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Medical Forum / General / Dentistry / August 2005Need help! Is office gal telling us the truth or lying?
Our ins. has "assigned" us to an unfamiliar dental office in a not-so-great part of town. The dentist my hubby saw is not the owner, but apparently the sole dentist of the distant dentist-owner. My husb. needs substantial work done: A multi-tooth bridge replacement that is currently a temporary stayplate (teeth 3,4,5,6,7) that should have been replaced (it's broken) a long time ago, a single crown (#10), and next to that, a 3-tooth bridge. The existing stayplate being replaced with a proper bridge will be extended to incl. teeth 8 (which has visible fracture lines) and 9 (no probs on this one and both of which are orig. teeth) for proper cantilever (?) - proper anchoring? Tooth #10 is a crown that needs to be replaced and then he has a broken bridge on 11,12,13 that will also be replaced. (I think I should trade him in for two 30 year olds!!). Our ins. has rather generous coverage for us, with some limitations (most all procedures are at no or low co-pay, premiums for which we pay dearly for). This, however, spawns virtually EVERY dental office we have gone to attempt to "diagnose" different problems which don't and have never existed that are "outside the plan" and for which they want $$$$. Or, they consistently claim that all the crowns/bridges are not covered, etc., due to "attrition, TMJ, jaw misalignment, etc.) and hoping that I am not aware of our benefits. Then, when they realize that I DO understand the dental cov'g, we get a "dear John" letter saying it's "best we go to another office" - because they clearly don't want to do the work per the ins. plan for low co-pays. The ins. provider (Delta) has been totally unhelpful and just keeps shuffling us to another office. This has gone on for 3 years and two big letters from us. Per the plan, we have to pay a $100 upgrade per tooth to have a GOLD base under the crown if we don't want the silver-colored , "high noble semi-precious metal" that is free to us with no upcharge. The gal that went over the treatment plan and costs at this latest dental office stated that any porcelain-covered crowns that have the (included) silver metal underneath instead of the gold will give a "gray appearance" to the porcelain tooth due to NOT having the gold underneath, which would give the porc. teeth a more "nat'l, normal color". She also stated that the "norm" for the dental ins. industry is that only teeth 6-11 on the uppers are covered for porcelain. The rest would have to be either the silver metal crowns/pontics (no porcelains) at no charge or pay the extra $100 per tooth for just the gold or $250 for porcelain w/gold upgrade. However, when my husb. smiles, teeth #4,5, & 12,13 CLEARLY show and it would look horrible with metal teeth there. (All these teeth that are being replaced are currently pfm or the normal stayplate mat'l (except two front teeth), with the exceptions of the very rear teeth which are gold crowns). I find it hard to believe that dental ins. standards suddenly would insist that those very visible teeth are not covered for a porcelain exterior when they so clearly show when he smiles. They might as well say that his front teeth should be metal also! So, my questions are: Is it definitely a benefit for strength, color and longevity (as she claims) to pay the upgrade from silver metal ("semi-precious" that we're allowed) to gold for either the underneath portion of a porcelain crown or even just for the very rear molars that would not be porcelainized? And, is it truly the standard that only teeth #6-11 on the upper are considered the ones to be normally covered for porcelain, even if the patient's smile clearly show these other teeth? She also said that we might "prefer" paying extra for porcelain shoulders ("which are not included") since the metal collars might show on all or some of these front teeth. I feel that the office is just trying to get extra money since I'm sure the ins. doesn't pay them that much for all this work, in addition to the capitation. And I must admit that the total for all these upgrades are quite a bit less, relatively speaking, than other offices have tried get from us (6 previous offices, so far!). But, I don't know if what she is saying is true and accurate. I just want to know the truth. Every office has a different story. Sorry for the length, I tried to anticipate possible questions you might have for clarification. Thank you for your help!  