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Medical Forum / General / Dentistry / February 2005overcharged???deep clean coupled with irrigation (chlorhexidine gluconate)
Thanks for taking a look at my message and replying with your comments. I was told by my dentist that I need a deep cleaning of my teeth. Later I found out that it was a periodontal scaling and root planning (my DMO insurance covers) coupled with "medical irrigation using chlorhexidine gluconate". The irrigation treatment does NOT have ADA procedure code and my insurance will NOT cover it. It costs $336 total. The treatment will be done in two seperated times ($168 each time). It will come out from my own pocket. I really want to get a second opinion about the price. It is the normal price for irrigation treatment? It is essential for this treatment? Thanks for all your inputs!!! I appreciate it very much!!! a guy from San Diego We do chlorhexidine irrigation at my office. There is a code for it. As for cost it would depend how many units were necessary. jwn dds > Thanks for taking a look at my message and replying with your comments. > [quoted text clipped - 11 lines] > > a guy from San Diego >Thanks for taking a look at my message and replying with your comments. > [quoted text clipped - 11 lines] > >a guy from San Diego MORE INFORMATION IS NEEDED Specifics: Scaling and root planing (4 quadrants. per quadrant) ........ INSURANCE PAYS _ _ _ _ _ (per quadrant) plus YOU PAY _ _ _ _ (per quadrant) IRRIGATION _ _ _ _ _ per quadrant. Joel While irrigation with Chlorhexadine sounds like a good idea, charging a hefty fee may be a little suspect. Some research suggests that the Chlorhexadine is no more beneficial than water when scaling and root planing. It is not effective in the presence of blood (which is usually all over the place if you really needed scaling and root planing in the first place) hence it's use for this purpose is dubious. Chlorhexadine is helpful as a daily rinse after scaling and root planing. Fawks >While irrigation with Chlorhexadine sounds like a good idea, charging >a hefty fee may be a little suspect. Some research suggests that [quoted text clipped - 8 lines] > >Fawks It might be a DMO thing too. (wink) .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. > It is not effective in the presence of blood (which is >>usually [quoted text clipped - 9 lines] >.. >Stephen Mancuso, D.D.S. Ya think ? ;*) -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > While irrigation with Chlorhexadine sounds like a good idea, charging > a hefty fee may be a little suspect. Some research suggests that [quoted text clipped - 8 lines] > > Fawks Yeah - this is my understanding of the irrigation story. I agree with Dr. Fawks. Linda (hygienist) >> While irrigation with Chlorhexadine sounds like a good idea, charging >> a hefty fee may be a little suspect. Some research suggests that [quoted text clipped - 12 lines] >Fawks. >Linda (hygienist) Chlorhexidine ........... Brand Names In the U.S. Peridex PerioGard In Canada Oro-Clense Peridex Category Antibacterial, dental Description Chlorhexidine (klor-HEX-i-deen) is used to treat gingivitis. It helps to reduce the inflammation (redness) and swelling of your gums and to reduce gum bleeding. Gingivitis is caused by the bacteria that grow in the coating (plaque) that forms on your teeth between tooth brushings. Chlorhexidine destroys the bacteria, thereby preventing the gingivitis from occurring. However, chlorhexidine does not prevent plaque and tartar from forming; proper tooth brushing and flossing are still necessary and important. Chlorhexidine is available only with your dentist's or medical doctor's prescription, in the following dosage form: Dental Oral rinse (U.S.) Before Using This Medicine In deciding to use a medicine, the risks of using the medicine must be weighed against the good it will do. This is a decision you and your dentist or medical doctor will make. For chlorhexidine, the following should be considered: AllergiesTell your dentist or medical doctor if you have ever had any unusual or allergic reaction to this medicine or to skin disinfectants containing chlorhexidine. Also tell your dentist or medical health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes. PregnancyChlorhexidine has not been studied in pregnant women. However, chlorhexidine has not been shown to cause birth defects or other problems in animal studies. Breast-feedingIt is not known whether chlorhexidine passes into the breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are taking this medicine and who wish to breast-feed should discuss this with their dentist or medical doctor. ChildrenStudies on this medicine have been done only in adult patients, and there is no specific information comparing use of this medicine in children with use in other age groups. Older adultsMany medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of this medicine in the elderly with use in other age groups. Other medicinesAlthough certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your dentist or medical