Oops, I meant to say gly-oxide  not oxy-glide.

"it is indead an Aetna DMO plan and we are changing it to the PPO plan
as soon as the employer has an open enrollment. I am just stunned how a
doctor can refuse you a cleaning."

In some cases, an ordinary cleaning might not be appropriate. But in
many cases it might still be a good place to start.

This sort of refusal seems very common with capitation plans. That's
because most such plans don't even pay the doctor for the exam and
cleaning! Some others pay only $5 or so, which doesn't even cover the
cost of the assistant setting up the room with cotton rolls and your
neck napkin. Ridiculous.

If a so-called "cleaning" can be passed off with a superficial
polishing in ten minutes, then the doctor might not lose too much money
by performing it. But if it really takes the type of effort that a
thorough dental prophylaxis sometimes requires, then the dentist would
be financially foolish to devote the necessary time.

So if the dentist actually fulfills the contract in difficult-cleaning
cases, he will LOSE money instead of earning it, and will go out of
business.

But by switching the patient to an alternative procedure, the dental
office can then charge the patient extra money, and actually be paid
for their work.

I regard all such capitation plans as traps for unwary dentists and for
unwary patients. The insurance company is guaranteed to profit, but the
patient and dentist then have to struggle to make ends meet.

Most patients are not informed of these facts when they sign up for the
capitation plans.
______________________________

"Browsing this forum I see a lot of members saying "you get what you
pay for" and I
don't completely disagree. However, in our case the doc (a she) just
seems rude. In my opinion, a doctor and his patient should work as a
team and not fight each others."

The nature of the capitation plan immediately places the dentist and
the patient in conflict with each other. Instead of forming a team, the
backwards nature of compensation in the plan forces the patient and
dentist to opposite sides.

Under the structure of these plans, the dentist is better paid when he
does NOT work for the patient!

This is the opposite of normal business practice. In most endeavors, a
person works and provides services, for which he expects, and receives,
compensation. The compensation is proportional to the work done; the
more he works, the more he is paid.

That makes sense!

But DMO plans don't work that way.

Such plans pay a dentist a pitifully small amount each month, for each
patient enrolled. This amount won't even cover a cleaning once a year,
but in order to convince dentists to sign up, the dental plans suggest
to the dentists that many of those people won't even call for
appointments.

So the dentist counts on the patients NOT coming in for services, as he
will lose money for every patient treated under the plan.

This is perverse. The dentist quickly realizes that the dental plan is
designed so that the dentist has more profit if he does NOT work for
the patients. And the dentist quickly learns that the small monthly
payment does NOT cover what the plan has promised to the patients.

So in order to meet his office costs, the dentist either has to refuse
the services he is supposed to provide, or to sell services that are
not covered by the plan in order to raise the necessary revenue.

It has been suggested that some dental offices agree to sign up with
these money-losing plans so that they can have the opportunity to sell
more expensive items to patients. That is indeed one way to turn a
money-losing burden into a profitable undertaking.

If the doctor spends more than five minutes cleaning your teeth, he
will lose money. So he is faced with the prospect of selling you
something more, just so he will be able to pay the rent and the office
employees.

Everybody loses under such a plan -- except for the insurance company.
_____________________________________

"Ps: gums are getting much better - almost normal again after only 4
days. We've tried calcium and vitamin c supplements, baking soda more
flossing and oxy-glide."

Various things can help the surface appearance and feel of the gums,
but for REAL improvement in gum health, the FLOSSING that you are doing
is the most effective part of the approach.

Daily flossing is not only more effective than the other agents, it is
also cheaper! There is nothing in this world that can compare with the
ability of dental floss to remove hidden interproximal plaque, and
improve dental health.

Combining daily flossing with careful brushing is the best way to
assure long-term gingival health.

Get a GOOD dental cleaning, or even periodontal scaling and root
planing if that is necessary (I can't tell whether you need it, because
I can't examine your gums over the Internet). Then, a regular
prophylaxis every six months (or more often), combined with thorough
daily brushing and flossing, will do more than all the over-the-counter
nostrums in the world.

- dentaldoc

Yup, those dad-burn dentists again mucking up the works.

Emma Wrote:

FWIW, in my practice SC&RP fee is $800-1200, depending on the case difficulty.
If peridex is indicated you get an Rx.