Healthcare in the United States is broken. We have no Universal Healthcare Coverage. Even if you do have insurance that doesn’t mean you’re covered for what ails you. I have discovered you stand a better chance getting your body ethically healed if you have a virus or a heart problem or a bulging hernia — but if what ails you is a broken tooth or aching gums — the chances of you paying big money out-of-pocket, in addition to your 100% coverage, is the smiling monster looming in the gloaming of Unethical American Dentistry.
Few people enjoy going to the dentist because the experience always results in a pain that bites hard. There are those who feel dentists and veterinarians are the least respected “doctors” in the medical community — but dentists alone have the highest suicide rate among the living:
Dentists, we learn, lead all professions in killing themselves–followed closely by psychiatrists.
I discovered this moral problem in the dental community when Janna broke “Tooth 14” and had to have a crown created. Crowns, we learned, are considered “major dental” along the lines of root canals and other gruesome cuttings and that can mean big money to unethical dentists.
The key, we thought, to finding a “good dentist” was to find one that participates in our health insurance. We have an outstanding dental plan with a top insurance company. In order to have a crown made you must have a “Predetermination of Benefits” letter first. That means you go in and see your dentist and the dentist then sends your insurance company a diagnosis and remedy — and then the fight begins with you, as the consumer, stuck in the gory middle.
A Predetermination Letter is not a guarantee or a promise. It only provides surface proof to your dentist of what your insurance company will pay for a procedure. A Predetermination Letter is not a referral. A Predetermination Letter is not a bill. A Predetermination Letter is merely a meaningless piece of paper that everyone must jump through to look important and official. Doctors and dentists always outrageously pad their fee in order to cover the highest possible payout across all insurance companies.
Doctors of the body — but not necessarily the mouth diggers — are only allowed to charge you for what your insurance company pays for if they are a “participating provider.” We were surprised to learn — our insurance company forewarned us — that dentists somehow feel they do not have to abide by their provider contract and, through legal wrangling, they have determined they can leave the four corners of their contract with your insurance provider and make you pay additional out-of-pocket money directly to them.
Here’s how the Unethical American Dentist Scam works: Your dentist charges $1,400.00 USD for a crown. Your insurance pays $400.00 USD for a crown. Your dentist wants you to make up the difference by paying $1,000.00 USD out-of-pocket.
When we were told by our insurance company to be wary of the “we want more money” scam — we asked why dentists can get away with asking for more money beyond our coverage while “regular doctors” do not?
We were surprised to learn “some dentists don’t feel bound by their provider agreements.” We were also told most dentists “only charge you $200.00 USD to $400.00 USD extra — a few will even be satisfied with what we pay and leave you alone — but you have to ask before they do any work because we have customers who think they don’t have to pay anything extra and end up getting a bill for $1,000.00 USD later.”
Our insurance company implored us to “Ask them upfront if they participate in our insurance and then zing them if they say ‘yes’ by asking if you have to pay extra for a crown.
Make them tell you over the phone. If they do charge you more than what we cover, and you still want to go there, you have a right to see the lab bill that shows the additional charges.” We sighed as we wondered at the “hunt for an honest dentist” that stretched out before us. “Some dentists won’t even accept insurance.
They don’t want the hassle.
They want you to pay the full $1,400.00 USD upfront, ” our insurance company contact continued, “I work for a dental insurance company and our dentist stopped taking insurance — any insurance. So after 20 years of going to the same guy, our family had to find another dentist.”
Most of the dentist offices we contacted didn’t want to give their “over-quote” over the phone — they wanted Janna to come in for an examination first — but why? — “Tooth 14” is the same tooth in every mouth and a crown in one office is required to be the same crown in another office because that’s how insurance works.
When we finally found a dentist who “participated” with our insurance company — without any caveats or reservations and who expected no extra cash — we realized how unlucky those are who must live day-to-day without any insurance coverage for body or mouth or being, and who must hope against the gloaming that an unethical dentist isn’t looming to bite them when they’re down and aching and broken with extra outrageous fees that no ordinary human being could ever begin to afford… even with 100% coverage.