Fees, Overhead, & Insurance
Dental care is not a commodity. It's not laundry detergent or breakfast cereal
or wireless minutes. Dentistry is a professional service that's both art and a
science. Yes, there are excellent dentists and not-so-great dentists. Often, you
get what you pay for.
Overhead costs are huge. Anywhere from 60% to 80% of what a patient pays goes
toward the expense of running a modern dental practice. Dentists pay for rent or
mortgage payments on their office space, payroll for hygienists, office managers
and receptionists, health insurance, taxes, supplies, business insurance and
technology - just to name a few. "A lot of people would be surprised to know how
tight the profit margins are," Dr. W. says. And many dentists are still paying
student loans from dental school.
Labs differ in the quality of the products they produce. We all want our
dentists to be using high-quality labs for things like crowns and dentures.
Should we have to ask about the labs? No. We should trust our dentists to select
a good one. "In my view, you always want to use a good lab," Dr. M. said,
"because if the crown breaks, I'm the one stuck redoing the thing for another
hour and a half for free. It's important to make sure I'm putting good stuff in
people's mouths, because the last thing anyone wants to deal with is a redo. It
doesn't make me look good, the patients get angry, insurance doesn't cover it,
and it's a waste of time. You want to do a good job." Dr. M. has invested in a
$100,000 machine that lets him make the crowns himself and cement them in one
visit. He says patients love it and it allows him to control the process and do
a better job. His fee, however, is higher than many in the area.
Insurance isn't really insurance. Dental insurance, the dentists told me, is
nothing like health insurance or auto insurance. It's a maintenance plan that
will cover cleanings and x-rays, maybe half the cost of a crown. It will not
protect you if you need a lot of work done. The maximum annual benefits, $1,000
to $1,500, haven't changed in the 50 years since dental insurance became
available. "It's a minor cost assistance, and there's a widening divide between
patients' expectations of their dental insurance coverage and the actual
coverage that's provided," says Dr. W.
Dental insurance drives docs nuts and they wish they didn't have to use it. "The
number one most complicated aspect of running a dental office, bar none, is
dealing with dental insurance. You wouldn't believe how long it takes to get
through to a rep, make sure the patient does have benefits, calculate a copay,"
says Dr. M. And the largest insurance plans in the country discount most
dentists' fees by 10% to 20%. If you're paying out of pocket, ask for a
discount. (You might discover the dentist is giving you one already.)
Dentists wish patients would value their teeth more. Teeth are a crucial part of
health and appearance. Untreated gum disease, for instance, is linked to heart
disease. (Would you choose a cardiologist based on price?) "With time, you will
come to realize that shopping price is a minor concern when it comes to your
health," says Dr. W. "Any minor cost differences amortized out over a lifetime
will become insignificant. You will get the best results and have the most
long-term satisfaction getting care from someone you trust."
So if you're convinced dentists are worth their fees, how do you find a good
one? The dentists had some suggestions:
Ask if he or she uses specialists. Who does your root canals? If the person on
the phone says, "We do everything here, that would scare me," Dr. M. says.
Ask your primary care physician which dentist she uses. Ask your lawyer. Ask
your boss. In other words, ask professional people whom they trust with their
Ask a dental specialist, like an endodontist. One specialist wrote to tell me,
"The best way to find a good dentist is to find a specialist who sees
everyone's patients on a referral basis. He or she will know who is good and
who isn't. Trust me, as a specialist, I know who is doing what, because I see
their work every day."
If a dentist doesn't take insurance, because he or she doesn't need to, that
will be a pretty good dentist. Those pros can book you for longer, and they
don't have to work under the constraints of insurance companies. Be prepared
to pay higher fees.
Look and look some more. Interview dentists, if they'll let you. Take the view
that your teeth are a lifetime investment.