Re: Need help! Is office gal telling us the truth or lying?

>
> 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.

--
..

Amatus

..
"arline" <arlinekal@xxxxxxxxxxx> wrote in message
news:arline.1u41py@xxxxxxxxxxxxxxxx
>
> 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!
>
>
> --
> arline
> ------------------------------------------------------------------------
> arline's Profile: http://dentalcom.net/forum/member.php?userid=812
> View this thread: http://dentalcom.net/forum/showthread.php?t=2716
>


.

Relevant Pages

  • Re: Need help! Is office gal telling us the truth or lying?
    ... >> (most all procedures are at no or low co-pay, ... we have to pay a $100 upgrade per tooth to have a GOLD ... >> is that only teeth 6-11 on the uppers are covered for porcelain. ...
    (sci.med.dentistry)
  • Re: Need help! Is office gal telling us the truth or lying?
    ... and longevity to pay the upgrade from silver metal to gold for either the underneath portion of a porcelain crown or even just for the very rear molars that would not be porcelainized? ... will not usually show on the crown on posterior teeth unless they are very obvious. ... doesn't pay them that much for all this work, ...
    (sci.med.dentistry)
  • Re: Need help! Is office gal telling us the truth or lying?
    ... insurance company will pay for x, y, and z. ... presenting alternatives such as porcelain butt shoulders. ... If my memory serves correctly, this plan may have a limit of $1,000 or ... teeth #6-11 on the upper are considered the ones to be normally covered ...
    (sci.med.dentistry)
  • Re: Ive seen things you people wouldnt believe...
    ... braces for teeth for actual _problems_ such as badly misaligned teeth, ... you guys seem to pay through the nose for it. ... doctors you'd see if you went private usually work for the NHS first, ... When you need drugs on a private prescription, ...
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  • Re: Need help! Is office gal telling us the truth or lying?
    ... A multi-tooth bridge replacement that is ... > currently a temporary stayplate (teeth 3,4,5,6,7) that should have been ... > crown that needs to be replaced and then he has a broken bridge on ... > is that only teeth 6-11 on the uppers are covered for porcelain. ...
    (sci.med.dentistry)