WatchMy old dentist stopped taking Delta Dental, so when I had a pain in a tooth I went to a new dentist who does take Delta. He did some xrays and a diagnostic cast. I was not that thrilled with the new dentist, but even less so when I got his bill for $339.
But then I got the Delta statement, which said that the provider "agrees to Delta Dental's determination of the accepted fee." Delta said the fees should have been $258 of which they pay 90%, and my co-pay is 10%, so I should just pay him $25.80 because that's what his contract with Delta says.
So I paid him the $25.80. Then his office sent me a letter claiming I was late with the remaining $81. I sent him a copy of Delta's notice that he agreed by contract to Delta's determination of the accepted fee. He claimed the bill for the remaining $81 was just a mistake. I think he just bills people to see if they will pay more than they are supposed to.
In this case, I'm actually very happy with a private insurer, because the insurer limited what the provider could charge. The free market works reasonably for these kind of things because it's not a pay-or-die situation.
Still, I wish there were some legal requirement for medical personnel to disclose fees and exact insurance coverage before non-critical work is done. Otherwise, you're just ordering off a menu with no prices on it. No, even worse: the waiter is ordering for you and not telling you the prices.
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Patrick says
Sweden has implemented a number of free
market reforms which, in some cases, even surpass the US system. School vouchers
were successfully introduced, creating competition within the frame of public
financing. Similar systems are increasingly being implemented in other public
programs as well, such as health care and elderly care. Another example is that the
pension system has been partially privatized, giving citizens some control over their
mandated retirement savings
Free market works well, when the people in power don't take advantage of the consumer.
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austrian_man says
One other requirement: the people in power can't let the corporations and monpolies take advantage of the consumer either.
If you limit government power but leave corporate and monpoly power unchecked, you just as screwed. Probably much more so.
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Bellingham, WA
Patrick says
We had a real-life demonstration of that. It was called the latter half of the 1800s.
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Bellingham, WA
"School vouchers were successfully introduced, creating competition within the frame of public financing. "
The wisdom of the Swedish system is that if schools take vouchers, they can't bill any more money, so vouchers are not price-supports.
I guarantee you vouchers in this country would not work like that. We are far too corrupt and self-dealing these days.
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Patrick says
You're right. How do you ensure there's fair competition? Doesn't it occur naturally anyway?
Corporations get greedy, that's when they start acquiring, grow larger and then become TBTF I guess.
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jag788's website
I had the exact same billing issues happen with my dentist years ago, with the exact same outcome. I have learned to keep records of everything, for any medical, dental or vision work. I also noticed a growing trend where dentist bill your insurance company 3-4 times, maybe in hopes a charge will go through twice?
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This is very common in medical insurance. It is illegal! The provider sends you a bill. You pay the bill. Then you discover that your insurer has already paid the "reasonable and customary" fee. You then have to spend a lot of time getting the overpayment back. When you get a bill from a medical provider and you have insurance: 1. Find out from the insurer what your proper co-payment is. 2. If the sum your provider is charging you is greater than the amount shown on the bill, call your provider and ask for a corrected bill. 3. If the provider tries to claim that you owe the larger amount, recite the three magic words, "this is illegal." I guarantee that they will back off at that point.
Medical providers are always trying this one--don't let them get away with it.
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I think he just bills people to see if they will pay more than they are supposed to.
I think you are right. A lot of stupid people would just pay it too.
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austrian_man says
The main thing is to stop large private campaign contributions.
Those contributions always come with strings attached, and those strings are usually about defeating the free market and fair compeition.
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BTW, can anyone recommend a dentist around Menlo Park or Palo Alto that takes Delta and won't over-treat everything?
If they recommend replacing all my perfectly good filings, they're out.
If they wiggle my jaw until it hurts and then tell me I have a jaw problem, they're out.
If they try hard to sell me a "night guard", they're out.
I want minimal treatment, and I want them to ask me before doing or ordering anything.
Maybe that's too much to ask.
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I would also like to hear dentist recommendations in the southbay "fortress" area.
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Patrick says
I can't recommend you a dentist, but from what I can tell, the only way to find a good one is to shop around until you find one, and avoid anyplace that's a chain or that advertises.
I'd also add this to your list:
Some dental places don't do regular fillings (as in with a drill). They use some sort of other procedure to blast out the bad parts (IIRC using air pressure, this was more than 10 years ago though). It's way more expensive and isn't covered by insurance. If the place you go to only does that, then run as fast as you can get out of the chair.
