I think my dentist is ripping me off.

I think my dentist is ripping me off.

Let me give some explanation.

I went roughly 20 years with almost no dental care. An incompetent small-town dentist back in Stanford that did a filling on me without proper anesthetic left me deeply dreading dentists. I couldn't afford a dentist most of my adult life and didn't have dental insurance. When I was in the Army, all they cared about was getting my wisdom teeth out, cleanings or maintenance was something they didn't really provide nor care about.

In November 2016, I finally go to a dentist. The dentist office is fancy and elaborate and expensive-looking, more like a hotel lobby than a medical office. They tell me I need a deep cleaning, a rather invasive cleaning that takes a couple of sessions back-to-back. Since I hadn't been to the dentist since the Clinton Administration, that seemed plausible.

After that, they want me to come back in 3 months for a follow-up. I do that. Then another 3 months, and so on.

Insurance only pays for 2 cleanings a year, so the last 2 of these annual quarterly cleanings were out-of-pocket to me. Also, at every quarterly visit for the next two years they tell me I'm doing great, no signs of dental problems, everything looks good.

Well, I start to get suspicious about why I'm having to come in quarterly and pay out-of-pocket every 3 months for a checkup when everything seems fine every time, when every 6 months is the norm and what my insurance pays for.

I finally asked my dentist office about it. What changed things was that I got new dental insurance this year, and suddenly I'm not getting ANY of my visits covered fully, that my first visit of the year (which was previously free) was now $80.

They said that because I'd had a deep cleaning, I didn't qualify for normal dental cleanings anymore, that I was now on "periodontal maintenance", which is why I had to come in every 3 months. It didn't matter that the cleaning was almost 3 years ago, that I'd be coming in every 3 months from now on for the rest of my life, and they would all be billed as "periodontal maintenance" (which is more expensive than a normal cleaning), and even tried to say I was outright ineligible for normal cleanings from now on and that if they tried to submit a claim for a routine cleaning that the insurance company would reject it because I've previously had that deep cleaning.

My new insurance doesn't fully cover ANY "periodontal maintenance" visits, although it does cover normal cleanings. So, they want me to come in 4 times a year, for 2 visits I'll be paying about $80 for out-of-pocket and 2 visits I'll be paying about $160 out of pocket for.

So, because I had a specific cleaning procedure almost 3 years ago, they're saying that for the rest of my life I'll have to come in once every 3 months, instead of 6 months for the rest of my life, and it always must be billed as a more expensive office visit and cleaning and can't be one of the two-a-year cleanings automatically covered by my dental insurance?

Yeah. I'm thinking I'm getting ripped off, but does anyone who knows more about dentistry and dental insurance have any more insight on this?

IANAD, but periodontal maintenance probably means you have gum disease, which can be halted/held at bay by ongoing maintenance but the damage can't be reversed. Those 20 years without visiting a dentist is probably when that set in.

Find a new dentist or tell them no, you're only coming in for what your insurance pays for,


When I changed companies, the new company didn't have dental insurance, so I paid cash to my dentist of nearly 20 years.

The next year we got insurance but my dentist wasn't in network. We went to these "other guys" and they did such a hard job on my gums (and my wifes because we both went in at the same time) and then said we'd need to come back in 3 months.


I never went back to that place and I returned to paying cash to my old dentist for the rest of that year. I paid less than what I'd been charged out of pocket to the "other guys" on that one bullcrap cleaning.

Don't take bullcrap unless you're throwing it at the jerk who gave it to you.

Morrus said:

IANAD, but periodontal maintenance probably means you have gum disease, which can be halted/held at bay by ongoing maintenance but the damage can't be reversed. Those 20 years without visiting a dentist is probably when that set in.

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Except every appointment after the first they say I'm fine, have no problems, have no issues ect.

I've not heard one bad word about the shape of my teeth or gums since that first appointment. The first couple of appointments they said they were monitoring the status of things since I'd not been to a dentist in so long, but things were looking very good.

Hence the extreme skepticism at this idea that I have to come in 4 times a year, for life, for extra expensive cleanings that my insurance won't pay. They aren't even telling me I'm in bad dental health, just that since I had this procedure done once, this is the way it has to be now.

Once you ave gum disease, you are at a high risk of it returning. Gum disease is linked to heart attack and such.

Insurance companies only want to pay two cleanings a year (or one cleaning every six months, which works out to be the same but you can't schedule the second too close or they deny it). Dentists want to permanently move you to every three months because of chance of recurrence.

IANAD, I can't give you any dental advice. I can say that dentists will go for minimizing risk, and insurance agencies will go for minimizing payout, and those don't always line up with each other, or with your personal needs and how risk adverse you are.

In other words, what you are saying does not sound like a particular dentist trying to scam you, but a common practice. But yes, it's a common practice which does favor them with being able to bill more.

Your dentist is not trying to rip you off, he is trying to create a new regular paying patient.
Talk to a couple of dentists about whatever shape your mouth is in - they cannot conspire against you if you do not mention that you are talking to others, but they will all diagnose whatever problems you have.

I have family that works in health insurance. Your story is familiar, based on the financial incentives to the dentist, and not automatically a sign of evil intent. (But no less annoying to experience, no doubt.)

I go about once a year. They send me it's time for blah blah blah every so often. Compromise and go twice a year. Over here the excess to claim is more than generic dental work. Anything expensive there is a dental school here I haven't had to resort to.

After 20 years I finally went to a dentist, thought I had some tooth decay (2 holes in the same place on opposite teeth), turns out I've just slowly ground down those two teeth. Had them fixed up and also had an amalgam filling replaced, fairly expensive but not too bad, won't be back to see them til next year.

People get an anesthetic for a simple filling? Now that's a rip off.

wingsandsword said:

Hence the extreme skepticism at this idea that I have to come in 4 times a year, for life, for extra expensive cleanings that my insurance won't pay. They aren't even telling me I'm in bad dental health, just that since I had this procedure done once, this is the way it has to be now.

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Sounds to me like your insurance is the problem, not the dentist.