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Sleazy new trend in the U.S.? - Dental Discount Plans

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Mirage

Junior member
Joined
Feb 27, 2018
Messages
19
I made an appointment with a dentist to begin my maintenance program, and this was the first to get my teeth cleaned and xrayed. Most dental discount plans cover (there is no such thing as insurance anymore) 2 cleanings and xrays per year. And I made it clear that this is what I wanted to have done, the first of one of these two appointments. Am I making sense to anybody reading this?


The person who makes the appointments said, "oh ok, so you haven't been in yet to have that done, so we will set you up and get that done with a 'new patient workup'." The day came and I went in. Someone came in and said she was going to take the xrays and then someone would be in to probe the gums, go over the xrays with me, and see what has to be done next. And I said, "and then they will clean my teeth, right?" Well no, I was wrong. I was there to see what kind of a cleaning would need to be done at another appointment. And my blood pressure shot past 160.. I said that's what I thought I was there for! The dentist was equally astounded that I was astounded, and said "wow, a lot of people seem so surprised!" Well yes, I guess they are!! Hello.


The dentist came in and looked at the bridge and asked how I was I was doing with it and I said not very well at all, and feel like everything I eat falls in behind and in front of the teeth -- is there something I could put in to fill the void in the bridge teeth to prevent that. She said no. And I said it's just that the whole appliance is just very uncomfortable but better than nothing. And then she said well I did have the choice to get the implants and that is what I chose. Well NO I did not have the choice! With no real insurance anymore, living off social security and a meager savings, no I didn't have a choice. That is what I could afford, and barely. I really hate the intimidation they throw at you. Average senior people cannot afford a mouth of nice implants which cost the equivalent of a mortgage. Which brings to mind another issue I'll address in another post.


What they USED to do when you got your teeth cleaned is this: first they took xrays, they cleaned your teeth (removed plaque) and polished them. Then the dentist looked at the xrays and then looked at your teeth. Part of the looking at your teeth process INCLUDED the poking around the gums with a pick to see what kind of periodontal work you may need. ALL of this USED to be included in each of the 2 cleanings your dental discount plan covered.


Is this the new thing now? You go in. They do xrays. They probe your teeth. They look at your teeth, but instead of cleaning them they decide what kind of cleaning you need -- for another appointment. In my case I need the full monte scaling and antibiotics, which is going to be another agonizing day of terror for me, all the shots. The first week in June. I am already panicking. I am terrified. My husband isn't helping and calls them all ripoff artists. And the dentist office got two appointments instead of one! I cannot even go to the dentist chair anymore without taking my best friend into the room with me for support, that's how afraid I am. Dentists should love me (feeling is not mutual). I am walking $$$$ for them because no matter what I do, the periodontal side is winning.


I said I need some kind of sedation for the next one, so they wrote me a prescription for two crummy pills that didn't touch me last time and won't this time either. My fear is way greater. When I checked out I had to pay $10 for that visit, because it apparently isn't _really_ covered by the dental discount plan, or they figured a way to get around that too. Here is the kicker. Since I'll be "sedated" (what a joke), I had to pay for the whole next appointment in full, all $650 of it. Now it just seems to me, first of all, that the twice-a-year cleaning has just become obsolete because they found a way to tell you why it just doesn't work, and that you need a separate appointment to tell you what kind of a cleaning you need. I feel that this is not right. At least my blood pressure went back down to 119/20 when I left.