doctor may want to change the dose, or other precautions may be necessary. Tell your dentist or health care professional if you are using any other prescription or nonprescription (over-the-counter [OTC]) medicine that is to be used in the mouth. Other medical problemsThe presence of other medical problems may affect the use of chlorhexidine. Make sure you tell your dentist or medical doctor if you have any other medical problems, especially: Front-tooth fillings (especially those having rough surfaces)Chlorhexidine may cause staining that, in some cases, may be impossible to remove and may require replacement of the filling Gum problems (other)Use of chlorhexidine may make other gum problems, such as periodontitis, worse Proper Use of This Medicine Chlorhexidine oral rinse should be used after you have brushed and flossed your teeth. Rinse the toothpaste completely from your mouth with water before using the oral rinse. Do not eat or drink for several hours after using the oral rinse. The cap on the original container of chlorhexidine can be used to measure the 15 mL (½ fluid ounce) dose of this medicine. Fill the cap to the ``fill line.'' If you do not receive the dental rinse in its original container, make sure you have a measuring device to measure out the correct dose. Your pharmacist can help you with this. Swish chlorhexidine around in the mouth for 30 seconds. Then spit out. Use the medicine full strength. Do not mix with water before using. Do not swallow the medicine. Dosing The dose of chlorhexidine oral rinse will be different for different patients. Follow your dentist's or medical doctor's orders or the directions on the label. The following information includes only the average doses of chlorhexidine oral rinse. If your dose is different, do not change it unless your dentist or medical doctor tells you to do so. For oral rinse dosage form: For gingivitis: AdultsUse 15 milliliters (mL) as a mouth wash for 30 seconds two times a day. Children up to 18 years of ageUse and dose must be determined by your dentist or medical doctor. Missed dose If you miss a dose of this medicine, use it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Storage To store this medicine: Keep out of the reach of children. Store away from heat and direct light. Keep the medicine from freezing. Do not keep outdated medicine or medicine that is no longer needed. Be sure any discarded medicine is out of the reach of children. Precautions While Using This Medicine Chlorhexidine may have a bitter aftertaste. Do not rinse your mouth with water immediately after using chlorhexidine, since doing so will increase the bitterness. Rinsing may also decrease the effect of the medicine. Chlorhexidine may change the way foods taste to you. Sometimes this effect may last up to 4 hours after you use the oral rinse. In most cases, this effect will become less noticeable as you continue to use the medicine. When you stop using chlorhexidine, your taste should return to normal. Chlorhexidine may cause staining and an increase in tartar (calculus) on your teeth. Brushing with a tartar-control toothpaste and flossing your teeth daily may help reduce this tartar build-up and staining. In addition, you should visit your dentist at least every 6 months to have your teeth cleaned and your gums examined. If you think that a child weighing 22 pounds (10 kilograms) or less has swallowed more than 4 ounces of the dental rinse, get emergency help at once. In addition, if a child of any age drinks the dental rinse and has symptoms of alcohol intoxication, such as slurred speech, sleepiness, or a staggering or stumbling walk, get emergency help at once. Side Effects of This Medicine Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Check with your doctor immediately if any of the following side effects occur: Rare Signs of allergic reaction (nasal congestion; shortness of breath or troubled breathing; skin rash, hives, or itching; or swelling of face Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your dentist or medical doctor if any of the following side effects continue or are bothersome: More common Change in taste; increase in tartar (calculus) on teeth; staining of teeth, mouth, tooth fillings, and dentures or other mouth appliances Less common or rare Mouth irritation; swollen glands on side of face or neck; tongue tip irritation Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your dentist or medical doctor. Revised: 08/14/1998 Yes, we agree. How could the fee be so outrageously high? Joel Mailgate reply. ** > While irrigation with Chlorhexadine sounds like a good idea, charging > a hefty fee may be a little suspect. Some research suggests that [quoted text clipped - 8 lines] > > Fawks Scaling and root planning, 100% covered by my DMO insurance. Irrigation, no cover at all because there is no code for it (according to the dental office). $84 per quadrant. >Scaling and root planning, 100% covered by my DMO insurance. >Irrigation, no cover at all because there is no code for it (according >to the dental office). >$84 per quadrant. How do you spell Bait and switch? .