Signaturearline > Per the plan, we have to pay a $100 upgrade per tooth to have a GOLD > base under the crown if we don't want the silver-colored , "high noble > semi-precious metal" that is free to us with no upcharge. I am not a dentist, but this is a tiny subset of the dental industry that I know a bit about. I have no problem with "High Noble" metal. If your plan covers that, I would relax. Most plans only allow "Non-precious" (predominately base) alloy. "Non-precious" is simply cheap junk. "High noble" alloy may be yellow or white in color. When making a PFM crown or bridge, the lab places a layer of opaque material over the metal which obscures the color of the metal so it does not show through the porcelain. Therefore, the color of the metal makes little difference in the final product. By the way, the most natural looking crowns and bridges have no metal at all. Everything else being equal, the difference in cost to the dentist per tooth for "High Noble" vs. "non-precious" is 5 to 30 dollars. The lab where my wife works sometime substitutes high noble for non-precious (at the same price) because it is simply easier to work with. Vaughn > I feel that the office is just trying to get extra money since I'm sure > the ins. doesn't pay them that > much for all this work, in addition to the capitation Your plan will probably pay the dental office about $200 for an entire years worth of care. Typical lab fees for one 3-unit bridge are $450. Why do you expect the dentist to do first rate work at a loss? Why people sign up for HMO plans is something I will never understand. Signature. Amatus . > > Our ins. has "assigned" us to an unfamiliar dental office in a [quoted text clipped - 66 lines] > story. Sorry for the length, I tried to anticipate possible questions > you might have for clarification. Thank you for your help! Vaughn: Actually, we have no choice in our dental plan. It's packaged with our PPO medical ins. I think the REAL question should by WHY do DENTISTS sign up for the plan, promising to comply with the benefits for the patients, when they have no intention of doing so. Most patients have no idea how many dentists (and forgive me, as I certainly don't mean to lump all of them together by any means) "skew" the patient treatment plans or supposed lack of coverages in order for his/her office to bring in money. I am rather unusual in understanding a small part of the benefits. NONE of my (educated) friends have a clue about what they are entitled to and go along with whatever they are told to pay. And ALL OF THEM have to pay, despite their plans saying otherwise. So, the question really is: WHY *do* the dentists sign up? We all know why... arline Signaturearline Apologies to Vaughn I meant to address the above reply to Amatus! arlin -- arlin This is one of the negatives about capitalism. At my market I overhead lady complaining to the manager that the peppers that were on sale wer not UNDER the sign of the sale. There were other non-sale pepper there. Actually, she was probably right! I had noticed that as well over th years but never bothered spitting into the wind about it. This is how the market "makes it up" on unsuspecting customers. DENTAL INSURANCE: We had some plans that compensate dentists $3 a mont no matter what is needed. Gee, those people have excellent teeth! WITHI REASON of course! Those plans are signed to "bait and switch" people. So before blaming the office gal (on salary, that's her job) or th dentist (not on salary but he has to bring home some bacon), we need t revamp the SYSTEM! Joely arline Wrote: > Vaughn: > [quoted text clipped - 11 lines] > the question really is: WHY *do* the dentists sign up? We all kno > why... arlin -- Joel34 I've heard that it's often possible to upgrade your plan from HMO to fee-for-service, and the difference in payments is not that great? So you might want to contact the actual dental plan provider and see if you can do that. > I've heard that it's often possible to upgrade your plan from HMO to > fee-for-service, and the difference in payments is not that great? So > you might want to contact the actual dental plan provider and see if > you can do that. Actually, if the patient cannot obtain any covered benefits and all the treatment which is offered to him/her is out of pocket, the cost of the policy does not matter. It would be the same cost (sometimes cheaper) to simply not have the policy at all. Signature/ Amatus / > I've heard that it's often possible to upgrade your plan from HMO to > fee-for-service, and the difference in payments is not that great? So > you might want to contact the actual dental plan provider and see if > you can do that. >WHY do DENTISTS sign up for the plan, promising to comply with the benefits >for >the patients, when they have no intention of doing so. They check the plan carefully before joining the plan. They make sure that the list of covered benefits is limited, then they simply stop doing any procedure which is a covered benefit. That way all treatment is an out of pocket expense for the patient, often at inflated prices. This is similar to the department store which advertises a color TV set for $40. When you get there, all the $40 sets are sold (if any were ever there to begin with), and they work hard to sell you the $150 set. Signature/ Amatus / > > Vaughn: [quoted text clipped - 12 lines] > the question really is: WHY *do* the dentists sign up? We all know > why... arline This post reminds me of something. A woman went to the meat market for lamb chops. The clerk said fine, they are 2.99 lb. The woman said down the street they are l.59 lb. The clerk said, well, why don't you buy them there. The woman said, they are out of them. The clerk said, well, if I would be out of them, I can sell them