Go to an out-of-network good dentist, or in-network dental factory?

December 10, 2008 4:27 PM

New cavities and replacing old amalgam fillings filter: go to a good dentist who isn't in-network and to whom I'd pay up to $1000 out of pocket, or go to one of those in-network dental factories?

I saw this out-of-network dentist for the first time today for a checkup. It had been a few years since my last appointment.

He seemed good... at least according to his thoroughness and gadgets. He has a digital x-ray machine, and some laser poker that can tell how much decay is in a tooth based on its reflectivity.

He found some cavities with the laser poker (corroborated somewhat by the x-rays). A couple were spots of decay underneath old amalgam fillings that he says generally do not provide a seal, and thus allow bacteria to get underneath.

Another was a tooth that didn't look like there was a cavity externally but he could tell from the laser poker + xray.

It's about $2200 quoted from the dentist for redoing all my amalgam fillings and fixing the new cavities. Delta Dental can only say today that they'll pay between 33% and 53% of the procedures' costs; they don't have an exact fee schedule down for this dentist because he's out of network.

To be honest, I don't know for sure whether this guy is that much better than one of the "dental factory" dentists.

gah!

Thoughts?

posted by schmoppa to health & fitness (6 comments total)

Maybe you should try visiting an in-network dentist for a second opinion? Or if money is no object, go for it with the out of network guy. The fact that somebody accepts Delta does not automatically make him or her a bad dentist.
posted by COD at 4:59 PM on December 10, 2008

My dentist is "in network" and not a "dental factory." My dentist is thorough and has gadgets. Clearly you need to visit an in-network dentist (or two) and see how you like them. Or just pay the out network fee if you like that dentist and can afford it.
posted by birdherder at 4:59 PM on December 10, 2008

Having an ethical, skilled dentist perform the work is critically important, for as you'll discover if you peruse the web for dental complaints, bad dentistry leads to broken fillings, unnecessary root canals, "re-do's," and other expensive woes.

Very few state dental licensing boards have made disciplinary actions available for public scrutiny, so you may have to do Google searches for the dentists you are considering (to check for patient reviews), and also check whether the dentists are listed with your local Better Business Bureau.

We looked up a local Delta in-network dentist at the BBB website and found he had an "F" rating and several egregious complaints lodged against him, ranging from charging for services never rendered to shoddy dental work. The dental mills can be pretty horrific, for many attempt to do the cheapest, fastest work in order to justify their paltry insurance payments.

Word-of-mouth referrals from long-term satisfied patients often are the best way to find professional, skilled practitioners.
posted by terranova at 5:03 PM on December 10, 2008

If you're suspicious trust your gut. The "dental factory" label is more true in large cities than it is in smaller ones.

There is also Dr. Ooogle and Yelp recommendations, which may or may not be useful/viable depending on where you live. It's tough to find a good dentist. Every time I ask someone the answer is usually "Oh I go home" and home is, like, Philadelphia or somewhere in Jersey or Boston or - NOT where they are currently living at the moment.

Not to be devil's advocate, but I don't find the BBB useful, ever, at all, because it is so easy for dentists to contest complaints. Or more precisely, the absence of a dentist or business from its rolls is no guarantee that there aren't complaints.

Do you have a FSA? After a really bad run of dentists, I finally just sucked it up and I am putting in a ton of cash into my FSA to pay for dental work out of network.
posted by micawber at 6:43 PM on December 10, 2008

Im assuming you are talking about a PPO plan with Delta, because if you have a Deltacare HMO-type plan, I don't believe you would get any benefits for going out-of-network. A PPO plan will pay, but at a lower rate for out-of network. Also, you can find a lot of good dentists in network, without going to a Doc in the Box clinic. Those generally are for the HMO type plans, and they do tend to be impersonal, they have to see several patients a day and spend as little time with them as possible to make money. And they have a huge incentive to do as much work as they can, whether or not it's necessary.

As far as the insurance company goes, they have their bottom line to look out for. They have their fee schedules which are below what the dentist charges, which isn't to say that the dentist is overcharging. The insurance company wants to be able to sell your employer a plan which purports to pay 80% of fillings, which they think is great. But it only means the insurance company will pay 80% of what they ALLOW for that filling. And they hate paying for composite/resin fillings on back teeth. So if it's a generous plan, the insurance will allow the dentist to charge for a composite filling, but they will pay for what an amalgam filling costs, leaving the patient to pay the remainder.

So what you are running into is: Out of network provider doing treatment that is paid at a lower fee schedule and at a lower percentage rate. I don't think that it is worth it. I'd ask coworkers who they go to. They must be on the same plan. Try harder to find a dentist in network.

As far as this guy is concerned. I am not a dentist, but I have been a chairside dental assistant for over 20 years. I don't feel entirely comfortable with a dentist who recommends changing out amalgam fillings for composite without pathology present. It's nice to have shiny new diagnostic tools, but they can be used to intimidate patients into going along with treatment that may not be needed yet. And his line about amalgam fillings not sealing is kind of bogus. Amalgam fillings are compacted into the prepped tooth and when properly placed fill it tightly and completely. As the filling ages, it corrodes and seals the tooth even better. If the dentist cannot enter a cavity by sticking an instrument into the tooth and feeling soft decay or in between the teeth where he cannot reach his instrument, the decay should be visibly obvious on xray.

Still, if you liked him and you feel comfortable with his treatment, and don't mind paying, ask him to triage the teeth that are in most need of replacing. Stand your ground and say you will only do the ones with active decay. Then revisit the treatment plan at your next treatment cycle.
posted by Jazz Hands at 6:46 PM on December 10, 2008

There can be both good and bad dentists in their own offices or in large dental clinics (mills). Dental mills generally have a higher rate of Dr turnover, and are more likely to have recent grads working towards opening their own practice. There are also many exceptions to this.

To find a skilled general dentist I recommend calling around to dental specialists such as periodontists and endodontists. Ask them for a name, if you hear the same name a few times, visit that dentist.

Find someone who really listens, who you have a good gut feeling about, and realize that it may cost more to do dentistry the way he or she feels is best.

Good luck!
posted by Northwest at 11:58 AM on December 11, 2008