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.

36 Comments

  1. When one of my front caps broke in half I had a huge ordeal – part of which was that the morning I was supposed to go in for some work, I was called and told they had to reschedule my appointment! Of course if you did that they would fine you!
    It cost me nearly a thousand dollars – and that was after a discount I got for paying it in full.

  2. Gordon!
    OUCH!
    Did you have no dental coverage at all?
    I learned the “real” price of what a doctor or dentist hopes to collect from those without insurance is a third of their rack rate. So if your dentist charges $1,200.00 USD for a procedure — $400.00 USD should be enough to satisfy reasonable costs and effort. Anything above that is pure, obnoxious, profit.
    I am reminded of a story from one of my former Columbia professors. He was part time and he also taught at Yale part time. Yale gave part timers full dental and medical coverage and he said he could “finally fix all his teeth.” He’d been suffering with various tooth ailments for a decade but couldn’t afford the outrageous prices on his teaching salary.
    I think when it was all done he had $30,000.00 USD work done on his mouth in four months — the full term of his one-semester employment at Yale. He used his time, and their money, wisely. 😀

  3. Hi David,
    What’s up with the high suicide rate?
    My dentist as a kid committed suicide. He had a wife and family and they found him drowned in a creek, his car parked nearby.
    A dentist I had out of college may have committed suicide. He was diagnosed with arthritis in his hands when he was 35. Shortly after the diagnosis, he died in a helicopter crash. He was the pilot and the only one on board. No one knows if it was suicide or not.
    Donna

  4. Hi David,
    Forget to mention that the second guy had a giant picture of a maneating tiger on the wall facing the patient. This always put my mind at ease. 😀
    Donna

  5. Hi Donna!
    I have no idea what it means that dentists have a high suicide rate. One professional friend of mine wondered aloud several years ago “What sort of person would want to stick their fingers in someone else’s mouth for a living? Even a proctologist uses a scope!”
    That’s fascinating about the lonesome helicopter crash. There’s an old saying in the Nebraska State Patrol that if you have a one-car accident on I-80 — a straight and lonely strip of road — crashing into a barrier or off an overpass… it’s a suicide that can be written off as an accident. I think that makes a lot of sense.

  6. Oh, and the maneating tiger is creepy, Donna! One great thing about having your teeth cleaned in the NYU area is you can overlook Washington Square Park from a dentist’s chair behind a window the size of a wall. It’s a spectacular view.

  7. David,
    My father knows all too well the woes of paying for dental work.
    He has three children, all of whom have had braces. One of his new stepdaughters (also named Emily) will be getting braces in a few short weeks. He and I both have had numerous other procedures also–root canals, crowns, wisdom teeth pulled, etc.
    Our dentist has a daughter that graduated high school with me and my dad used to joke that he was singlehandedly paying for her college education.
    On another note, our dentist is also uncharacteristically evil. The best story I have to describe his purely evil nature is about the time he pulled a tooth out of my mouth that wasn’t even kinda sorta semi loose. I was in middle school and it was my last baby tooth. He asked me if it was loose, and I said no. He fiddled with it for a few minutes and said, “Nope, not loose at all. Well, we might as well just get rid of it anyway since it’s the last one.” Before I could really contemplate what he was about to do, he grabbed that hook-looking tool, wedged it underneath the tooth and pried it out. No warning. No drugs. No mercy.

  8. Hi David,
    I wonder why dentists can charge above and beyond what the provider agreement with the insurance company allows? It seems if that is the case, why go to a dentist that is in the insurance plan?
    When my first son was born, we had a problem with the insurance company and the hospital getting into a dispute over what the insurance company should pay. The hospital kept sending us bills, and the insurance company said we had paid everything we needed to pay. After a while, our statements from the hospital were changed from “bill” to “this is not a bill” notices that requested us to contact the insurance company.

  9. What’s a “squick,” Nicola?
    Do you have healthcare — body, mind, mouth — provided to you as a citizen of the UK or do you have to purchase coverage privately?
    Is there any truth to the old stereotype chestnut that “The English” do not “value” their teeth and don’t actively care for them with orthodontia and such — while the Americans are obsessive in the opposite direction?

  10. EMILY!
    Wow! What great tooth stories! Do you have appropriate dental coverage at your current job? Does it cover orthodontia? I sure feel for your dad having to deal with all that money and negotiation when it comes to proactive dental work.
    Your story about the removal of your tooth just makes me shudder! It’s like a scene from “Little Shop of Horrors!” Jinkers! My mother hates the dentist — she grew up in a time when drills where powered by the dentist’s foot on a pump and there was no novocaine or carbocaine.

  11. Chris!
    You ask the right question! Why participate in an insurance network if you aren’t going to abide their payout schema? Somehow, our insurance company told us, the dentists legally challenged their provider agreements across the board and now they believe they can collect their “full fee” as they wish without getting approval from the consumer first. It’s a real mess and it’s the dirty little secret of the dental insurance companies and they’re trying to fight the dentists for us.
    MDs have also found a legal loophole when it comes to deductibles. MDs can charge you your co-pay FOR EACH DIAGNOSTIC TEST they perform on you. Most MDs used to charge you a co-pay for each OFFICE VISIT — but they’ve discovered now they can build up that co-pay for services by testing you — blood tests, glaucoma nerve tests, ekgs, etc. are all considered now separate and billable diagnostic procedures and, if you’re not careful, you can end up paying $100.00 USD per office visit instead of $20.00 USD. Our insurance company told us you can deny those diagnostic tests if you don’t want to pay the co-pay, but you have to ask each time, “Are you billing me extra for this?” It’s all such a joke!