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. >Scaling and root planning, 100% covered by my DMO insurance. >Irrigation, no cover at all because there is no code for it (according >to the dental office). >$84 per quadrant. Get the SRP and skip the squirting thing. You can do that yourself later. Joel Thanks! The funny thing is that the dentist (at least the front desk person from that dental office) said that they do NOT do SRP/irrigation seperately. They told me that it is NOT grocery store that you can choose product! I think I'd better switch to OTHER insurance plan :-) Sanshi >Thanks! The funny thing is that the dentist (at least the front desk >person from that dental office) said that they do NOT do SRP/irrigation >seperately. They told me that it is NOT grocery store that you can >choose product! Oh you woulda known it! Too funny! >I think I'd better switch to OTHER insurance plan :-) > >Sanshi >They told me that it is NOT grocery store that you can >>choose product! > >Oh you woulda known it! > >Too funny! Yeah, and one of my pet peeves... People don't show up at the grocery store with no means to pay. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>They told me that it is NOT grocery store that you can >>>choose product! [quoted text clipped - 6 lines] >People don't show up at the grocery store >with no means to pay. Yeah but really. 95% of the dentists would never insist on BUYING the expensive rinse with the 100% covered service. Joel >Thanks! The funny thing is that the dentist (at least the front desk >person from that dental office) said that they do NOT do SRP/irrigation >seperately. They told me that it is NOT grocery store that you can >choose product! Exactly. This is not Burger King. You don't get it your way. You take it my way or you don't get the damn thing. >I think I'd better switch to OTHER insurance plan :-) The cost of indemnity dental insurance, and the imposed waiting periods, far outweigh the cost of just paying for it yourself. >Sanshi -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >Exactly. >This is not Burger King. >You don't get it your way. >You take it my way or you don't >get the damn thing. As long as its all disclosed up front, that is fair. Joel >Thanks! The funny thing is that the dentist (at least the front desk >person from that dental office) said that they do NOT do SRP/irrigation >seperately. They told me that it is NOT grocery store that you can >choose product! > >I think I'd better switch to OTHER insurance plan :-) Very smart idea ! .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. >Get the SRP and skip the squirting thing. >You can do that yourself later. > >Joel Keep it 'G' rated Joel. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >Scaling and root planning, 100% covered by my DMO insurance. >Irrigation, no cover at all because there is no code for it (according >to the dental office). >$84 per quadrant. There is a code for irrigation. $84 is cheap. My fee is $250/quadrant. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > Scaling and root planning, 100% covered by my DMO insurance. > Irrigation, no cover at all because there is no code for it (according > to the dental office). > $84 per quadrant. There is an ADA code for irrigation but your DMO does not have a fee agreed upon with your dentist. Thanks a lot for all your replys. Could anyone here recommend a dentist for me? I am new to San Diego and have DMO insurance. I do not want to "TRY" every dentist to find out a good one. Very frustrated.... Thanks in advance! >Thanks a lot for all your replys. >Could anyone here recommend a dentist for me? I am new to San Diego and [quoted text clipped - 3 lines] > >Thanks in advance! Step one, get rid of the DMO .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. > Scaling and root planning, 100% covered by my DMO insurance. > Irrigation, no cover at all because there is no code for it (according > to the dental office). > $84 per quadrant. and later: > Thanks a lot for all your replys. > Could anyone here recommend a dentist for me? I am new to San Diego and [quoted text clipped - 3 lines] > > Thanks in advance! Dear Sanshi: You wrote that scaling and root planing was "100% covered" by your DMO insurance. However, this is not entirely accurate in the usual meaning of the word "covered." What the DMO means is that YOU don't pay any extra for the treatment. In that sense, you consider it "covered." But instead of "covering" it, by which most people mean the DMO will actually PAY for it, the DMO may pay little or nothing to the dentist. Since the dentist obviously can't pay the rent if he's paid little or nothing for your treatment, it becomes a financial necessity for the dentist to do one of the following: 1. Keep your treatment very short so you don't use much of his valuable time. How long could he stay in business working almost for free? How could you, or anyone, make a living working for free? 2. Or, the dentist could give you the full time you need, but find a way to charge you extra for the