Last time I had a deep periodontal cleaning done, it was done under one code beginning with D4. They also put in an antibiotic, which was less than $100 if I remember. My dental discount plan covered all that for less than $300 at the beginning of last year. It seems that between then and now they have come up with a whole lot of new periodontal codes beginning with D4 that aren't covered by any dental discount plan, and are designed to get your money. These include applying the antibiotic beneath the gum (don't forget, that antibiotic has to be ordered by them (probably a code for that), and you have to worry about whether your pharma plan covers it), and there is a code for each tooth, as well as a code in case two or more of the teeth are adjacent, also if the antibiotic is inserted between, or in the front or back of the tooth. I swear, I just can't believe this and wish someone would just stop the nonsensel


It is absolutely crazy! In fact I would call it downright sleazy, and I am wondering who on earth is allowing the dental community to get by with sliding around what is covered. We already see how they got around tooth extractions. Has anyone actually had a $75 extraction done? I've had a few extractions done with teeth loose enough to almost fall out, but oddly enough, they all had to be done by "specialists", which jacked up the price to $300+. I also would like to know if periodontal work will ever be covered by any kind of REAL insurance, or if there will ever be real insurance without unrealistic annual caps which makes it all a lie anyway, and how much worse this is going to get before it gets better, if ever. It seems to me too that implants would cost a lot less than bridges because implants seem to be a lot easier to make and place. Am I right or wrong about that?
 
C

comfortdentist

Well-known member
Verified dentist
Joined
Jul 19, 2009
Messages
2,879
Location
Miami, Fl
I will partially address this all.
Insurance has become very difficult in most areas. I had my very first homeowner's claim about a year ago. The insurance din't want to pay what was obviously completely ruined and no doubt what the thing cost. Like it had a name on it and model plate. Still they only allowed 1/5 the cost with replacement value insurance. Long drawn out fight with me submitting actual invoices from 18 years ago. Bottom line NO insurance company will provide homeowner's insurance because of the one claim. Now the same problems happen with dental insurance. In order to sell the insurance cheaply the insurance doesn't cover many many procedures AND they pay a much smaller than average market rate to the "preferred" providers. "Preferred" providers are dentists who have agreed to accept a much lower pay because they don't have enough business elsewhere. Since they get paid less than their overhead they must come up with other ways to get paid for their services. Some of these certainly are normal and correct and some seem to be there just to generate income.
As to your own needs I can't say what they are but it is both normal and appropriate to expect the following:
Examination of your mouth including soft tissue and full mouth periodontal probing. The dentist must have appropriate x-rays of your mouth to perform a proper examination. This can't be avoided.
It is the dentist who must determine what type of cleaning you need. It is their legal responsibility. You the patient can't diagnose. Now this is where the unethical dentist can over diagnose disease. So if you don't trust the doctor get another opinion. In reality you needs for root planning increase greatly as you age and this cost much more and requires 4/year follow up cleanings to help keep the disease under control. As to locally administered antibiotics the people on the discount plan get them the most. I think they are overused.
I can say that this wasn't much of a problem thirty years ago. And there are still some very ethical dentists just a lot less I'm afraid.
 
brit

brit

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It's not new: there are warnings about 'Dental Discount Plans' in USA on this information page. https://www.dentalfearcentral.org/fears/cost-of-dental-treatment/

What Comfortdentist says in USA about covering overhead has to be right....you tend to get what you pay for and I have found going to UK private dentists who charge quite a lot just for basic maintenance of regular check ups and cleanings, is the best way to protect yourself from unnecessary treatment. You are a 'loyal patient' who doesn't shop around and they can make a living, as their profit margin is decent even on just maintenance visits. I just 'pay as I go' and do not use any insurance plans.
The old idea in the UK NHS was for a check up to be virtually free for most people especially children and it was an opportunity you gave a dentist to trawl around looking for work they might like to do on your teeth!

If you are always looking to pay the lowest cost, you could be risking over-treatment or with appropriate treatment: corners being cut that you would rather were not, if you had the knowledge to know any different. This can relate to the materials and equipment used, the time taken to do a better job or in USA especially the amount of time you actually get from the dentist as opposed to lots of steps being delegated to support staff/assistants.
 
