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I think my dentist is ripping me off.

wingsandsword

Villager
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?
 

Morrus

Well, that was fun
Staff member
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.
 

Janx

Adventurer
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.
 

wingsandsword

Villager
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.
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.
 

Blue

Orcus on a bad hair day
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.
 

Eltab

Villager
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.)
 

Zardnaar

Adventurer
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.
 

cbwjm

I can add a custom title.
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.
 

Morrus

Well, that was fun
Staff member
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.
Sounds to me like your insurance is the problem, not the dentist.
 
I've had this problem. Sometimes it seems like a dentist's "thing".

I see a dentist every year and get cleanings once to twice per year. Moved to a new place, and the dentist told me I needed periodontal treatment. When through all the pain of getting that approved, treated, etc, and put on the every-three-month schedule. OK, fine -- though there was a % out of pocket, plus the dentist's office would push some "extra" treatment (basically a point injection/spray) that my insurance would not cover, every time I came in.

Relocated, new dentist -- no mention of need for periodontal treatment, just regular treatment.

Relocated again, back to the prior location and back to the prior dentist. They jumped right back on the "periodontal plus extras" treatment schedule. So I fired them (it did not help that they screwed up my billing, too). Found a new local dentist, started from scratch -- they basically told me that I had a couple of spots to watch, but did not go into the deep cleaning routine.

So it really feels like a racket with that one dentist.
 

wingsandsword

Villager
I've stopped using it. Prefer the brief pain over fuzzy headed for a bit. Injured myself a few years back and now normal levels of pain don't hurt as much.
You get fillings done without novocaine or anything similar? Just letting the dentist drill into a tooth without any numbing agent whatsoever?

That's a little higher on the Fort Save DC than I'd like like to repeat. I had a dentist do that to me once as a teenager, that was enough for a lifetime.
 

wingsandsword

Villager
I've had this problem. Sometimes it seems like a dentist's "thing".

I see a dentist every year and get cleanings once to twice per year. Moved to a new place, and the dentist told me I needed periodontal treatment. When through all the pain of getting that approved, treated, etc, and put on the every-three-month schedule. OK, fine -- though there was a % out of pocket, plus the dentist's office would push some "extra" treatment (basically a point injection/spray) that my insurance would not cover, every time I came in.

Relocated, new dentist -- no mention of need for periodontal treatment, just regular treatment.

Relocated again, back to the prior location and back to the prior dentist. They jumped right back on the "periodontal plus extras" treatment schedule. So I fired them (it did not help that they screwed up my billing, too). Found a new local dentist, started from scratch -- they basically told me that I had a couple of spots to watch, but did not go into the deep cleaning routine.

So it really feels like a racket with that one dentist.
Yeah, that's basically my suspicion on this, that it's something that this dentist is doing to maximize his take, to engage in bill padding.

I'm planning on seeing a second dentist, getting a second opinion. If a second dentist says I don't need this 4x a year schedule with bigger, more expensive appointments, I'll trust the second opinion on that.

The fact that every visit after the first one has involved the dentist saying there are no problems, no issues, everything's looking good ect. . .makes me very suspicious about this.
 

Morrus

Well, that was fun
Staff member
You get fillings done without novocaine or anything similar? Just letting the dentist drill into a tooth without any numbing agent whatsoever?

That's a little higher on the Fort Save DC than I'd like like to repeat. I had a dentist do that to me once as a teenager, that was enough for a lifetime.
Zardnaar watched Marathon Man’s torture scene and thought “I can do that!”

In other news, I have never heard of a dentist who would do a filling without a local anaesthetic.
 

wingsandsword

Villager
Sounds to me like your insurance is the problem, not the dentist.
Remember that healthcare, including dentistry, in the US is almost entirely profit driven.

If a dentist can find a way to justify extra visits, at a more expensive billing code, they may very well use them.

Rather than 2 visits a year at ~$70 each, billing for 4 visits a year at ~$180 each and telling the patient it's medically necessary (as long as they can find some plausible way to justify that to the insurance company, even if it's not strictly needed) is something many dentists would do here. That way the dentist would be making about 5 times more off me a year than they would with normal, standard 2x/year cleanings that wouldn't cost me anything out-of-pocket from my insurance.

That's from his end, that's making $140 off me a year vs. making $720 off me a year.

From my end with my current insurance (which costs me about $80/month for dental insurance, which is completely separate from health insurance), it would be ~$0 out-of-pocket each year (for 2x/year regular cleanings), to paying ~$520 out-of-pocket a year (for the 4x/year "periodontal maintenance" visits he wants).

That's my suspicion.

(I know you live in the UK, I figured this might give some perspective on how it financially works here that is probably different than how it works there).
 

wingsandsword

Villager
Zardnaar watched Marathon Man’s torture scene and thought “I can do that!”

In other news, I have never heard of a dentist who would do a filling without a local anaesthetic.
The problem was that the doctor did it wrong.

He missed with the needle of Novocaine. Numbed part of my face and jaw, but that tooth still had sensation.

He ignored me when I tried to tell him I could feel everything and it HURT. He said I was faking it and being dramatic, and when I tried to resist, he had his hygienist physically hold me down while he drilled one of my molars and filled it.

He thought because my tongue was numb and I was talking funny from the novocaine having numbed part of my face, that the tooth had to be numb too and I was lying about feeling it all as he drilled in.

That was a quarter century ago. Still remember it vividly. It's why, aside from mandatory dental checkups in the Army (where they said they saw no issue requiring treatment, my last one being about a year before I went to this dentist who was making such a hubbub about me needing all this treatment) and having my wisdom teeth cut out in the Army (because they're fanatical about that) I didn't see a dentist for around 20 years.
 

Morrus

Well, that was fun
Staff member
(I know you live in the UK, I figured this might give some perspective on how it financially works here that is probably different than how it works there).
Dentists aren’t usually on the NHS, and we rarely have dental insurance. My dentist is private and I pay for everything. $80 sounds quite reasonable.
 

Morrus

Well, that was fun
Staff member
He ignored me when I tried to tell him I could feel everything and it HURT. He said I was faking it and being dramatic, and when I tried to resist, he had his hygienist physically hold me down while he drilled one of my molars and filled it.
.
Seriously? Somebody held you down and drilled into your tooth against your will?

Medical procedures without consent are criminal acts. If what you are saying is true, you’ve been seriously assaulted by somebody who should be in prison.

I don't really know what to say. You have dentists holding you down and torturing you against your will, dentists fraudulently forcing you to undertake expensive treatment plans your insurance won't pay for... I dunno. Did you offend the Dentist Illuminati?
 
Last edited:

Scott DeWar

Prof. Emeritus-Supernatural Events/Countermeasure
You get fillings done without novocaine or anything similar? Just letting the dentist drill into a tooth without any numbing agent whatsoever?

That's a little higher on the Fort Save DC than I'd like like to repeat. I had a dentist do that to me once as a teenager, that was enough for a lifetime.
when I was 10, I had 6 fillings without Novocain. I also walked in to the ER in 2011 at the age of 48 with full on septic shock that had the docs put me in an induced coma for 6 weeks. one filling is noting on the pain scale now days.
 

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