Yesterday, I saw a patient I’ve been seeing for only a couple of months. He has fairly extensive restorative needs, and we’re “chipping away” at them. He’s lost some teeth. Others needed root canal therapy. Multiple crowns are in progress and planned. Implants are in his future, too.
At yesterday’s appointment, I did a core build-up and crown on #15, which recently had endodontic treatment. It was not an easy tooth to restore due to extensive damage and difficult clinical access. Thankfully, using the Isolite made a nearly impossible job quite a bit easier (than it would have been).
It was still a challenge. And, the patient took notice how hard I was working. After we were done, this conversation followed:
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“Can I ask you a question?”
Sure!
“I see advertisements for crowns as low as $450. (My fee is triple that.) How can they possibly come out ahead if they have to work as hard as you did on that tooth?”
That’s a good question. And, if I didn’t have some experience in seeing what really goes on with those clinics, I’d wonder, too. There are two possibilities, and I’ve seen both. The first is that they DON’T spend that kind of TIME restoring the tooth. The second approach is that the advertised fee is rarely the real bottom line fee. They add on a lot of extra charges for things that are normally included such as: the temporary crown, anesthesia, gingival retraction, “desensitization,” adjusting the bite on the temporary, adjusting the bite on the final crown, and so on. (I’m not making any of this up, folks.) My fee is all-inclusive. No surprises. No extra charges. I do whatever I need to do to make it right.
Furthermore, a crown is not a crown is not a crown. There are different levels of skill. There are different qualities of materials and lab work (craftsmanship). It’s no different than any other professional field.
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It’s nice when a patient appreciates that there IS a difference and that not all dentists are the same. In this economy, it’s an even bigger challenge to find patients who understand that you often DO “get what you paid for.” Dr. X’s crown is NOT necessarily the same as Dr. Y’s crown.
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I’m glad you posted this and I wish more people would become aware of these tactics. I’m not saying ALL dentists do this but I believe it is way more common than we might believe. I recently had a patient that we recommended periodontal scaling procedures leave because we were “too much” especially because we were not in network. They returned a couple weeks later to our office to get the work done. They shared with me the treatment plan. They shared with me the other plan and in addition to the root planing code each quadrant also included root desensitization, gingival curretage, subgingival irrigation, & specialized o.h. instruction…when all was said and done the fee was greater than ours!
About a year and a half ago I received a request from one of my dental supply reps that I allow a doc they were setting up in a small town to see how my office computers and operatory computers were set up. So we got talking about business and such and insurance came up. I told him I was not a fan of PPO’s and he said, “You need to learn how to play the game.” Pretending to be naive I asked him to explain “the game”? He went on to basically explain bundling of fees and using extra charges as you described above.
Like I said, I don’t think all dentists do this but I also believe it is more common than one might imagine.
Ken
Hi Ken,
Thanks for chiming in. In my 24 years of experience and observation, it is VERY common.
thanks for sharing