Re: Is this dentist a con artist? Is this a fair price for what I got?



>I went in today for a crown, that is, preparing for the crown.
> My Delta PMI insurance is supposed to cover this so I was pretty sure
> it was going to be in the neighborhood of $275. But when I got there
> he told me it was going to be $525.

The prophesy came true.

> Let me clarify that I know Delta PMI is a rip-off; but this is the end
> of the year and I had already had this dentist examine me and
> determine that the crown was needed, and I did not want to switch
> dentists. I also am under the impression that the dentist does good
> work (the least painful shots I've had and he seems to know what he is
> doing (??), and he's a member of both the ADA and the state
> association for around 14 years, for what that's worth.

Just because the office might be mis-leading you on billing, does not mean
they are doing poor work. They might do fine work.

> Anyway, he says, "Look, it's like this: I send my lab work out to a
> lab that I work with and the prices Delta gave you are based on
> Delta's labs which I don't work with. If you want to have it done at
> that price you would have to make an appointment with another dentist,
> and that would be a shame since we're here today, ready to do it. I
> used to do it with their lab, but I don't any more."

Delta does not have any lab's. They do not specify which labs to use. None
of that is true. The dentist is free to choose any lab he wishes to work
with.

> I could see I was being snowed, but the fact is, I DID want to get it
> done today, and I figured by the time I dealt with the hassle of
> getting these x-rays transferred over to another dentist, or made
> another 2 appointments with another dentist before he'd do it, it was
> just too much trouble to go somewhere else to get it done. In other
> words, this guy had me by the balls.

Actually, you had him since it would have cost him more to have the empty
chair than it would have cost you to transfer records.

> But I said, "Tell me, doctor: Does this insurance really do me any
> good, or would it cost the same if I came in without the insurance?"
> He said, "Oh, no! The insurance is good, for YOU. But not for me. I
> only make a few dollars per month off insurance but you are getting a
> good deal because I usually charge $1200 for this." I said, "Really?"
> and he said "Yes, that's what I would usually charge."
>
> So here's how he broke down the price:
> "Treatment for Tooth" [what is this, exactly?] $ 30
> "Standard co-payment: PFM Crown or Onlay" 100
> "Porcelain" 150
> "Porcelain margin" 75
> "Noble or high noble metal" 200

The $30 charge make no sense. The plan may not have any coverage for
porcelain on molars, so he is charging you a premium to have porcelain. His
lab fee will be about $10 more for the porcelain. However, this is the
hidden part of the bait-and-switch. If he had disucssed this difference
with you ahead of time, it would have been more respectful. The lab will
charge him an extra $10-30 to make a porcelain margin. You probably don't
need a porcelain margin on a molar. I personally, made all my PFM crowns
the same way and just figured a porcelain margin into the fee for every
crown. Charging more for nobile metal is the other part of the
bait-and-switch. Again, I have never made a crown with anything except
high-noble metal, so it is just part of my standard fee. So, the dentist is
charging you $525, plus the $500 he gets from Delta. He now gets his real
fee (I doubt he really charges $1200 for a single crown without a build-up).
Sounds like bait-and-switch, oh, wait I already said that, sorry.

> After the procedure, he tells me, "I had to go very deep. I did not
> reach the pulp, but I still think you should get a root canal, just as
> a preventative, so that you don't need one later and have to drill
> through the crown to do it. If I were you, I'd schedule it now and get
> it done before I do the crown, just to prevent needing it later."

Adding in the RCT would be more bait-and-switch, but you later said he was
going to refer you to an endodontist for the RCT, so I cannot say that. He
should be able to tell ahead of time if a prophylactic RCT would be
indicated. Personally, I think that is almost never needed. W_B may
disagree, but that is okay.

> He came back after he did the impression and said, "So, do you want to
> schedule the root canal or not?"

If he was going to do the RCT, he should have stopped and finished the RCT,
first, then return to the crown preparation. Fit would be better that way.
And, why did he come back after the impression, he was supposed to make the
impression and be there while it is in your mouth.

> So then he put in the temporary filling or whatever it is, and then I
> went to pay the $525 and make an appointment for the crown to be
> installed in 2 weeks.

Hopefully you got a temporary crown which covers the entire tooth, is smooth
and comfortable to chew on. Not some junky "tin-can".

> I said, "Well that's strange because he just told me something
> different..."

Strange indeed

> What's up with this guy? Is he a TOTAL CON ARTIST, or what?

You are smart enough to figure it out.

> Did he change his mind because he realized insurance would not approve
> a "preventative" root canal?

Insurance company will pay for the RCT regardless. They will pay whatever
their rate is. In the PPO situation, the payment will be low, so I would
expect him to refer yours out, but do it himself for the regular fee
patients.

> Is it acceptable to prescribe a "preventative" root canal if one
> drills close to the pulp?

Sometimes.

> I specifically recall him saying "It's close enough to the pulp that I
> would go ahead and do it if I were you, but it's not NECESSARY." But
> he was definitely pushing for it and I said, "And what is the downside
> if I DON'T do the root canal now?" And he said "Then you might have to
> drill through the crown later, which would perhaps weaken it and lead
> to later chipping or cracking it".

There is no way to offer you any advice on this without seeing you IRL.

> I must say that I hate going to dentists and feeling I'm being sold
> *** I don't need. I hate going to a dentist and feeling like I'm
> dealing with a slimy used car salesman.

Give up on the HMO, the PPO and the discount plans then.



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Amatus

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