C

comfortdentist

Well-known member
Verified dentist
Joined
Jul 19, 2009
Messages
2,879
Location
Miami, Fl
It's not new: there are warnings about 'Dental Discount Plans' in USA on this information page. https://www.dentalfearcentral.org/fears/cost-of-dental-treatment/

What Comfortdentist says in USA about covering overhead has to be right....you tend to get what you pay for and I have found going to UK private dentists who charge quite a lot just for basic maintenance of regular check ups and cleanings, is the best way to protect yourself from unnecessary treatment. You are a 'loyal patient' who doesn't shop around and they can make a living, as their profit margin is decent even on just maintenance visits. I just 'pay as I go' and do not use any insurance plans.
The old idea in the UK NHS was for a check up to be virtually free for most people especially children and it was an opportunity you gave a dentist to trawl around looking for work they might like to do on your teeth!

If you are always looking to pay the lowest cost, you could be risking over-treatment or with appropriate treatment: corners being cut that you would rather were not, if you had the knowledge to know any different. This can relate to the materials and equipment used, the time taken to do a better job or in USA especially the amount of time you actually get from the dentist as opposed to lots of steps being delegated to support staff/assistants.
Yes Brit you are correct. I have patients that I have had for thirty years and new ones too. I am honored that they trust me and I don't violate the trust. I charge what I need to to provide the treatment that is best for the particulares of a given patient.
One day last week 5 patients drove 20-100 miles away to see me.
 
letsconnect

letsconnect

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Interesting letter on the ADA website:

Letters: Overtreatment


April 17, 2017


I have been a general dentist in private practice since 1976 and have experienced the changes in dentistry in marketing to patients. Even though my practice has a nice website, almost all of our new patients are referred by existing patients. Recently, I had a patient that received a discount cleaning, exam and X-rays from a dental clinic advertised in our local newspaper. He wanted me to check the proposed treatment plan. He has been a patient in our practice for 14 years, and usually visited us twice a year for routine prophylaxis, exam and any necessary X-rays but had not scheduled his recall hygiene visit six months ago. He stated that the discount special sounded like a good deal. However, he wanted me to evaluate a proposed treatment plan and stated that he trusted me. The proposed treatment plan and estimate from the other dental clinic listed two crowns, one crown buildup and two composite restorations. Before I did his exam, I informed him that my usual fee for the ADA code for a similar crown was significantly less expensive. After the exam, I informed him that he does not need any crowns or buildups. One of the teeth to be crowned only required a two-surface composite restoration and the other tooth needed no restoration or crown. Two other teeth had proposed composite restorations. The first restoration was on a lower canine to add to a worn incisal edge due to attrition. This was unnecessary and, if restored, would likely be worn off in a short time. The other restoration was for a worn area of cervical abrasion on a lower bicuspid. I informed him that this restoration was coded as a three-surface restoration but was actually only a one surface restoration. My estimate for two restorations was thousands of dollars less expensive. I have a lot of feelings right now regarding this experience with this patient. Obviously, the patient does not trust the dentist advertising a cleaning, exam and X-rays at a deep discount.


I do not know what the answers are to resolve this issue. I believe some people are paying way too much for needed treatment and worse, some people are receiving unneeded treatment. I have seen other patients in my office for second opinions from highly advertised dental clinics. One patient, who recently received dental insurance from a new job, was told she had 11 cavities. I informed her that she had no cavities. I believe this stems from a lack of busyness in many dental practices. There are fewer adult patients covered by dental insurance than 10 years ago. Management employees of many corporations usually do not receive any dental insurance when they retire at age 65. It was not that policy in the past, but it seems that the corporations care more about the next quarterly profit than the people who helped make them these profits. Lastly, there are increasing numbers of dental students graduating with significant debt from school loans. This causes enormous pressure for some dentists to overtreat some patients and not refer patients to specialists. I see patients from corporate dental offices with overprescribed dental treatment plans and for unnecessary treatment. There seems to be pressure upon these dentists to meet corporate production goals. Again, it is all about meeting the expected earnings for the next quarter. I know some general dentists that never refer anything outside their practice unless it is hopeless, mistreated or the patient has exhausted his or her insurance benefits or has no money. I have seen too many patients with poor results from general dentists who attempted molar root canal therapy, orthodontics, periodontal therapy and implant placement without adequate training. We need general dentists and specialists to work together. We need to have the patient's interests first.


