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Medical Forum / General / Dentistry / November 2005Is this a dental insurance thing?
Called my Delta PMI dentist today to make appointments for free cleanings for my wife and I, to get them done before our insurance ends (and I mean, ENDS!) on Jan. 1. The receptionist informed that I cannot get in for a cleaning until February! I then asked if I could get an appointment to have a crown done, and she said yes, I could get one next week. (That, I'm sure there's some money in, as Delta does not cover the "premium" materials.) After I hung up, I thought I should have asked her "What if I were a paying client? Then, could I get an appointment for a cleaning in December?" I think I am going to have a friend call and see if they can get a new patient appointment for a cleaning, on a cash basis, before February, and if they do, then I'm going to raise hell about it. A lot of offices have a tight schedule for their hygienists, with recall appointments, new patient appointments, and such...so this doesn't seem all that odd. It couldn't hurt to do a bit of spying as well. I always hate when I call a physician's office to schedule an appointment and their first question is what insurance to do you have. I also wonder if my answer determines when my appointment will be. Let us know how your covert operation goes. T > Called my Delta PMI dentist today to make appointments for free > cleanings for my wife and I, to get them done before our insurance [quoted text clipped - 13 lines] > before February, and if they do, then I'm going to raise hell about > it. > Called my Delta PMI dentist today to make appointments for free > cleanings for my wife and I, to get them done before our insurance [quoted text clipped - 13 lines] > before February, and if they do, then I'm going to raise hell about > it. I think you're catching on. Steve The receptionist informed that I cannot get in for a cleaning until February! ________________________ Let's say that you were to walk into that office with $2000 in cash. Let's say you went up to the reception desk and fanned out ONE HUNDRED twenty-dollar bills in front of the receptionist. It will take up the whole desk. Let's say that you were to tell them that you needed a cleaning THIS WEEK and the whole two thousand bucks is theirs! Is there any doubt in your mind that they would quickly find a spot in the schedule to clean your teeth? Is is hard to understand why the same dentist would not be eager to do a "no-pay" cleaning for you? It shouldn't take a Ph.D. in economics to figure this out. - dentaldoc >The receptionist informed that I cannot get in for a cleaning until >February! [quoted text clipped - 16 lines] > >It shouldn't take a Ph.D. in economics to figure this out. That's why I like the NHS. Not the dental arm of the NHS but the doctor/hospital side. Priority is given on the basis of need. The dental side of it has got too mixed up with private practice and the money grabbing/greed side of people has been encouraged. Ann >The receptionist informed that I cannot get in for a cleaning until >February! [quoted text clipped - 5 lines] >twenty-dollar bills in front of the receptionist. It will take up the >whole desk. Sounds like you have experience with this! >Let's say that you were to tell them that you needed a cleaning THIS >WEEK and the whole two thousand bucks is theirs! [quoted text clipped - 8 lines] > >- dentaldoc >>Let's say that you were to walk into that office with $2000 in cash. >> [quoted text clipped - 3 lines] > >Sounds like you have experience with this! Has a standing appointment at the Bunny Ranch... ...so I hear. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >The receptionist informed that I cannot get in for a cleaning until >February! [quoted text clipped - 18 lines] > >- dentaldoc No, it doesn't take a genius to figure this out. However, it is not a matter of thousands of dollars, and it IS a matter of the dentist living up to their end of a deal. While you can argue that the dentist IS offering the cleaning (in February), the fact is, that it is indeed not in a timely manner, and there is an unwritten expectation that one should be able to get a cleaning in a timely manner. I should think that I should be able to get a cleaning - a 15-25 min. procedure - some time within a month. Therefore he is not living up to his end of the deal, imho, and I think this is morally wrong and reprehensible. It seems to me the whole matter of "dental insurance" is a scam and very dishonest, and that many - not all - of the dentists participating in this scam are guilty of scamming their patients one way or another. It's one thing for a dentist to accept $2000 cash for a cleaning before scheduling a "free" one, as in your scenario. Any fool would do that. But it is another for him to basically avoid giving a free cleaning to someone he has contracted to give one to, within a reasonable amount of time. People expect "dental insurance" to operate like medical insurance. When I am sick I can usually get an appointment with a doctor within a week even if the doctor is indundated with patients during flu season. But dental "insurance" does not operate under the same principles as medical insurance, and so the whole thing is basically dishonest. It is SOLD as meeting certain expectations, yet those expectations are not met. Even calling it "insurance" is really dishonest. I'm just venting. I'm going to complain about this to the dental group once I get my crown done. (I don't want an angry dentist working on my crown - in case he finds out I complained) After December I'm looking for a new dentist and I'll let them know why (for all the good that will do)(zip). >>The receptionist informed that I cannot get in for a cleaning until >>February! [quoted text clipped - 59 lines] > dentist and I'll let them know why (for all the good that will > do)(zip). While it is natural to be angry at the dentist for "not living up to his end of the deal" (and I agree), it is really even worse than that. Generally the insurance companies don't care (in fact they are aware of the scamming and bait-and-switch that goes on) and are very unlikely to strongly police these practices. The "system" (such as it is) allows the insurance companies to maintain a list of dentists, so they can sell these plans to employers. The employers can show their concern for their employees by offering a dental benefit. Everyone wins--except the patient. These plans do not fit any real definition of insurance--you are quite right. Steve > While it is natural to be angry at the dentist for "not living up to >his end of the deal" (and I agree), it is really even worse than that. [quoted text clipped - 9 lines] > >Steve I agree with everything you said. >Everyone wins--except the patient. ...and the dentist. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > ...and the dentist. Unless it is a switch-and-bait office.  Signature/ Amatus / > >>Everyone wins--except the patient. [quoted text clipped - 5 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com But is that really winning ? >> ...and the dentist. > [quoted text clipped - 6 lines] >> >> W_B -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > But is that really winning ? Those that I have spoken to say they make a lot of money with the bait-and-switch deal. Signature/ Amatus / > > But is that really winning ? [quoted text clipped - 15 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com It's one thing for a dentist to accept $2000 cash for a cleaning before scheduling a "free" one, as in your scenario. Any fool would do that. But it is another for him to basically avoid giving a free cleaning to someone he has contracted to give one to, within a reasonable amount of time. ________________________________________ It's not really another thing. By scheduling the $2000 cleaning he has to free up the time to do it. That will generally be done by avoiding a "free" cleaning, which is a total loss to the dental office anyway. If the capitation cleaning is a "free" cleaning, then the dentist ALWAYS has an incentive to minimize the number of "free" cleanings scheduled, and maximize the cleanings that actually bring in revenue to pay the office expenses. It doesn't matter whether he gets paid just $100, or a fanciful $2000 for the cleaning; either case is much better than a "free" cleaning. So to paraphrase and agree with your comments above, any fool would schedule a paid cleaning before doing the work for free. You're absolutely right when you say: "But dental "insurance" does not operate under the same principles as medical insurance, and so the whole thing is basically dishonest. It is SOLD as meeting certain expectations, yet those expectations are not met. Even calling it "insurance" is really dishonest." Agreed! As I have mentioned elsewhere, there is a big difference between true insurance and a capitation dental plan. Read the comments by Dr. Steven Bornfeld. He's right on target. Best regards, - dentaldoc > While you can argue that the dentist IS offering the cleaning (in > February), the fact is, that it is indeed not in a timely manner, and > there is an unwritten expectation that one should be able to get a > cleaning in a timely manner. I should think that I should be able to > get a cleaning - a 15-25 min. procedure - some time within a month. The dental office has it figured out down to the last possible moment. They review the HMO contract with a lawyer and determine exactly how far out they can post-pone your "free" therapy without being in violation of the contract. They schedule you as far out as possible, then never confirm your appointment, plus they will certainly book someone else into the same slot. Often they will book many HMO patients for the same slot 2-4 months away. They figure if they book 5 people for the same appointment, one of them might remember on their own and show up. The HMO system does not lend itself to any reasonable level of care in the dental setting. Period . The insurance company cannot say they are in violation of the contract if they make the "free" appointment within the allotted time frame (even if it is on the last day of that time-frame). The dental office is under _no_ obligation to confirm or remind you of your appointment. They need you to forget about it. Many HMO offices will train the staff to never provide a written confirmation of the time that is given to the patient, as this would be proof that the appointment exists. Signature/ Amatus / > >>The receptionist informed that I cannot get in for a cleaning until [quoted text clipped - 60 lines] > dentist and I'll let them know why (for all the good that will > do)(zip). >insurance company cannot say they are in violation of the contract if they >make the "free" appointment within the allotted time frame (even if it is on [quoted text clipped - 3 lines] >written confirmation of the time that is given to the patient, as this would >be proof that the appointment exists. Just to clarify, mine is not an HMO dental contract, it is a Delta PPO. And the office did actually call us to tell us we were due for an appointment, back in OCT. but we were too busy and could not go, then forgot about it (we just never made the appointment). I think this PPO contract is big on the bait and switch approach to making money as opposed to the not scheduling scam. They figure that they will get you in there, find a cavity, and sell you up on something. >It shouldn't take a Ph.D. in economics to figure this out. > >- dentaldoc JimSoCal didn't even finish elementary school. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > I think I am going to have a friend call and see if they >can get a new patient appointment for a cleaning, on a cash basis, >before February, and if they do, then I'm going to raise hell about >it. You're just a real pain in the a**, aren't you ? Glad you're not my patient. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com |
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