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Medical Forum / General / Dentistry / February 2005Crown over implant - cost
Hi, As a result of an accident, my daughter needed to have an implant installed in place of a missing front tooth. The general medical insurance paid for the implant work. I was hoping that the crown would be covered as well - but no such luck. Imagine my shock when I saw that the claim was denied and the amout submitted by our family dentist for the crown is $2,000 which is 2-3 times higher than we saw claimed for crowns before. Here my questions: 1) Does $2,000 sound right for a front tooth porcellan crown? Is there something making crown over the implant more expensive than over a tooth? 2) If the charge does not sound like customary, what is the best way to dispute it, other than to indicate to the doctor that he will lose the business of my family going forwad? Is there an effective way to influence him through some type of dental board? Many thanks, Roman > As a result of an accident, my daughter needed to have an implant > installed in place of a missing front tooth. The general medical [quoted text clipped - 4 lines] > before. Here my questions: > 1) Does $2,000 sound right for a front tooth porcellan crown? I usually hear about $1,500 so $2,000 is on the high-normal range. > 2) If the charge does not sound like customary, what is the best way to > dispute it, other than to indicate to the doctor that he will lose the > business of my family going forwad? Is there an effective way to > influence him through some type of dental board? Dental board won't help you any... at least not in Canada. Dentists are allowed to charge what they want. You can go to another dentist and get billed $1,500 to $2,000 there if it makes you feel better. jwn dds |> As a result of an accident, my daughter needed to have an implant | > installed in place of a missing front tooth. The general medical [quoted text clipped - 17 lines] | | jwn dds Insurance or not. My understanding is that the failure to disclose fees prior to treatment is failure to inform under the auspices of "informed consent". The Canadian equivalent of dental boards frowns upon such activities. Quoted from the RCDSO code of ethics: "Provide unbiased explanation of options with associated risks and costs, and obtain consent before proceeding with investigations or treatment." http://www.rcdso.org/pdf/RCDSO_Ethics_v6_1706.pdf  SignatureRoy rem NADA to reply I've found that even with a verbal or printed estimate, patients will be surprised with teh final bill regardless. jwn dds > |> As a result of an accident, my daughter needed to have an implant > | > installed in place of a missing front tooth. The general medical [quoted text clipped - 35 lines] > > http://www.rcdso.org/pdf/RCDSO_Ethics_v6_1706.pdf True, and 9 times out of 10 they were expecting it to be 1/2 as much. SignatureRoy rem NADA to reply | I've found that even with a verbal or printed estimate, patients will be | surprised with teh final bill regardless. [quoted text clipped - 40 lines] | > | > http://www.rcdso.org/pdf/RCDSO_Ethics_v6_1706.pdf > True, and 9 times out of 10 they were expecting it to be 1/2 as much. Why does just the false tooth for an implant cost more than a whole crown job? >> True, and 9 times out of 10 they were expecting it to be 1/2 as much. > > Why does just the false tooth for an implant cost more than a whole > crown job? You are probably quoting a fee for an implant abutment and a crown. The surgeon places and then exposes the implant fixture. The abutment is the structure that attaches to the fixture in the jawbone, and the crown is constructed on top of that. Sometimes, pre-made "stock" abutments can be used. Sometimes, owing to the location or inclination of the fixture a custom abutment must be made by the lab. Custom abutments are much more expensive generally. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> True, and 9 times out of 10 they were expecting it to be 1/2 as much. > >Why does just the false tooth for an implant cost more than a whole >crown job? Because of the fixture costs. Read Bornfeld's response. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >I've found that even with a verbal or printed estimate, patients will be >surprised with teh final bill regardless. > >jwn dds This is an issue with education in this country. The average graduate has few comprehension skills. Joel Amen. I've spent 30 minutes explaining how an infectied pulp tissue needs to be removed or the tooth needs to be extracted. I use repetition, pictures, etc. and I still get "Can't you just fill over top of it?" This is when I leave the room and let the assistant try. jwn dds >>I've found that even with a verbal or printed estimate, patients will be >>surprised with teh final bill regardless. [quoted text clipped - 5 lines] > > Joel >Amen. > [quoted text clipped - 5 lines] > >jwn dds K.I.S.S. "your tooth hurts because the nerve is exposed and you have an infection". "It can either be fixed or extracted" Then give an Rx and a quote" -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Yes this was when I was younger and even more foolish than I am now. :) >>Amen. >> [quoted text clipped - 18 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com >I've found that even with a verbal or printed estimate, patients will be >surprised with teh final bill regardless. Why would anyone be surprised if they were 1)given a printed estimate with a dollar amount and then 2) based on that information decided to go ahead with treatment? Where is the surprise? >jwn dds > [quoted text clipped - 37 lines] >> >> http://www.rcdso.org/pdf/RCDSO_Ethics_v6_1706.pdf >>I've found that even with a verbal or printed estimate, patients will be >>surprised with teh