Another thing is that asking around isn't necessarily helpful. If you have bad teeth and ask around, you will come across plenty of people who have normal teeth who go to average dentists who will say they they are fine, but in reality, if you have bad teeth, an average dentist isn't your best choice. you would need a particularly good dentist.
I know all this because I grew up going to an average to below average dentist, and when I got my own good dentist, I could really tell the difference. That and I moved around a lot at one point so I know the difference. Yeah, I have a ton of root canals, crown, implants. but very few cavities since most of those were removed when I got crowns or entire replacement teeth.
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We get bills from doctors almost every month despite the fact that we have insurance. My father used an anatheseologist several years ago and occassionaly we get bills and letters from him. He told him that he wasn't going to pay since the insurance reimbursement should be enough, but he refused to take no for an answer. Apparently he refused to take my father's insurance, despite the fact that the doctor who was working alongside the anathesologist and did the procedure took the insurance.
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That's a great example of why all the charges and insurance reimbursement rates should be spelled out up front, before the procedure. At least they should give you a decent estimate like an auto shop would.
There really ought to be a law.
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Hi,
I've never posted here, but love the site and figured that finally I can add something of some value.
I am a root canal specialist in SF.
I work with about 50 dental offices who refer to my practice to perform root canal procedures for their patients. I see it all, every type of practice.
If you are looking for a dentist, here are some guidelines:
The dentist should own their own practice (the buck stops there).
They should be between 35 and 55 years old (experienced, but not out of touch).
They should NOT be networked with too many insurances. Those that take multiple insurances need the business and must rip through procedures quickly to earn a reasonable living. Ideally, a fee for service practice is the best. Trust me when I say that in the end, it is much less expensive. Non-networked practices will help you with your insurance and may only cost slightly more than a networked provider. Standards, ethics, and quality are key here. FYI, Delta Dental is not too bad (currently) and is the only insurance that almost all of us take.
Avoid flashy offices.
Avoid "cosmetic" dentists.
Avoid any dentist who wants to replace your working silver (amalgam) fillings with composite (white) fillings. These guys will keep me in business for a long, long time. My amalgams have been in my mouth for more than 20 years. Yours?
The bottom line is that all you need is an ethical dentist. An ethical dentist won't come up with a $20k treatment plan. They won't do anything that they know a specialist will do better (implant placement, molar root canals). They will do what you need and only what you need first and foremost. They won't fix what isn't broken. They will develop a personal/professional relationship with you.
I hope this helps :)
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Thanks! That really is helpful.
The problem is actually that a composite filling has cracked after 15 years, so I need to replace it. I also have some amalgam fillings for more than twice as long, and there is no problem with them.
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Patrick says
I agree. Yes, I also had problems with going to the doctor and them maybe or maybe not using a lab that takes your insurance. Same thing as your doctor being on your insurance, but then the other people they work with being out of network, etc.
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Patrick says
I have done this lost of times with dental work. You have to get the dental office to submit the procedure codes to your insurance and wait 4-6 weeks to get an answer (it comes in the form of a letter mailed to your home). The time lag being a major flaw here since if it's late in the year the point is moot because your dental insurance will change for the next year. That's a major drawback since the paltry annual dental limits dictate that you use it or lose it by the end of the year.
This was done I think with Delta Dental or whatever Wells Fargo was using at the time (which I'm reasonably sure was Delta Dental).
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jvolstad's website
http://www.trdp.org/
I use TRICARE (Delta Dental). Not too many dentists take this insurance, but found a great doc in Foster City. I'm one of his few non-chinese patients.
http://wenwudds.com/dental/index.php
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jvolstad's website
Patrick says
Try Dr. Wu. I'm sure he also takes "regular" (non-military) Delta Dental.
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francophile100 says
A good dentist is worth driving across town for. I do it.
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I am a retired DDS. I had my own private practice for over 30 years and I agree 100% with endodoc..find a dentist with lots of experience because there is no substitute for this. Don't be talked into having silver replaced with composite unless you want the change..the best way to find a good dentist is ask friends. Good luck to all...
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Stay away from practice that takes HMO. Stay away from western dental and access dental.
I am dentist also.
Gabe
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Keep in mind the following:
Dentist are only trained to deal with your mouth. We are now discovering that the mouth and teeth have a lot to do with your body's overall health. Example: Heart disease and root canals are definitely connected.