James Lynn Davis, D.M.D.
Peoria, Illinois

(source: https://www.ada.org/en/publications...o-the-editor/2017/april/letters-overtreatment )
 
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comfortdentist

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Jul 19, 2009
Messages
2,879
Location
Miami, Fl
All true

I know the USA dental market and your only safe space is the small office that doesn't accept the cheap dental plans.
In general you should expect a full explanation of any dental treatment needed with a level of comfortable openness in the discussion. There should be no immediate need pressure. Most all dental problems took some time to develop.
 
M

Mirage

Junior member
Joined
Feb 27, 2018
Messages
19
Thank you everyone. I am trying so hard to establish repertoire with a dentist I can trust, and don't want to have to keep shelling out $125 to keep getting second opinions. I hope I found one who I can keep going to. I don't know what is normal procedure anymore. How do I know who is trustworthy, especially when they get good reviews? My nerves are absolutely shattered. There are well known dental mills around here, and plenty of warnings and reviews to stay away from them. People go to those who don't need a lot of work done. I know dentists all want their money (everyone is getting cheated today), but I want fair and honest work done on my teeth because I am paying for the best coverage that is available in this geographical area. I go to who is in my network and who has gotten the best reviews. I look at reviews, not TV commercials and flyers.


But when the dentist took a look and mentioned how surprised she was that "everyone seems surprised that they don't get their teeth cleaned" when they made that appointment they thought that's what they were getting done, something did not sound right with that. Like I said, I thought that the "twice a year routine cleanings" that the dental discount plans normally cover included xrays, probing, cleaning, and lastly, the dentist looks at it all afterward and lets you know what shape your teeth are in and what needs to be done next. Better communication is needed there.


I can't just cough up the thousands of dollars that it costs now to have major dental work done. I also need to put a roof over my head. I have had problems with my teeth all my life and have purchased the best insurance possible all throughout my working career, and now, with no gaps in coverage. Then all of a sudden, after I retired, true dental insurance just disappeared. I shopped around and still purchased the best dental discount plan I could find in this area. Most expensive does not equate to best. In the state of Florida there simply is NOTHING better available. I have the best. I have looked, it is not there. Nothing covers the D4 codes. Do you hear what I am saying? Real dental insurance does not exist in the state of Florida because I have looked, and I have had my broker/agent look. It is NOT HERE. I have seen the jokes about people's teeth in the UK. Americans aren't laughing, believe me.


Major work like implants, periodontal work, and bridges for many of us, is not within our budgets, so we do what we can do within our budgets, and I feel like we are getting a little bit fleeced. I think I found one I can trust, but I am asking you these questions to assure myself that what is happening to me is ethical, and that I am not being fleeced.


The reason why I left the last small practice dentist was because I got the most painful shot of my life into the roof of my mouth. That dentist identified a problem tooth (which I knew about). He advised me of that during a routine cleaning visit, one like I described above. He pushed an implant and shrugged his shoulders, smiled and more or less said too bad for you when I mentioned that money was an issue for me. Nice. And this is where it gets nasty and where I started not trusting dentists. I took his dental plan to another dentist, my current dentist. During the exam, she identified another tooth that was crowned (one tooth away from the other one) and said that had a slight crack in it and should be addressed soon because it wasn't going to last long. I'm thinking great, now what. I definitely cannot afford 2 implants and that's when my only option what this horrid permanent bridge. I may have been able to afford an implant for the first one which of course would have involved a bone graft. I honestly believe that first dentist knew all along about the crack on the other tooth, and figured once he got 5 grand out of me for the first implant, THEN he would have mentioned the crack in the other tooth!! And then he would have put me in an extremely difficult financial situation. And this is what I mean by really sleazy.