procedure. That will make up for the lack of payment from the DMO, so the dentist can now afford to treat you. With regard to a DMO, every dentist I know recommends REAL dental insurance instead. I've been in San Diego for thirty years, but I have never yet seen a DMO worth joining. Your DMO will restrict you to choosing a dentist from a limited list of dentists who were willing to work under the conditions imposed by the DMO structure. It would be very difficult to recommend a dentist to you because all the better dentists I know refuse to have anything to do with the DMO schemes, for the reasons outlined above. Good luck. You should consider dumping the DMO and give yourself free choice of dentists instead. Have you thought about getting an independent second opinion to determine if any other dentists consider the proposed treatment to be necessary or advisable? Best regards, dentaldoc >all the better >dentists I know refuse to have anything to do with the DMO schemes, for >the reasons outlined above. > >Good luck. You should consider dumping the DMO and give yourself free >choice of dentists instead Absolute truth. I would rather sit on my kiester and not get paid than work my tail off for nothing. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>all the better >>dentists I know refuse to have anything to do with the DMO schemes, for [quoted text clipped - 7 lines] >I would rather sit on my kiester and not get paid than >work my tail off for nothing. About your kiester discussion, I went back and the patient did not say how much (at 100%) the DMO was paying to the dentist. It could be zero,. of course! You could be right. Joel > With regard to a DMO, every dentist I know recommends REAL dental > insurance instead. I've been in San Diego for thirty years, but I have [quoted text clipped - 4 lines] > dentists I know refuse to have anything to do with the DMO schemes, for > the reasons outlined above. Sorry to divert this thread, but I happen to be in San Diego too, and I'm not limited by a DMO. Know anyone who does good crowns? I've asked people I know, but not a lot of them have crowns to begin with, and patient satisfaction doesn't necessarily tell the whole story. I had a crown done elsewhere, and later I was told it was a seriously poor fit and needed replacement. Up till then, I was perfectly happy with it. Hey, I'm a layperson, I don't know a good crown from a bad one. How do I pick a dentist? >> With regard to a DMO, every dentist I know recommends REAL dental >> insurance instead. I've been in San Diego for thirty years, but I [quoted text clipped - 16 lines] >with it. Hey, I'm a layperson, I don't know a good crown from a bad >one. How do I pick a dentist? There are a number of excellent practitioners in San Diego, maybe SoCal Sam or Rod Kurthy or one of those guys. If you end up there, tell them Hi from Joely. Joel >>> With regard to a DMO, every dentist I know recommends REAL dental >>> insurance instead. I've been in San Diego for thirty years, but I [quoted text clipped - 19 lines] >There are a number of excellent practitioners in San Diego, maybe >SoCal Sam or Rod K...y or one of those guys. One of those 2 called we at home one Sunday and was very rude. I would end be able to recommend that person. >If you end up there, tell them Hi from Joely. > >Joel .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. >One of those 2 called we at home one Sunday and was very rude. I would >end be able to recommend that person. [quoted text clipped - 5 lines] >Stephen Mancuso, D.D.S. >Troy, Michigan, USA YUP, but I always try to separate what I believe to be a good practititoner from what may have been a rude occurrence. A good dentist is always a good dentist, rude or not. Joel >>One of those 2 called we at home one Sunday and was very rude. I would >>end be able to recommend that person. [quoted text clipped - 12 lines] > >Joel Sorry, but. that 30 minute telephone call was enough to show me that person is much more interested in selling tapes and manuals than he is interested in patient care. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. >Sorry, but. that 30 minute telephone call was enough to show me that >person is much more interested in selling tapes and manuals than he is [quoted text clipped - 5 lines] > >I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. I suppose so. I must admit that I transmitted misinformation though. I thought it was H.F. Joel >>Sorry, but. that 30 minute telephone call was enough to show me that >>person is much more interested in selling tapes and manuals than he is [quoted text clipped - 12 lines] > >Joel HF called the office and was obscene on the phone. RK called while I was at home and convinced me of how petty his mind is .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. >>I must admit that I transmitted misinformation though. I thought it >>was H.F. [quoted text clipped - 11 lines] > >I am writing on a Tablet-P Thanks. I am relieved. I would not want to erroneously hold a bad opinion of someone. Joel |
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