to you for .99 cents a lb. Something like selling the TVs. Gail > >WHY do DENTISTS sign up for the plan, promising to comply with the benefits > >for >the patients, when they have no intention of doing so. [quoted text clipped - 35 lines] > > arline's Profile: http://dentalcom.net/forum/member.php?userid=812 > > View this thread: http://dentalcom.net/forum/showthread.php?t=2716 >Vaughn: > [quoted text clipped - 11 lines] >the question really is: WHY *do* the dentists sign up? We all know >why... arline I didnt have a choice with my choice of companies. So - its usually a choice of bad and worse. :( As far as why dentists sign up - they get a flat fee for a each patient per year so the LESS they do the more they profit. If your dentist blows you off - he's not living up to his contract with your insurance. It sounds to me like you need to speak with your employee benefits department IMMEDIATELY! The insurance contract is between YOU and your COMPANY/EMPLOYER and NOT between you and your dentist. If you are not satisfied with your insurance plan, talk with your employer and tell them the problems you have encountered!!! > Our ins. has "assigned" us to an unfamiliar dental office in a > not-so-great part of town. The dentist my hubby saw is not the owner, [quoted text clipped - 65 lines] > story. Sorry for the length, I tried to anticipate possible questions > you might have for clarification. Thank you for your help! One more thing: if you are NOT happy with your dental insurance, then cancel it and don't pay for it, and/or find another policy that meets your needs better than the one you have at present!!! The problem is YOURS, not anyone else's problem. This seems very obvious to me, and should to you as well. Good luck on this. > It sounds to me like you need to speak with your employee benefits > department IMMEDIATELY! The insurance contract is between YOU and your [quoted text clipped - 71 lines] > > story. Sorry for the length, I tried to anticipate possible questions > > you might have for clarification. Thank you for your help! Oh I do not know ... I am reading this differently. It sounds like th insurance company will pay for x, y, and z. The dental office i presenting alternatives such as porcelain butt shoulders. This is mor expensive but not necessarily IMPORTANT. Same for precious meta bridgework versus base metal bridgework. There are oodles of base meta bridges made and if the workmanship is OK then they will last a goo long time. If my memory serves correctly, this plan may have a limit of $1,000 o $1,500 per year. Am I on target? If so, its the total plan tha matters. Why not list as this: a. crown tooth 14 .... $700 b. pontic tooth 23 .....$700 c. Pontic tooth 12 ... $700 d. crown tooth 11 ..... $700 plan pays ....... a patient pays .....b Joel QUOTED BELOW, So, my questions are: Is it definitely a benefit for strength, colo and longevity (as she claims) to pay the upgrade from silver meta ("semi-precious" that we're allowed) to gold for either the underneat portion of a porcelain crown or even just for the very rear molars tha would not be porcelainized? And, is it truly the standard that onl teeth #6-11 on the upper are considered the ones to be normally covere for porcelain, even if the patient's smile clearly show these othe teeth? She also said that we might "prefer" paying extra for porcelai shoulders ("which are not included") since the metal collars might sho on all or some of these front teeth. I feel that the office is jus trying to get extra money since I'm sure the ins. doesn't pay them tha much for all this work, in addition to the capitation. And I must admi that the total for all these upgrades are quite a bit less, relativel speaking, than other offices have tried get from us (6 previou offices, so far!). But, I don't know if what she is saying is true an accurate. I just want to know the truth. Every office has a differen story. Sorry for the length, I tried to anticipate possible question you might have for clarification. Thank you for your help -- Joel34 Gosh, I appreciate the input, bu _no_one_has_really_answered_my_questions_! (reprinted at bottom o Joel's last remarks above). Instead the conversation veered mor towards dental insurance and whys and wherefores. Sure woul appreciate a dentist or two answering my specific questions so I ca make an objective, somewhat informed decision - :>). And Jacob, be realistic. As stated earlier, we have NO CHOICE abou the dental plan. This is what comes with our medical insurance (union to boot!). And we're in no position to "cancel our insurance" as yo suggested - we're in our young 60s, have been insured with the sam union since the 70s and certainly not a favorite of ANY insurance co at our age. We don't have an "employee benefits" dept. as we ar contractors and are considered "employers" ourselves. There are prob over a 1000 employees in this union - the union reps. are not going t listen to us. Maybe when time comes again to renegotiate with th dental ins. company, perhaps they'll reconsider, but they're not abou to step in and do anything now when they have a contract with Delta. We pay over $700/month for our