread.

 

[letsconnect]

I suppose the first thing to check is whether the NZa (Nederlands Zorgautoriteit) regards a charge for extra time spent as "charging an additional fee unduly"? You wouldn't want to run foul of their regulations ?

Of the things you listed in the first post, "slow teeth cleaning" should be easy - it looks as if you can charge in 5-minute intervals, so if it takes 45 minutes instead of 30 minutes because someone is anxious, then you just bill for 45 minutes - unless something got lost in (Google) translation...

 

[Dr. Daniel]

I suppose the first thing to check is whether the NZa (Nederlands Zorgautoriteit) regards a charge for extra time spent as "charging an additional fee unduly"? You wouldn't want to run foul of their regulations ?

That’s the challenge of charging extra time, it does. The outcomes of all dental procedures is clear, but the outcome of dealing with fear is subjective and unclear.
regarding teeth cleaning in the Netherlands: you have a valid point there, but up until two years ago the cleaning was not measured by time but by the extent of the cleaning (all teeth, some segments, individual teeth).

 

[letsconnect]

That’s the challenge of charging extra time, it does.

If that's the case, then an extra charge (even a "voluntary contribution") is probably out of the question, unless you fancy a run-in with the NZa . Of course, I have no idea what the repercussions would be. Is there an equivalent to the Dental Defence Union (dental indemnity insurance) in the Netherlands that provides dento-legal guidance and advice? Maybe one could check with them and see what they advise. I know that in the UK, tipping dentists for good service is a no-no...

Perhaps you could try joining forces with other dentists who have a special interest in helping fearful patients, and write to the NZa outlining the problem (and propose a way of dealing with it)?

 

[Enarete]

This is a really tough question. I would definitely be willing to pay extra, but I struggle with time being what I pay for. Another struggle would be the quantification for that. In my mind I would be happy to pay to have less pressure, take things slowly, not being in rush.. which is all about time at the end, but taken differently. And I struggle with how to quantify that, because as a patient you want to know what you pay and if that‘s in minutes extra, then what if ten is not enough? Those would be my thoughts and probably would stress me out.

My preference would be a „package“, such as an extra treatment for phobics that takes longer (without specification) and then knowing the end price. Not sure how this could work with the insurance though.

 

[Dr. Daniel]

If that's the case, then an extra charge (even a "voluntary contribution") is probably out of the question, unless you fancy a run-in with the NZa . Of course, I have no idea what the repercussions would be. Is there an equivalent to the Dental Defence Union (dental indemnity insurance) in the Netherlands that provides dento-legal guidance and advice? Maybe one could check with them and see what they advise. I know that in the UK, tipping dentists for good service is a no-no...

Perhaps you could try joining forces with other dentists who have a special interest in helping fearful patients, and write to the NZa outlining the problem (and propose a way of dealing with it)?

I did not ask this question for my practice but for online advise.

 

[letsconnect]

I did not ask this question for my practice but for online advise.

I know, abstract thought is not my strong suit ?... Though I suppose what I'm struggling with here is that the concept of paying for longer treatment is inextricably linked to the dental system within a particular country.

For example, in England, there are lots of different possibilities as a private dentist to get paid for extra time (for example, charging for a special longer consultation, charging by time, charging everyone a bit more and spending extra time with fearful patients, etc.). As an NHS dentist, there are no such options at all (except for perhaps creatively dragging the treatment out so you get paid for two bands of treatment, but you'd have to be able to justify that during an inspection). So if you have a special interest in supporting anxious patients but you'd like to work for the NHS, your best option is to train as a special care dentist and work for the community dental service.

 

[letsconnect]

In the Netherlands there is a treatment code for 5 minutes extra for treating a fearful patient, it is called U5 and is worth 15 euros and a dentist can use it several times. The problem is that a dentist needs to ask for it beforehand, and it takes lots of bureaucracy and usually not approved for general practitioners.
In the past I used to explain beforehand that I will use that code and the insurance might not accept it but eventually I stopped using that code.

Maybe if there was a "standardised" way of assessing all new patients for insurance purposes that was recognised by the NZa, e.g. by using a validated dental anxiety scale (such as the dental anxiety scales here)? 10 extra minutes would be a lot better than 5 extra minutes though .

I'm still trying to get my head around the Dutch system - so the charges are fixed for all dental procedures, but what about purely cosmetic ones? Surely there must be differences in what dentists can charge for, say, veneers (unless ALL dentists and labs and lab technicians in the Netherlands work to exactly the same high standard)?

 

[Dr. Daniel]

I'm still trying to get my head around the Dutch system - so the charges are fixed for all dental procedures, but what about purely cosmetic ones? Surely there must be differences in what dentists can charge for, say, veneers (unless ALL dentists and labs and lab technicians in the Netherlands work to exactly the same high standard)?

The NZa list are the maximum prices a dentist can charge for each procedure. This has nothing to do with the insurance. My clinic does not work with any insurance: all our patients pay right after the treatment to us directly and if they can send the invoice to their insurance to have it reimbursed, but that is not our clinic's business, we don't deal with insurances.
Theroreticly speaking, I could use the U5 code (5 minutes with a 'special needs' patient) but I choose not to.

 

[letsconnect]

How about using code Y01 (Information provision, in units of five minutes)? Isn't talking a patient through a procedure a type of information provision? (or do they question that code as well)

P.S. feeling like a doofus now - I never realised that the Netherlands is a dental tourism destination... you learn something new every day

 

[Dr. Daniel]

Honestly, I am not familiar with that code. Thank you for enlightening me.

 

[letsconnect]

I have no idea if it's applicable (would probably need to see the full Dutch version to find out!)