I think the dentists either need to operate within the bounds of peoples' dental discount plans like they used to do, or the dental discount plans need to get their plans up to date because the way I see it, they are now useless and outdated if the processes they claim they cover are obsolete. Like my current dentist said, there are suddenly a lot of surprised people. I can't keep paying $125 for second opinions and consultations! I am very much hoping this is the dentist I can trust.


As for the antibiotics, yes I do need them. I have taken incredibly good care of my teeth and mouth, every thing I as a non-dental person can do. Because I am terrified of dentists and anyone who touches your teeth and want to spend as little time in that torture chair as possible. I have done all I can do and have followed every direction I have been given. I have had every single checkup I have been advised to get. I am 68 years old and have genetically lousy teeth and receding gums. I have had gum grafts and bone grafts. I get angry when I'm told I need to floss better. Good grief, you can't floss any better than I floss. Plaque loves my teeth. I don't know how to use a dental pick and pick it off my own teeth. I have a water pik. I use mouthwash. I use the best toothpaste. I don't eat sweets, or smoke, or drink. There is only so much I can do. I pay for the best dental discount plan there is, and it is not adequate. I totally agree about the overuse of "antimicrobial agents" (I think that means antibiotic); she says I need this treatment in 4 teeth (and the last dentist did in two). Is there something else I can ask the dentist to do instead? I feel completely hopeless at this point. They already did bone grafts in the left half of my mouth. If this is the norm, then these poor discount plans need to keep up or stop advertising about how great they are.
 
M

Mirage

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Feb 27, 2018
Messages
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>Most all dental problems took some time to develop.


That's true, but sometimes even when you do every single thing you possibly can to take care of your teeth, you still lose. Too many times dentists put the blame on us for our problems and I don't think that is fair. I have done everything, and still have problems. I cannot afford the same level of care a Hollywood celebrity can. I do what I can.

I expected to get a routine cleaning/xrays/evaluation and didn't realize that that process has now been split into two different sessions. Apparently neither do others.
 
L

LittleLynnie

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Nov 22, 2016
Messages
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Location
Canada
Because I'd had a bad experience of a dentist finding unnecessary work in my kids (!!!) mouths, I decided that the only way to find an honest dentist was to ask neighbours, family and friends. And since they would really have no idea if they were being told the truth, and only getting work that was necessary, I specifically looked for people who said that they often went in for check-ups, and found that nothing needed to be done at all. They certainly had some checkups show a need for a filling or two, but they also had checkups when their dentist said that all looked good and to come again 6 or 9 months later.
 
M

Mirage

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Feb 27, 2018
Messages
19
I have read everything on this site about "Dental Discount Plans" in the USA and even in the UK. I've also read about them elsewhere. I have done my research.
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There seems to be a feeling that I and others are perhaps shopping for the cheapest plan we can find, expecting the moon and stars, and are then crying a river that we get inferior care. I would like to put this myth to rest. Because that is NOT the way it is. Not in my case anyway.
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1. Yes If I see two plans for the same amount of money, and one offers better prices, it is economically wise to pick the better plan. Who wouldn't do that? I was lucky enough that my dentist told me honestly that my plan was a better plan than the one they offered even though their plan cost a little bit more. I want to get what is best for my teeth because I have been through a lot.


2. Every geographical area is different. We don't have "cheap" plans and "expensive" plans. They are all comparable in what they charge for dental work. What determines the difference in price is whether or not they have a waiting period, annual cap, and how much that annual cap is. Like if it has a low annual cap, as in they aren't going to cover much, it is a "cheap" plan. Do you see what I mean? And I don't have a "cheap" plan and I am not trying to get something for nothing. I have the best plan that is available here. It is also being sold to people as something fabulous that has finally come along, which is a lie.


3. We in this geographical area don't even have a choice of an "expensive" plan that has adequate coverage. Such a plan DOES NOT EXIST, so to tell us we get what we pay for is not really a fair statement. It is not like we have anything to choose from, and that is sad.