insurance. The premiums are not base on age - same cost for all owner/operators as we are called. arlin -- arlin Arline, answers below your text.. > So, my questions are: Is it definitely a benefit for strength, color > and longevity (as she claims) to pay the upgrade from silver metal > ("semi-precious" that we're allowed) to gold for either the underneath > portion of a porcelain crown or even just for the very rear molars that > would not be porcelainized? No difference in strength, color may look better, however the margins will not usually show on the crown on posterior teeth unless they are very obvious. it depends on the part of the country and were the dentist was trained. Each region has different ideas on how and where margins should be placed and what shape they will take. the color and type of metal is mostly a cosmetic thing, (thus the extra cost) > And, is it truly the standard that only > teeth #6-11 on the upper are considered the ones to be normally covered > for porcelain, even if the patient's smile clearly show these other > teeth? Not sure on this, so many dental plans are so different for different parts of the counry. > She also said that we might "prefer" paying extra for porcelain > shoulders ("which are not included") since the metal collars might show > on all or some of these front teeth. Porcelian shoulders, (usually not as good for strength, longevity, seal) are only done for anterior teeth usually teeth 6-11, even thing I did not do that many when I practiced general dentistry, and opted for a good subgingival margin (the metal if any hides below the gums) > I feel that the office is just > trying to get extra money since I'm sure the ins. doesn't pay them that > much for all this work, in addition to the capitation. could be? could be something else, it all depends. > And I must admit > that the total for all these upgrades are quite a bit less, relatively > speaking, than other offices have tried get from us (6 previous > offices, so far!). Why do you need to get the upgrades? there is nothing wrong with standard porcelian fused to metal (non precious) crown/bridges, they look super good when done properly! > But, I don't know if what she is saying is true and > accurate. I just want to know the truth. Every office has a different > story. Sorry for the length, I tried to anticipate possible questions > you might have for clarification. Thank you for your help! hope this helps. Dr. Braces > Our ins. has "assigned" us to an unfamiliar dental office in a > not-so-great part of town. The dentist my hubby saw is not the owner, [quoted text clipped - 28 lines] > base under the crown if we don't want the silver-colored , "high noble > semi-precious metal" that is free to us with no upcharge. If done correctly, there should not be any problem using semi-precious alloy The gal that > went over the treatment plan and costs at this latest dental office > stated I would insist that the dentist go over the treatment plan and not settle for hearing from "the gal" and make sure your dentist answers ALL your questions BEFORE you begin any treatment. that any porcelain-covered crowns that have the (included) > silver metal underneath instead of the gold will give a "gray > appearance" to the porcelain tooth due to NOT having the gold > underneath, which would give the porc. teeth a more "nat'l, normal > color". She also stated that the "norm" for the dental ins. industry > is that only teeth 6-11 on the uppers are covered for porcelain. There is not really any "norm" for dental insurance -- you should read your contract and see what is covered and included in YOUR dental insurance contract == it should state that, and if you have questions, contact your insurance company The > rest would have to be either the silver metal crowns/pontics (no > porcelains) at no charge or pay the extra $100 per tooth for just the > gold or $250 for porcelain w/gold upgrade. What would the fee be for doing these with semi precious metal and porcelain? That should be less expensive. However, when my husb. > smiles, teeth #4,5, & 12,13 CLEARLY show and it would look horrible > with metal teeth there. (All these teeth that are being replaced are [quoted text clipped - 4 lines] > exterior when they so clearly show when he smiles. They might as well > say that his front teeth should be metal also! If esthetics are a concern, then you should pay the extra fee for porcelain with semi-precious metal crowns > So, my questions are: Is it definitely a benefit for strength, color > and longevity (as she claims) to pay the upgrade from silver metal [quoted text clipped - 4 lines] > for porcelain, even if the patient's smile clearly show these other > teeth? The issue is NOT what the standard is, but what YOUR dental insurance plan covers in your insurance contract She also said that we might "prefer" paying extra for porcelain > shoulders ("which are not included") since the metal collars might show > on all or some of these front teeth. Again, I would insist on discussing this with your dentist and NOT with "the gal". The dentist should be able to have the margins below the gumline so that they are not