final bill regardless. > > Why would anyone be surprised if they were 1)given a printed estimate > with a dollar amount and then 2) based on that information decided > to go ahead with treatment? Where is the surprise? In my experience, a lot of treatment is completed over the course of several weeks or even months. The original written estimate is usually 'lost' and often not clearly understood anyway. Patients often get confused about 'total fees', 'insurance estimates', and 'out-of-pocket estimates'. Some problems are brought on by a lack of communication. Patient asks, "How much is a root canal?" Dentist replies, "$575, but the insurance usually pays 80%." Patient says, "OK, let's do it." Three weeks later the dentist does a $175 build up, and says that the patient needs to set up an appointment for a crown which costs another $800. The patient is shocked, thinking the root canal was pretty much the whole deal. I try to communicate two fees: The total cost of treatment and then the total out-of-pocket expenses. People still get confused, I/we don't always communicate well enough, and treatment can change and become more expensive in the middle of the work (what I thought was a 2 surface filling turns into a 3 surface, a tooth ends up needing a root canal, I find a crack under an old filling, the patient asks to have an amalgam removed since they are numb in that area for other treatment, etc.). JME, Fawks >>>I've found that even with a verbal or printed estimate, patients will be >>>surprised with teh final bill regardless. >> >> Why would anyone be surprised if they were 1)given a printed estimate >> with a dollar amount and then 2) based on that information decided >> to go ahead with treatment? Where is the surprise? The original poster was referring to ONE crown, not ongoing treatment for six months- yr. >In my experience, a lot of treatment is completed over the course of >several weeks or even months. The original written estimate is usually >'lost' and often not clearly understood anyway. Patients often get >confused about 'total fees', 'insurance estimates', and 'out-of-pocket >estimates'. still sounds like a scam: >Some problems are brought on by a lack of communication. > Patient asks, "How much is a root canal?" Dentist replies, "$575, [quoted text clipped - 3 lines] >up an appointment for a crown which costs another $800. The patient is >shocked, thinking the root canal was pretty much the whole deal. You need a new roof on your house. You ask, how much for the roof? The roofer says: $3,000. You say, "go for it." When the roof is done, you receive a bill for $9,783 with no explanation. (460/1550 = 3000/9783) or You ask, how much for the roof? The roofer says $3,000. You say "go for it". After the old roof is torn off and new plywood is attached, the roofer spends $1,000 on nails, and informs you that you need to pay another $5,783 for a functioning roof. So what you thought was going to cost a total of $3,000 is now actually $9,783. (The material between the plywood and the roof is really expensive). >I try to communicate two fees: The total cost of treatment and then >the total out-of-pocket expenses. [quoted text clipped - 5 lines] >filling, the patient asks to have an amalgam removed since they are numb >in that area for other treatment, etc.). Yes. >JME, > >Fawks The roofing contractor is expected to "pad" the bill enough to cover any unexpected "surprises" during the job. Health care professionals are expected to only bill for what they actually do. Do you understand the difference between a "bid job" and a "time and material job" ?? [I am not arguing that the OP is right or wrong, simply pointing out that one cannot directly compare how roofing contractors figure a job price to health care.] Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >>>>I've found that even with a verbal or printed estimate, patients will be [quoted text clipped - 51 lines] >> >>Fawks >[I am not arguing that the OP is right or wrong, simply pointing out that >one cannot directly compare how roofing contractors figure a job price to >health care.] Plus ... when the implant fails, a hot tar patch won't help! >>[I am not arguing that the OP is right or wrong, simply pointing out that >>one cannot directly compare how roofing contractors figure a job price to >>health care.] > >Plus ... when the implant fails, a hot tar patch won't help! Reminds me, I gotta get my semi-annual cleaning done, better schedule... >The roofing contractor is expected to "pad" the bill enough to cover any >unexpected "surprises" during the job. [quoted text clipped - 8 lines] >one cannot directly compare how roofing contractors figure a job price to >health care.] Do you think people ask for a 'quote' before heart surgery ? Do you take the lowest bid from parachute packers ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Shoddy business practices are shoddy business practices, whether in dentistry, or any where else. When the dentist knows the full cost is $1550, yet baits the person by saying the cost is $460, this is a scam, even if you prefer to call it a "communication problem". This is as ludicrous as the roofer who says the roof will cost $3,000 then charges $9,000. Does the roofer have a "communication problem"? You can try to make nonsense excuses, but it just won't fly. Nonsense rationalizations for deceptive business practices and ignorance of the law will not work on me - yes, even in healthcare, *especially in healthcare*, where they are most prominent. >[I am not arguing that the OP is right or wrong, simply pointing out that >one cannot directly compare how roofing contractors figure a job price to >health care.] >>>>>I've found that even with a verbal or printed estimate, patients will be >>>>>surprised with teh final bill regardless. [quoted text clipped - 50 lines] >>> >>>Fawks Bait and switch is wrong in any field. Health care does not allow the luxury of knowing in advance what will be needed in the final steps (in many cases). Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > > Shoddy business practices are shoddy business practices, whether in [quoted text clipped - 68 lines] >>>> >>>>Fawks >Bait and switch is wrong in any field. Unless you are a rat exterminator or a railroad support personnel. >Health care does not allow the luxury of knowing in advance what will be >needed in the final steps (in many cases). >Bait and switch is wrong in any field. What about fishing ? For actual edible fish that is... >Health care does not allow the luxury of knowing in advance what will be >needed in the final steps (in many cases). We could narrow that statement to 'dental care' v. "Health care " --*Or*-- Expand it to: "<insert any profession>" Here's a few to consider: Carpentry Wiring Plumbing Dictatorship Creating a democracy where it has never historically existed before... #################################################### Don't twist your brain in too tight a knot, the list is endless. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE Just as any contractor builds in his profit and allows for extras, so should dentists. If the roofer finds some more damage after the agreed price, then he usually eats it as he has made money from his hundreds of other customers. Likewise, a dentist makes lots of profits from his hundreds of patients and if his estimate didn't cover, for example a cracked tooth that he did not see on the tooth he had quoted the patient on the estimate, then the dentist should "eat" that extra time he spends in labor and materials. Just as the roofer will make a profit in the end with all his customers, so will the dentist with all his patients. Therefore, I really have to state that a contractor and a dentist should perform by their estimates without the inclusion of any hidden damages unless they are extremely "open and obvious" to either a roofer or dentist! Jerry* > The roofing contractor is expected to "pad" the bill enough to cover any > unexpected "surprises" during the job. [quoted text clipped - 76 lines] > >> > >>Fawks >Therefore, I really have to state that a >contractor and a dentist should perform by their estimates without the inclusion >of any hidden damages unless they are extremely "open and obvious" to either a >roofer or dentist! > >Jerry* How would you recommend heart or brain surgeons adapt their practices to work like 'contractors' ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com In a similar fashion as anyone who is self-employed! Just use common sense and ethics to be fair at what one does do in life and keep in mind that not many people can afford large financial costs that are set forth in the original estimate, let alone an increase to same. Do you really think a dentist is going to go "Out of Business" by eating the costs of inaccurate estimates? I don't think so, but I can tell you that the small roofing company would most likely go out of business first. No one has to go out of business.. The point is just showing compassion and humanity in any self employed business and not trying to make such a large nest egg at the expense of our people. Jerry* > >Therefore, I really have to state that a > >contractor and a dentist should perform by their estimates without the inclusion [quoted text clipped - 11 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com That is just my point. The health care provider does not add in extra profit to cover every possible outcome. If he did, a simple filling would cost $2500.oo USD. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > Just as any contractor builds in his profit and allows for extras, so > should [quoted text clipped - 109 lines] >> >> >> >>Fawks >That is just my point. The health care provider does not add in extra >profit to cover every possible outcome. If he did, a simple filling would >cost $2500.oo USD. That's next year! And,,,,,,,,,,,,,, after you do all that stuff right (once in a while [ :-) ],,,,,,,), the patient's employer will change carriers while you are treating the patient, and you find out there was a lapse in coverage for the 5 days you were treating the patient. This now becomes "your" fault. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >>>I've found that even with a verbal or printed estimate, patients will be [quoted text clipped - 30 lines] > > Fawks > >>I've found that even with a verbal or printed estimate, patients will be > >>surprised with teh final bill regardless. [quoted text clipped - 20 lines] > > People still get confused, I/we don't always communicate well enough, > and treatment can change and become more expensive in the middle of > the work (what I thought was a 2 surface filling turns into a 3 surface, [quoted text clipped - 5 lines] > > Fawks This is pure speculation on my part, but perhaps patients are "shocked" when the bill they receive is significantly greater than they'd expected because, in their day-to-day experiences, prices are not quite so dynamic. I mean, you go to the grocery store to buy something, and usually the price on the product is exactly what you pay (how many people have you seen leave something behind in the store because the price tag was wrong, and they were expecting to pay less? I've seen quite a few.). I'm not trying to equate dentistry and retail here, I'm just saying that people rely heavily on past experiences to predict future events. Likewise, if in the past they had some type of dental procedure done, and they ended up paying exactly (or almost exactly) what they'd been told they would pay, they wouldn't expect the price to go up the next time (hence the shock). With respect to root canal treatment and caps, I really do think that the patient should be informed about the cost of the treatment as a whole, rather than just a part of the treatment (especially if a part of the treatment is integral for a completely successful outcome). I think R's post demonstrates why quite well. Anyway, this is just the layman's perspective. > I mean, you go to the grocery store to buy >something, and usually the price on the product is exactly what you pay Yeah but I bet most people don't show up at the grocery store without any means to pay. Just one of my pet peeves. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>I mean, you go to the grocery store to buy >>something, and usually the price on the product is exactly what you pay [quoted text clipped - 3 lines] > > Just one of my pet peeves. "...One hamburger...for which I will gladly pay you...on Tuesday!" Wimpy > -- > > W_B > > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >Yeah but I bet most people don't show up at the grocery store >without any means to pay. > >Just one of my pet peeves. Or pretend they have hunger insurance when they do not even work there anymore! > > I mean, you go to the grocery store to buy > >something, and usually the price on the product is exactly what you pay [quoted text clipped - 9 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com Yeah ... I could see how that would pose a problem. :S Now there's something I'm not looking forward to dealing with (ahem ... that is, if I ever become a dentist. *crosses fingers*). >> > I mean, you go to the grocery store to buy >> >something, and usually the price on the product is exactly what you [quoted text clipped - 7 lines] >> >> W_B >Yeah ... I could see how that would pose a problem. :S Now there's >something I'm not looking forward to dealing with (ahem ... that is, >if I ever become a dentist. *crosses fingers*). So... you want to be a dentist...? -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >> > I mean, you go to the grocery store to buy > >> >something, and usually the price on the product is exactly what you [quoted text clipped - 13 lines] > > So... you want to be a dentist...? What gave it away? =p I'm joking. Yes, I do. =) >> >if I ever become a dentist. *crosses fingers*). >> >> So... you want to be a dentist...? > >What gave it away? =p I'm joking. Yes, I do. =) Kewl. Contact me privately. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >> >if I ever become a dentist. *crosses fingers*). > >> [quoted text clipped - 5 lines] > > Contact me privately. Done. I agree. Fawks > With respect to root canal treatment and caps, I really do think that > the patient should be informed about the cost of the treatment as a > whole, rather than just a part of the treatment (especially if a part > of the treatment is integral for a completely successful outcome). Thanks. In other words you are confirming that the crown over the implant is more work or more specialized work than a regular crown. By the way are you referring to US$ or Canadian? Regards, Roman >> As a result of an accident, my daughter needed to have an implant >> installed in place of a missing front tooth. The general medical [quoted text clipped - 17 lines] > > jwn dds Are you familiar with photograps? >Are you familiar with photograps? Nope, never heard of it. What are photogreps? lol >>Are you familiar with photograps? > > Nope, never heard of it. What are photogreps? >Hi, > [quoted text clipped - 4 lines] >the amout submitted by our family dentist for the crown is $2,000 which is >2-3 times higher than we saw claimed for crowns before. >Here my questions: >1) Does $2,000 sound right for a front tooth porcellan crown? Is there >something making crown over the implant more expensive than over a tooth? Yes, yes. >2) If the charge does not sound like customary, what is the best way to >dispute it, other than to indicate to the doctor that he will lose the >business of my family going forwad? The fee sounds about right to me. >Is there an effective way to influence >him through some type of dental board? No. >Many thanks, > >Roman -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >As a result of an accident, my daughter needed to have an implant installed >in place of a missing front tooth. The general medical insurance paid for >the implant work. I was hoping that the crown would be covered as well - >but no such luck. Imagine my shock when I saw that the claim was denied and >the amout submitted by our family dentist for the crown is $2,000 which is >2-3 times higher than we saw claimed for crowns before. ... Based on my experience, I believe there is a tendency when you go to the people doing an implant for them to estimate "the cost" for the customer. But when they make that estimate they are thinking that is just and only for the work to install the implanted post. And it is easy for the customer to presume that is the estimate for the complete job. But that estimate doesn't perhaps even hint that there is an even greater cost beyond this for the crown that is going to be put on top of that. Then you are into this thousands of dollars before you realize the true cost will be twice or more than what you expected. But that was just my experience and what I suspect some others find. >>As a result of an accident, my daughter needed to have an implant installed >>in place of a missing front tooth. The general medical insurance paid for [quoted text clipped - 17 lines] >Then you are into this thousands of dollars before you realize the >true cost will be twice or more than what you expected. Sounds like a scam. >But that was just my experience and what I suspect some others find. |
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