Question:
My health plan includes a dental plan benefit. The catch is that I have to give
up my dentist of 18 years and go to a dentist affiliated with my health plan.
I recently tried this new dentist. For a $10.00 co-payment I got a cleaning and
a couple of X-rays. This seems pretty reasonable except that this dentist
recommended that I get three old fillings replaced with new ones and another
filling be replaced by a crown. Net cost to me approximately $700.00, net cost
to the health plan...who knows?!
Now I wonder if this health plan dentist isn't milking the dental plan and
his unsuspecting patients for an aweful lot of needless work.
I wonder if other people are having similar experiences with dental plan dentists.
Answer:
Heath care premiums are also skyrocketing because there is no desire on the part
of your health plan carrier to control costs. They know most companies MUST offer
health care, so there is no benefit to reducing their percentage of the growing
costs.
Try, for example, getting your health carrier to tell you how much they will pay for
a particular service. With this information you could shop for a doctor who only
charged what they pay. Most carriers will tell you to have a doctor (after a paid
visit) submit their estimate directly to the carrier, and then will tell you how
much of that estimate they will pay. The amount paid CANNOT even be assumed to be
the amount they would pay on a lower estimate from another doctor.
It is just as likely that the original dentist did a poor job when he
worked on your teeth before and he doesn't want to admit that he isn't
a very good dentist.
You really have no evidence that the new dentist is trying to cheat you.
Before you accuse the new dentist of doing something wrong you should
get another opinion from a third (and impartial) dentist.
One more thing to keep in mind is that this is not only a matter of
money. Your health could be affected by this. Don't assume that the
cheapest solution is the best solution.
My health plan is an HMO. They seem to be able to control their costs very well.
The premium I pay is about 40% of what "The Blues" would charge.
However, I believe they're out of their league as respects to this dental plan.
I expect the dentist(s) they choose to deal with are taking full advantage of
the plan's lack of expertice in dentistry. I submit that these dentists offer
an extremely attractive package to get you "in the door." A $10.00 co-
payment is not bad for an exam and cleaning. What they get from the health
plan in addition is probably enough have a nice cash flow from all the patients
referred by the plan.
But, they make their money by recommending dental work that is not necessary.
This work is only covered for a fraction of the cost by the carrier. The
lion's share is paid by the patient.
I am writing to my carrier expressing my concerns over this, and if possible
would they consider amending the dental plan so that I may choose my own
dentist. If not, I'll just use my own dentist anyway.