Never trust the ADA (or AMA). The ADA is a massive trade union representing dentist - not patients. Their main purpose is to help members make more money. They have been called a group of thugs by dentists who disagree with their policy. You wouldn't trust the NAR would you? Same kind of association, different industry.
Most dentists are ill-informed by their trade propaganda (aren't we all). The internet and your brain are a much better source of accurate, patient-oriented information.
Amalgams. This is a marketing term for Mercury fillings. Mercury is highly toxic. These fillings leach mercury over time that gets absorbed by your body. Unless you are a super healthy person on a perfect diet the body will not be able to push the mercury out of your body - so it will store it in your tissue, organs (brain included), joints, etc.
Amalgam fillings require the dentist to drill out more of your tooth. And they expand over time - the result is cracked teeth - which leads to a root canal. That keeps the endos busy.
In fact Amalgams have been banned in many countries and in parts of California. The US, often behind the curve, just announced a "phase out" of mercury in dentistry. Someone, somewhere, thinks mercury is a bad idea.
My dentist thinks any metal in the mouth is a bad idea. He hasn't placed a mercury filling in 20 years (Over 60% of US dentists won't place Amalgams anymore). He said dentists like Amalgam because it is more profitable - it doesn't take much chair time - you are in and out quickly. That is the real reason dentists like Amalgam. They will give you all sorts of BS about it being stronger and lasting longer (that comes from their trade union). Remember, they don't care about your health - they have million dollar house payments, Mercedes leases, etc.
More:
Dentists are the least healthy of medical professionals. They have twice the divorce rate, twice the suicide rate, retire earlier, etc. Many dentists now believe it is from their own exposure to mercury while placing fillings.
I met a dentist who has a dental materials company (he is high up in the dental food chain and well respected). He used to sell Amalgams so he is very familiar with the industry. I asked why Amalgams haven't been banned in the US. He said simply legal liability. He said it would be a trillion dollar liability under the US legal system. If the industry admitted Amalgams were toxic they would have to replace all of the fillings..
He said if you ever meet a dentist who still places Amalgams - RUN!
But Pat, I totally agree with you on a law requiring all health professionals to disclose the cost before service. I had the same issue with taking my infant son to a pediatrician for a sever cold. I was paying cash mind you. And no one in the office would even give me a rough estimate of the cost. Once the appointment was done they gave me a bill ($175). Obviously they could have told me a what a routine doctor visit would have cost before hand. Oh, and then a week later I received a bill in the mail!!!!! I chewed them out for that one - I was NOT nice.
My perspective:
I have lived in several different countries and used their medical systems. The US ranks the lowest of them all - and I lived in some third world countries.
My philosophy now is that it is my body and I am the only one who cares about it. I get as informed as I can and always double check what the doctor or the industry recommends.
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imagine a cash-based health care system instead of one with trillions of dollars in government or health insurer funny money setting the prices of "reasonable" care.
Imagine a system in which doctors can't set rates based on the trough of money in government or insurer coffers, but actually have to accept clients and follow treatment plans based on what the customer can actually pay with cash or credit.
We are not alone in wanting our government to provide equitably, minimally for our health care, retirement, or medicine but we are also not alone in living in a country where social services to provide health care, retirement, and medicine for the elderly and economically disadvantaged is simply not sustainable in the long term.
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zzyzzx says
Just had my first child and seeing plenty of medical bills. A thought like the one I quoted has crossed my mind, but I think there's also room to believe the whole insurance system is so complicated, perhaps by design, that the doctors/praticioners don't understand it. The communication and understanding between insurance companies and doctors may be so poor that the doctors don't know how much they're owed. The statements are written very confusingly. Some remind me of the paperwork for financing a car purchase.
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Global Roamer is correct about amalgams. Amalgams are dangerous. I found a mercury free dentist that also takes extra precautions when moving amalgams. My dentist actually almost lost his kidneys from the mercury from amalgams in his system. This is no joke. Everyone's tolerance for mercury is different.
I think it may have been affecting my health I had four amalgams since childhood. They crack your teeth eventually from hot and cold variations. The bacteria gets beneath the amalgam filling and rots your teeth under the amalgam. My dentist has documented this and teaches at the dental school. So since the bacteria in the mouth is associated with other health problems, this makes the amalgams very dangerous to your overall health. This is even without the toxic mercury that can affect all sorts of important things in your body.
I have a friend that was poisoned with mercury when all her amalgams were removed at once. The lesson is if you have lots take them out over time and get a professional that will not vaporize the mercury so that you inhale it into your system.