  12. David,
    I believe I have the option of adding dental coverage to my plan, but to date I have not. The last time I went and saw Dr. Mengele (as I affectionately call him, among other things) was for a root canal a couple of years ago. I was covered under my father’s insurance at the time, which is an excellent policy. Somehow the idea of having even more money deducted from my paycheck just in case that evil man has to torture me sometime in the near future just doesn’t sound too appealing!

  13. EMILY!
    That’s exactly what most people do: They cover their bodies but won’t pay for their teeth. Amazing! So if you crack another tooth, you’re willing to pay $1,400.00 USD for a new crown? Or would you go to a dental school for a longer wait but a better price?

  14. Squick – is a word meaning yuk/sick/ewwwwww all rolled into one – or to put it in proper English – “a negative reaction to the offensive” or to “gross one out”; to perform an action that makes other people cringe in disgust; …
    We are supposed to get our dental care on the National Health System in a similar manner to our healthcare. However many of us ( up to about 40% in some areas cannot find a NHS dentist). Some choose to purchase privately – a lot have to because there is no NHS cover.
    We are nowhere near as obsessed with our teeth as the Americans and the chestnut it correct – teeth are bottom of our list.

  15. Love “Squick!” Nicola — my new favorite word! 😀
    Gah! “Can’t find an NHS dentist.” We’re heading down that path here: “I can’t find a dentist that takes insurance.” Scary times…
    If you plan on a Hollywood career and your teeth aren’t “picture perfect” — plan on spending $20,000.00 USD for veneers — slivers of porcelain glued over your existing teeth if you want to work at all. You spend that money to look glossy, not to have a proper bite or “fixed” teeth.
    Thanks for confirmation of the old chestnut — not let’s both not bite down on it too hard! 😉

  16. This article is total BS! I work in a dental office which participates in many insurance plans. We accept what the insurance pays plus the patient’s DEDUCTIBLE and PERCENTAGE OF COST SHARE per their insurance contract (if applicable). We do not “ignore” our participating insurance contract. Patients fail to understand that in most cases they do not have 100% coverage PER their insurance plans, even for participating provider offices.

    This unfortunately, is how the dental insurance system is set up. It is not the fault of the dental office, which has nothing to do with the provisions of the patients’ dental plans!

    1. It’s unethical for you to blame the patient. The insurance company sets the price of the service and too many dentists use that as a “partial payment” and try to stick the patient with the remaining amount. Deductibles indeed!

  17. i have never known one honest dentist in my life.a lot of them really botched me up when young and created problems for me in the future. im not alone,
    inside scoop on american dentistry cut and dry…… its corrupt ruthless and toxic, theres no such thing as good insurance.
    its a very EVIL sadistic GAME brought to you by big insurance companys and the ADA. its total fraud and nothing justifies the outrageous cost. and risks.
    i guarantee you that no matter what treatment plan you agree to the dentist will always have hidden surprises and costs for you later along with new findings along the path it goes on and on .

    dentists should tell the truth ! but usually will not tell you everything .if you know as much as they do or more you cacth them in a lie everytime.
    okay a professional liar, wow next up? jack up the price real high! i guarantee the more the dentist dislikes you the higher the price and more pass the buck run around ur gonna get

    avoid the dentist unless you want extractions even then be leery because they will tell you everytime IT CAN be saved, really? thats their exuse for not wanting to help you stay alive/4k for a root canal and crown vs what… a few hundred to get rid of a no good tooth he or she knows damn well isnt really saveable . thats sick!

    i would like to see medicare cover extractions for life threating abcess tooth troubles bare minimum but?
    its also like suggesting legalizing lsd .wont happen

    .

    1. I feel and understand your outrage, Michael. Do you have dental insurance, or do you have to pay out of pocket? I agree it is oftentimes cheaper, and smarter to just pull a tooth instead of always trying to save it via root canal and crown.

      1. medicare SSDI covers zero. private insurance is worthless for extensive work. in my case with gum disease and tmj problems i should get extractions. i would like to keep as many teeth as possible but i am realizing it is not worth a heart attack or stroke. looks like amoxicillin will put this nightmare aside temporarily anyway
        skrewed with fixin em$$$$$$$$ and pullin em makes tmj worse .periodontal surgery… already did that too.not again!
        what to do? not sure

        need to find someone i can trust , difficult .

        1. Do you live near a university with a dental school? Students in their final years will work on you, with direct supervision from their DDS teachers, for a very reasonable fee that is often negotiable, and at least 66% cheaper than a “real” dentist in private practice. The only difference between the students and the outside is the awarding of a DDS diploma and the “kids” are often more attuned to the newest and best techniques.

          1. I agree and disagree! Students will be more attuned but they lacks of real life experience. Their intentions are right and not yet become but they may take wrong judgments and wrong decisions. The way they move the file in root of your tooth and experienced doctor is very different. Best thing is go to countries like India, China or Mexico visit very best dentist out there. They are still very reasonable and still in service business than extortion business…!!