4. Our cheap, crappy dental discount plans, which is the only help we average people have to be able to afford MAJOR dental work limits us to networks. I too "network" by talking to people to see who they like, particularly the dentists who actually have empathy and understand how to work with people they (dentists) have scared to death, but I am also restricted to a physical network of dentists who participate with the dental discount plan carrier. And some of these plans actually choose your dentist for you. It is what it is -- really pathetic for an advanced country, but you take what you get and what is available.


5. I am wondering if this site caters to rich people. Does it? If so, I'm in the wrong place. But the average Joe/Jane is very afraid of dentists too. It is a fact that WE NEED SOME KIND OF INSURANCE TO HELP US PAY FOR MAJOR DENTAL WORK in the United States, ESPECIALLY PERIODONTAL WORK.
 
letsconnect

letsconnect

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Hi Mirage,

As you say, "It is what it is", and it's not really within the scope of a charitable website such as this one to bring about sweeping political and social change.

However, it is concerning that you feel that this website says that people who are looking for affordable dental care are cheapskates.

If you could point us to the relevant sections and sentences on the websites which you find objectionable, that would be really appreciated. That way, we could make changes to the wording to ensure that others don't feel offended.

Many thanks for your help!
 
brit

brit

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I don't think insurance works well for dentistry anywhere in the world. If you want/need a check up every 6 months and a hygienist clean every 6 months...that is a known recurring cost....no insurer can easily make a profit on that as insurance is supposed to work by everyone paying in 'just in case' but only a few 'unlucky ones' having to claim.

I think saving/budgeting and 'pay as you go' can maybe work best for most people. You know what your regular recurring costs are so you put that amount aside every month; and any treatment you occasionally need - (it rarely needs all to be done at once) - you save up for or take a loan out for. This way you also have full control over the dentist you use and have full control over what speed you get dental work done.

Obviously people with a long history of avoidance needing a fair amount of dental work are in a difficult position and no insurance is going to cover the work needed....once you are dentally fit, they may be willing to sign you up to some kind of plan (eg Denplan in UK)....but again 'pay as you go' could be cheaper and give you more control.

This website is to help all dental phobics and in the UK we have the opposite problem in that the NHS is supposed to offer full dental care to all residents of the UK but many people do not realise that what is covered on the NHS for dental is not necessarily the best available and is quite basic. When people realise this or for other reasons, they may choose to prioritise private dental in their budget. I still use NHS for medical though and it is mainly 'free at point of use' as it is funded out of general taxation in UK.
 
M

Mirage

Junior member
Joined
Feb 27, 2018
Messages
19
>If you could point us to the relevant sections and sentences on the websites which you find objectionable, that would be really appreciated. That way, we could make changes to the wording to ensure that others don't feel offended.


Would you please provide a link where I could write directly to you and be assured of complete confidentiality? I would appreciate that.
 
M

Mirage

Junior member
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Feb 27, 2018
Messages
19
>https://www.dentalfearcentral.org/contact/

I have tried to contact you through this link, using your form for several days now, and it will not send. It just continues to try to send, and then the Captcha box expires, and I have to go through all the checking of the boxes again. So I am unable to use this method to communicate. If possible, a direct email would be the way to accomplish this. Thanks.
 
letsconnect

letsconnect

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Yes you could pm or send an email to [email protected]

I'm surprised the form doesn't work for you - other people's forms are coming through?
 
M

Mirage

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Joined
Feb 27, 2018
Messages
19
>I'm surprised the form doesn't work for you - other people's forms are coming through?

Mine didn't. It is rather long. I tried through Safari and Firefox, and the screen just sits there, and the little arrows just spin and spin. Then the captcha link expires and I have to sit there and continue to click on those until it's satisfied that I have clicked all the right ones. That too is difficult because sometimes a "car" looks like a tiny dot halfway into another square, or it's not possible to tell if it's even a car, sigh.. Thank you for the link. I will get back on this soon. I'm surprised it didn't work as well.
 
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