Tough to say.  The perio fees look pretty normal, even for a general
dental office.  I would say the crown fees look normal, but the extra
buildup fee seems just a way to pump things up unless you have severely
broken-down teeth that require posts and cores in order to keep the
crowns in place.  Don't know where you're posting from, but from here in
Brooklyn NY those look like pretty "healthy" fees.
    I'm unfamiliar with "Pacificare HMO"--I thought there usually was
little or no out of pocket expenses in HMOs.  These fees are higher
considerably than mine.
    With a significantly complex proposed treatment plan like this, I
always think it's a good idea to get a second opinion if you have doubts.

Steve

"The pricing is here http://www.webdck.com/crown.html I scanned and
uploaded. It shows it would be $4660.00 without insurance."
_____________________________

I'm glad you posted the copy. It shows what is going on here. In a
nutshell, the main problem is that you have a capitation, "HMO-style"
dental plan, instead of REAL dental insurance.

HMO dental plans simply don't pay the dentist enough to survive. So how
DOES the dentist survive?

By selling you all kinds of stuff that is NOT on the plan, so that you
have to pay extra cash. That way, the dentist can survive by charging
you a bunch of "extras," and the dental plan survives because you are
fooled into thinking that they are providing you with a great "deal" on
prices. Some deal!

Let's look at this "plan." The usual dental HMO (which does NOT operate
like a medical HMO -- your experience proves this) will cover a molar
crown for much LESS than the $990 plus $175 listed here. That's $1,165
for each crown.

Dr. Bornfeld has already mentioned that the fees seem in the ballpark
for his area, but remember also that he can make a crown for $700, so
your price of $1,165 is already about 66% higher than that.

66% is not a small amount.

Yes, I know that Dr. Bornfeld mentioned that the $700 fee is too low
and will have to come up some to be realistic. But I am in your part of
the country (southern California urban market), and you can still get
similar PFM crowns for $800 - $850. The $1,165 is high even for my
area. Heck, even the $990 is already a bit high for this area, and
that's not even counting the extra $175 per tooth for the "buildup," if
actually needed.

If you were to have the plain metal crown which is automatically
"covered" by your dental plan, the cost might be $250 - $350 each. (Do
you have a plan booklet which explains this? Let me know what the
listed fees are. The $250-350 is my guess based on past experience.)

But the dentist and the plan know that no sane dentist could ever do
the work for that kind of price. Also, they know that patients rarely
accept their listed, "bargain" crown.

So the plan baits you into "their" offices, where you are switched to
something more expensive, so that the dentist can pay his rent instead
of losing his shirt under the plan.

Your statement shows that by switching you to a porcelain crown instead
of plain metal, and by claiming that a high-gold metal will be used
under the porcelain on each crown, the dental office can then charge
you $617 for each crown instead of the basic covered amount listed for
molar crowns in your plan.

I don't know if your teeth all require the separate buildups, but at
least you are only being charged an extra $5 each.

Have your employer provide you with a REAL dental insurance plan
instead of a dental HMO. Dental HMOs do not work like medical HMOs!

REAL dental insurance usually pays 50% of a crown cost. Then, at a $800
rate for a porcelain (PFM) crown, you only pay $400, instead of the
$612 on the "bargain" HMO!

See how the "bargain" plan actually costs you more?
_____________________

"He is the breakdown in cost the "treatment coordinator" gave me - I
asked for a copy.

"They say without insurance this would cost over $1500.00 as you can
see here -

http://www.webdck.com/price.html - I scanned and uploaded."
_________________________

This second upload gets interesting, and it reveals how HMO plans
survive.

The summary at the bottom of the page lists a total of $565 for the
four quadrants of root planing. That's not bad, as local fees for four
quadrants can run $600 to $800, or even more.

But look at how your fees are obtained. The HMO plan lists the fees at
$40 per quadrant, for a total of $160 for all four quadrants, not the
$565 on your "worksheet."

So how do they get the $160, which apparently is the actual co-pay for
your treatment, up to $565?

First, you get charged $40 for "periodontal evaluation." Most dentists
include this in a full, ordinary dental exam, at no extra cost. Your
plan may have a clause that allows you to be charged the additional fee
-- does it?

Second, you are charged an additional $55 for "gross scale." Why would
you need a gross scaling when it has only been 7 months since a full
regular dental cleaning? Gross scalings are meant for cases which have
substantial calculus buildup due to the patient skipping dental
cleanings for years. So WHY is a "gross scale" needed after only seven
months?

(I hope that you were told two years ago that simply getting a cleaning
every 3 months is NOT enough. Your daily, thorough brushing and
flossing is even more important for the success of the original
scaling.)

Third, there is the extra charge for "subgingival antibacterial
irrigation." This is not covered by your plan and you are being charged
the full price, which comes to $240 for two visits, and another $70
four weeks later.

This irrigation may, or may not, have real value in your case. It is
mostly useful for cases with substantial periodontal bone loss and deep
pocket formation, where floss and brushing cannot reach the bottom of
the periodontal defects. Research shows that when done at the time of
SRP (scaling and root planing), then the irrigation can sometimes be
helpful.

But if you have a milder case with smaller pockets, the value of
irrigation with SRP might be less.

And the value of irrigation alone, at a visit 4 weeks later when no SRP
is even being done, is highly questionable.

The Most Important Question: Do you really need SRP in the first place?
That can only be determined by a good periodontal exam. 1. What are
your pocket measurements? 2. What were the measurements back when you
first had the SRP? 3. What were the measurements at each 3-month visit?
How much had the pockets improved?

What are the differences in your pocket measurements today, compared
with just 7 months ago? Have they deteriorated so much, that a new SRP
is really needed?

In my opinion, the heart of the matter is not really how much is
charged for the SRP, but is whether you need it in the first place.  --
and whether you have been shown how to maintain its benefits by your
own HOME care.

Hope this helps. And if you are really curious, it can't hurt to get a
second opinion, from an independent dentist with a good reputation and
who is NOT known for high fees, or "smile makeovers," or similar stuff.

A second opinion from an HMO dentist would not be helpful, because the
second HMO dentist is subject to the very same financial constraints
and motivations as the first dentist.

Best regards,
- dentaldoc