Pocket Dentist

Are there "caps" on what a dentist can charge for various services?

I'm not asking about insurance coverages or anything like that. What I want to know is does the dental associaiton limit the amount a dentist can charge for particular services or have a guideline for dentists to go by when pricing or is it up to the particular dentists' overhead? Also, is it ethical for cash buyers to be charged 4 times more than what an insurance company would be charged for the same service? I realize when a dentist accepts an insurance they're obligated to accept negotiated reduced fees in exchange for the business and experience. But then is it right for them to charge non-insured patients who are coming out of pocket for the whole thing (hence, no claim forms for them or waiting to get paid, or any of that hassle), 4-6 times more for the same service?

I'm a dentist.

My friend, there's a lot you don't understand.

Dentists (and physicians) have a fee schedule for every service they offer. This fee schedule is set for the year, and doesn't change. Each year, it goes up slightly.

When a patient comes to the office with an insurance policy with whom the doctor participates, they are obligated to ask from the patient for the "allowable" fee. Sometimes that allowable fee is as low as 50 or 60% of the actual fee listed on the doctor's fee schedule. For example, a dentist may ordinarily charge $1000 for a crown. Many insurance plans require that the doctor accept only $700 for the crown ($500 of which may come form insurance, and the rest of which comes from the patient "out of pocket"). That $300 is called an "insurance write-off". $700 out of $1000 isn't bad. Often times, the allowable fees dictated by most insurance plans for major work (e.g. crowns, bridges, root canals, 3rd molar extractions, etc.) is fairly reasonable. Why? Because if it wasn't, doctors wouldn't participate with these plans. And if doctors don't participate and the patient cannot make use the insurance policy, they find another policy. So, it's in the insurance company's best interest to make the doctor semi-happy when it comes to major work.

But what about routine dental work? The allowable fees range from mediocre to atrocious. We tend to get ripped off by insurance companies setting allowable fees as low as 20 or 30% for routine work like check-ups, cleanings, and fillings. And what kind of work do dentists spend the majority of their time doing? Routine work like check-ups and fillings.

So why would any doctor in his right mind participate with these insurance companies when they rip us off like this? Because they send us patients who MIGHT end up needing the more profitable major work. Every doctor's dream is to have a practice where all of its patients are fee-for-service, i.e. no insurance participation. But the reality is that such practices are relatively few and far between, because we need insurance companies to refer us patients more than we need to get paid what we'd like to charge for our work.

The upshot is that, when you don't have insurance (or don't have access to a dentist who participates with your insurance), you are subject to the fee listed on the doctor's fee schedule. Your insurance will pay whatever it's going to pay for the crown, and you're responsible for the rest.

We're not overcharging you by doing this. We're simply not undercharging you the way we do with patients on insurance plans with whom we participate.

For More Pocket Dentist Info Click On The Blue Links Below

Many people who plan to visit a cosmetic dentist for the first time find themselves unsure as to what to expect from an initial consultation. Unlike regular dentistry, cosmetic dentistry focus on the aesthetic aspects of teeth and offers a variety of treatments, some of which you might never have heard of. Since your cosmetic dental consultation is likely affect both your teeth and your wallet, it is important to know how to properly plan for the event. The following advice on how to prepare for a dental consultation and what to expect in return can be very useful:

Offer as much information as you can

The purpose of your cosmetic dental consultation is to review your dental and medical histories with the dentist, and to discuss your tooth-related wants and concerns. As part of the process, your dentist will conduct a visual examination of your mouth and teeth and determine which, if any, additional diagnostic methods might be necessary in order to see the full picture. In order to help your cosmetic dentist, be prepared to discuss the aspects of your teeth that you are looking to fix. Be sure to arrive at that dental office knowing what your priorities are so that your dentist can come up with a course of treatment that will best work to suit your needs. In order to ensure that your desired procedures won't compromise your health in any way, you'll need to provide your dentist with a list of all of the medications that you are currently taking. You should also notify your dentist of any allergies or sensitivities that you might have. Finally, be sure to alert your dentist as to any medical conditions that might be of concern with respect to treatment. You will probably be asked to fill out a medical history form, but feel free to supplement the information on this form via a verbal discussion with the dentist.

Take that insurance card with you

If you happen to have dental insurance, then be sure to bring the relevant information along when you arrive for your initial consultation. One item that is typically discussed during a consultation is the cost involved in the various procedures that you might be looking into. In order for your dental office to best advise you as to what your out of pocket expenses might be, they'll need to look at your insurance plan to see what it does and does not cover.

Bring your x-rays along

If you had x-rays taken during your last dental appointment, then you're going to want to bring them to your cosmetic dental consultation. Many dental offices will simply forward your records to another office; but in some cases, you might have to pick them up yourself. If your last set of x-rays was taken long ago and you're not certain as to how valid they are, then ask your soon-to-be cosmetic dentist what to do rather than deciding on your own to simply not bring them.

Bring a parent, as necessary

Many cosmetic dental practices require that people under the age of 18 be accompanied by a parent or legal guardian. If you haven't yet reached 18, then ask your dental office what its policy is before showing up solo.

Read up on the various procedures

The world of cosmetic dentistry offers a variety of treatments and procedures designed to make your teeth look better. The downside to this is that the notion of choosing the right treatment can be extremely overwhelming. In order to make the most out of your initial cosmetic dental consultation, read up on some of the more popular treatments so that you're mentally equipped with the basics. While a good cosmetic dentist will take the time to describe any suitable procedures in depth, it will help you to at least have a general idea as to what he's talking about.

Remember, your goal in having your initial cosmetic dental consultation should be to walk away feeling satisfied with the information you received and comfortable with the treatment plan that your dentist has developed. By coming prepared with the proper knowledge and information, you can do your part to make that initial consultation a precursor to your cosmetic dental success story.

The information in the article is not intended to substitute for the medical expertise and advice of your healthcare provider. We encourage you to discuss any decisions about treatment or care with an appropriate healthcare provider.

Jack Elder is a writer for Yodle, a business directory and online advertising company. Find Your Guide to a Winning Smile or more Dental Care articles at the Yodle Consumer Guide, The Yodler. Also check out

Many thanks for reading our Pocket Dentist article

Tagged with: • • • •