Reply #14: Always two sides to any story....

[Wakingupnow]

For years I've been reading DU posts, shaking my head both "yes" and "no" but this is my first post, because, as a dentist in practice for 40 years, I simply have to add to this dialogue. After three years in college and four years of dental school, I did a pediatric dentistry graduate program for an additional two years. I took this preventive dentistry thing very seriously and spent time teaching parents how to do their at-home cleaning with their children, believing that when you or your child has a professional cleaning, the film of plaque on the teeth is mostly gone for 24 hours and that's all! Having a cavity filled DOESN'T STOP THE DECAY! It simply repairs the damage caused by the dental infection ("dental caries") that created the hole(s) in the first case. Home care and diet will determine if new decay will occur, and we want our patients to have a drastic reduction in the need for additional fillings if we all work together toward that goal. Most dentists have a tendency to do what they've been taught and continue to do this for their full career. Most people don't look to change that much, and so "silver caps" (actually stainless steel crowns) are taught and also mercury amalgam(so called "silver" fillings) for children--and adults for that matter.And recurrent decay and re-filling becomes necessary to preserve teeth that a couple of generations back would have been pulled.

I'm not defending things that dentists do that focus more on making money than serving the dental health needs of their patients, but I am wanting to shed light on the "whys" that some things happen. The dental insurance game has pushed this tendency for these kinds of things to happen. In 1975 when dental insurance plans came on the scene, people with these plans could receive up to $1000 worth of benefits in a calendar year REGARDLESS OF NEED but only for services that were included in the plan --ONCE APPROVED--and other services were excluded --REGARDLESS OF NEED. When the premium was $10-15/month for a family plan, it was easy to perk up an insurance benefit and people could receive some serious dental services. Today, those premiums have tripled or quadrupled, but the benefit cap for some plans is still $1000. That will "buy" about one third as many services as it would 30 years ago.

Re: being "clients" of a DMO or insurance program. Dentists become employed contrators of the plan and enter into a contractural arrangement with the plan to agree to provide services based on what is called a "usual/customary" fee for certain services. What is supposed to be an "average fee" can be different in the same community between various plans, many of which are with the same insurance carrier! So what's different between dental plans and medical plans? A lot. In our practice we work for our patients--not for a third party company that is in business to make profits. I believe it is better to focus on assessing current dental health factors, informing our patients (or their parents) of those findings and what treatments can be done to raise the level of health--if they choose-- and what investment in time, energy and money it will take to provide those services. Since I am not a "participating provider" patients are ultimately responsible for all fees. We jump through the appropriate hoops to help our patients maximize their benefits. If the plan will reimburse non-participating dentists directly, we can agree, once receiving a "pre-determination of benefits", to have that portion of fees paid directly to our office. Otherwise the patient pays the fee in full, insurance claims are submitted electronically the day of service, and the patient receives their benefit usually within 1-2 weeks.

We even stopped calling these plans "dental insurance" preferring as a more accurate term "pre-paid partial reimbursement." There are pluses and minuses to this approach. With this present economy, many people are dependent on any benefits to do any treatment, and they may have to choose an "in-network" office instead of coming to us. We have financing options available with 3rd party financing programs(for health care only) or credit cards.

It's important to point out that my dental office is like a small hospital with a physical facility, equipment, a staff and supplies. Fees have to support all of these costs of creating and maintaining the facility and provide appropriate compensation for the doctor. Compare this to the hospital in the medical system. When I was 5 years old, I had a tonsillectomy, was in a private room for one night, and all fees, including the doctor's fee ($50), totalled less than $100! (my father gave me my actual hospital bill which was paid IN FULL by the family health plan). What would that cost today?

Excuse my rambling, but there are thousands of dentists who are working from a service-focused direction with the best interests of their patients at the top of the list of priorities. We provide services that not only help people keep their teeth but enjoy attractive looking smiles and do it with comfort. I plan to do another reply that will address some of the other complaints of pediatric dental scamming. We do have an economy where we can choose those who provide our dental services. There are people who drive some distance to come to our practice because of the way we provide dental care. There are other people, just minutes from our office, who are focused entirely on getting the cheapest services and will go somewhere where these abuses occur. Sometimes it takes having an unsatisfactory experience that creates the awareness to look for something better. The best transaction (whether it is for a filling or a cap or an oil change for that matter) is one where the customer/client/patient receives value that exceeds the dollar cost of the product/service and the provider/seller/manufacturer receives appropriate compensation. IMHO that is the goal we could all aspire to achieve.