visible, but it's really impossible to answer this question without examining the patient. I feel that the office is just > trying to get extra money since I'm sure the ins. doesn't pay them that > much for all this work, in addition to the capitation. And I must admit > that the total for all these upgrades are quite a bit less, relatively > speaking, than other offices have tried get from us (6 previous > offices, so far!). To be honest, getting opinions from 6 dentists does seem a bit excessive to me; generally, most patients get a second opinion, not 6, but you are fortunate that your insurance company allows that many opinions on treatment. But, I don't know if what she is saying is true and > accurate. I just want to know the truth. Again, ask the dentist, and DON'T rely on her. Make sure you understand EXACTLY what will be done BEFORE anything is done, and considering your concerns, I would have the dentist write out the treatment plan, including what you can expect in esthetics and what the fees will be. Every office has a different > story. Sorry for the length, I tried to anticipate possible questions > you might have for clarification. Thank you for your help! Lastly, one will get what one is paying for in their dental insurance contract, and that is the issue in your coverage. It is not unusual for an insurance policy to state that it will cover "the least expensive professionally adequate treatment" or some words like that. If you had a more inclusive policy, your premium would be higher, but from what you've written, it does sound as if your policy is rather good and covers more than most. Many policies don't cover any crowns at 100% as yours does! Good luck in your quest for dental care. Jacob wrote, Lastly, one will get what one is paying for in their dental insurance contract, and that is the issue in your coverage. It is not unusual fo an insurance policy to state that it will cover "the least expensive professionally adequate treatment" or some words like that. REPLY Exactly! I had a poor patient who waited three years for her new denta insurance. Then she comes in and wants a four unit bridge. Sure enoug in the policy is the clause that if teeth are missing on both sides o an arch (they were) they would pay for a removable, not for fixe bridgework. Even so, the $1,000 would not cover a 4-unit bridge. So the dental insurance gets people in the door, but what happens afte is anyone's guess. Its not like auto-accident insurance o house-catching-on-fire insurance. Joe -- Joel34 > Lastly, one will get what one is paying for in their dental insurance > contract, and that is the issue in your coverage. It is not unusual for [quoted text clipped - 6 lines] > most. Many policies don't cover any crowns at 100% as yours does! Good > luck in your quest for dental care. Please allow me to disagree with Jacob on some points with the intention of kindness and respect to his opinion. Standard insurance policies are set up to create some risk to the company writing the policy. They collect the premium and try to design a plan that will leave them with some net profit at the end of the year. If lots of covered persons get lots of care, they could potentially lose money that year. The HMO plan is set up differently. The insurance company collects the premium, skims off a specified amount as profit, then simply dispenses what is left to the offices which participate on a "per head" basis. Typically, (for dental) this means between $8 and $15 a month for every "head" registered with that office. Some HMO plans will hold back a small percentage of the collected premiums and dispense that at the end of the year to the dental offices which performed the least amount of covered benefits. The insurance company makes a guaranteed profit from the HMO plan regardless of the amount of use the plan gets. So, naturally, the insurance company will try very hard to advertise the HMO plan as being a better choice. The employer saves money on each worker who signs up with the HMO, so the employer will try to convince workers to switch as well. Often, the employer does not know how the plan is operating, and actually believes the worker is getting better coverage, when in fact the worker is getting virtually no coverage at all. Signature/ Amatus / > >> Our ins. has "assigned" us to an unfamiliar dental office in a [quoted text clipped - 133 lines] > most. Many policies don't cover any crowns at 100% as yours does! Good > luck in your quest for dental care. >But, I don't know if what she is saying is true and >accurate. I just want to know the truth. Every office has a different >story. Sorry for the length, I tried to anticipate possible questions >you might have for clarification. Thank you for your help! The truth is that you are on an HMO. The run-around is referred to as: "bait & switch" You will likely be better off in the long run to find a good dentist and pay him/her. Extensive reconstructive treatment is usually best done over an extended period of time. Your husband likely needs and NTI also. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com |
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