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I don't know that mercury fillings are so bad. Aside from the brain damage the far right-wingers accuse me of, I don't think my mercury fillings have hurt me at all.
And on the other hand, the reason I need a dentist now is that a ceramic composite filling cracked. And that's my newest filling. All the old mercury amalgam ones are uncracked and doing well.
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Dentists and hospitals are notorious for trying to pull a fast one on their patients. Good catch Patrick!
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Why would anyone bless an insurance company. They are just a middle man between you and the doctors, lawyers, etc., essentially sucking off the every day man and woman, creating jobs where people sit around in office buildings playing around with and crunching statistical numbers in order to find a way to get more money out of people somehow or another, while also giving less, and less, and less, and less back.
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I just received a delta dental statement also, saying that I owe the dentist I went to. The dentist I went to, did an xray, cleaning and an evaluation. Before I signed papers, his employees had called my insurance company and explained to me what I would be paying. That day that I went in, I paid the 53.10 that he is saying I owe him. I have my bank statement to prove that I paid, the evaluation paper of what my insurance is covering and what I would have to pay out of my pocket and the receipt!
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Berkeley, CA
Dental in the US is nuts . I am Irish and have had my teeth maintained under a socialist system of free health care . Basically my employer and I paid into a system where I could have 2 free checks up's and a 2 free cleanings a year .
I have been in the US for 6 months and so far I have had 3 wisdom teeth removed and they have repaired a old chip on a front tooth .
When they hear that I don't have dental insurance they go into complete meltdown . They seemed to be stunned that I am happy to pay for it out of my own pocket . However it does not stop them from going about how much better dental care is in the US compared to Europe .
My wife is a ER Doctor in a poor area and her boss is always on to her about how to ' bill better '
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Patrick says
Big companies suck. People join them to feel safe. They suck. They destroy innovation and the human soul and all they do is give us federal reserve notes in exchange for our lives. We are dying, one minute at a time, and spending it within the walls of cube farms, away from kids and family, earning monopoly money they can hedge against but we the sheeple cannot. Now get busy filling out TPS reports. The other worst thing about big companies is they allow the DSM IV certified psychopaths and sociopaths a venue to leverage their severe mental illness into massive success - Machiavellian psychos who only feel good going up if they beat someone else down.
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I am self employed and have been for about twenty years. I have a wife and one child we had Health Net, after switching from Kaiser, for health and Delta for dental.
In 2004 I talked my wife into dropping all and paying for doctor and dental services out of pocket. We do have a policy to cover major hospitalization .
I have found that Labs, Doctors, and Dental offices all negotiate if you ask. I always ask how much before I accept services. The discount is usually around 25%. We have also had to pay for my wife's treatment for Graves including all lab and other tests.
In the past eight years I calculate we have saved over fifty five thousand dollars and received better and more frequent service due to the fact we do pay cash.
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JeffreyB says
How much is that policy?
We pay $750/month to Blue Shield for a policy which just covers some preventive care and major medical. There is an $8,000 deductible, which means it basically pays nothing unless we get really sick.
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Agree with endodoc. I have gone to the same dental practice for 45 yrs. They take Delta Dental & most of the time are OK on the bill. However the front office personnel seem to change a lot. Occasionally they bill Delta incorrectly & they refuse to pay. So just call Delta & give them the procedure code. Delta can tell you the correct one & you can inform the dentist.
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grinderman says
where is this? every er doc I've ever known works straight shift work as a hospital employee. I've never heard of an er doc billing.
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JeffreyB says
I had a high-deductible health plan aka "catastrophic health insurance" for many years and thought it was a great option. But that was before the law changes in 2004 that set up health savings accounts, so I don't know how it works now. If you and I could convince the rest of America to use hd plans and pay routine care out of pocket, health care costs would drop by at least 50%. Unfortunately it will never happen.
I believe that hd plans are going to get a lot more expensive or unavailable under obamacare. The final rules aren't all that clear, but these plans are going to have to cover a lot more than they used to. That's really too bad.
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Hi Patrick, the policy we have is a ppo 2500.
the policy costs about $425 a month. Coverage to $1,000,000
We are both in our 50s and in mostly good health. One child 15.
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And won't work at all with an ambient ethos in which all services are organized along the lines of 'how savagely can we rob, defraud and ass fuck the consumer before there is a chance of getting indicted or sued and who do we lobby to change the law so it's impossible for the consumer to defend themselves?'
uomo_senza_nome says