Do some dentists use loopholes to get more money?

[Stuart141]

I am 42 and never had cavities, my wife needs some work done. On my 1st visit to a new office was told I needed scaling below the gums and an "antimicrobial" in 2 places, Went in for cleaning and in the chair was told the "antimicrobial" wasnt covered (Safeguard discount plan) and was $70 for the two applications and it was optional - said go ahead if it means I dont lose a tooth, so visit cost $120 (normally it costs nothing). I was also told they wanted to do another cleaning in four months (not six), I was tol my gum disease level was a 3 out of 5.My wife went and was told she needed a filling and had a crack in a back tooth, the filling was covered to some degree but they want to do a 3 surface porcelein onlay whcih costs about $700 and then they also list an "upgrade" which they say my coverage "requires" - whcih made no sense to me whatsoever. When I checked with my HMO (Safeguard) the procedure isnt even covered by my HMO, only the metal onlay which would have been $220. I called the dentist and they say they "dont do metal onlays" only porcelein...seems convenient. This $700 procedure is more expensive then any of the negotiated procedures listed on the fee schedule compares to $220 for a full porcelien crown, even dentures for $400 my HMO pays for etc - it just seems to me they are trying to use loopholes to get more money out of people. In addition they also told my wife they wanted her back in 3 months for another cleaning - she was told her gum diseaes level was a 2 out of 5 (not as bad as mine, bu oddly they want her back earlier...). They get $18 for each cleaning from us each time, in all my life neither my wife nor I have had clenaings more than twice a year. I noticed my coverage allows for more than two $18 cleanings a year "if medially necessary". So the question is whether this office is ultra-caring or just out to make lots of money any way possible? Was the porclein onlay really all they could offer or should they have presented other options?

[Sue10191]

Stuart,
First of all let me say congratulations! You are 42 and have no cavities?  You have been doing something right.  I am sure you have taken the Drs advice in seeking a second opinion.  I had the same dental office for 30 years but switched because the cost was so much higher than what my insurance paid.One of the dentists there was always trying to pedal something we did not need.  My husband and I both left there.  We each tried two different dental offices which agree to accept what the insurance pays.  I had a lousy experience at an appointment for a crown.  My tongue broke out in white lesions even before I got out to my car.  The pain and discomfort were unbearable in the office.  The assistant failed to get a good impression the first time which would not have been a big deal except for the fact that it was excruciating to bite down and hold a second time as by now my tongue and gum were burning from some god awful substance they dripped all over it.  So I ended up at a dentist who had left our original dental office and joined a new practice.  He is honest but conservative.  When a crown fell off from my original dentist, it had not yet been five yrs, so my insurance would not pay for a new one.  The dentist put a crown on it even though others had told me the tooth would need an implant next time the crown falls off.  It was below the gum and one of the smaller teeth toward the front of the jaw.  When the crown fell off about two months later it took more tooth with it causing me to need an implant or bridge.  The dentist said whichever I decide he would credit the $1100 from the crown. I thanked him.  I chose the implant Dr in the same practice.  I mentioned the credit to the office personel and they said it was not noted in my record and they never called me back about it.  Now I feel a bit odd about mentioning it again.  The implant is $3800.  I also had a CT scan, $400, of it along with some appointment fees related to it.  My insurance will pay less than half the cost of the implant.  If I add up all this tooth has cost me over the years I am sure I will faint.  It had already had two crowns.  Now my fear is that the other crown I had from what I am calling the interim dentist(the one that gave me painful lesions)will fall off and I will have to pay the new dentist for gluing it back on.  Also the other negative about switching dentists........they send records, xrays etc incomplete.  My new dentist couldn't even figure out from the records forwarded when my last cleaning was.  Now that is just plain irresponsible and vindictive.  My advice to you is to run screaming from your dentist.  My husband and I have not had an easy road to a new dentist but as the cost rose at our first dentists office so did the need for us to have new procedures and products.  We had been advised to be fitted for and purchase something for teeth grinding, myself, my husband and my daughter. But just when you think maybe I am a little sensitive because of the recent bad experiences I have had, I will tell u one more quick story.  My husband was sent to a dental/plastic surgeon to have a tooth extracted. The tooth had a large gold crown which my husband requested to be given.  It was explained to him that he could not have his gold crown because it was a hazardous material!!!  We have told this story to at least two other dentists and they found it quite humorous.  There is no law in our state of Ct which would prevent my husband from receiving his gold crown.  I bet his wife is a jeweler we joked!!!! Good Luck to you and your wife.  There are honest and capable dentists out there.

[Jerome Tsang, DDS]

Could be both.  If you're concerned about your dentist's treatment recommendations, it never hurts to seek a second opinion at another office or go back to your original dentist you  trust.  Unfortunately dentist are people too and you'll meet all kinds of them.  Some are great, some aren't so great.