Surprise extra charge for dental procedure
June 10, 2021 1:04 PM   Subscribe

I went to the dentist today expecting to have 2 fillings done. When I went to pay at the front desk, they told me they did an extra filling on one of the teeth that was already scheduled to get a filling, and presented me with a bill for 3 fillings "because you were already numbed up and we were working in the area." But I never consented to the extra filling, and it's quite a lot of money (1.5 times an already-steep bill) and an unpleasant surprise.

The office had previously sent me a treatment estimate for 2 fillings, so that's what I was expecting.

Trying to negotiate whether I wanted an extra filling in the middle of the procedure, with my mouth numbed up and kind of on a time crunch, would not have been ideal either. I probably would have said yes, but I wouldn't have been happy about it. Nonetheless, to not be informed at all really rubs me the wrong way.

If they were already in the area, I might expect the extra filling to cost significantly less. But they are charging full price, same as they would if it was the only filling they were doing and they had to prepare the area from scratch. It's not adding an extra surface to the planned filling, it's a small but completely separate filling on the same tooth. As far as I can tell, it took less than 5 extra minutes (though I'm not a dentist so who knows).

In general, I like this dentist a lot. She does great work, she explains things patiently and well, and I trust her opinion. I have a lot more work scheduled with her. It doesn't seem like they're trying to make an extra buck off of me. They saw something needed doing, did it quickly, and charged me their regular price for the work. It's just the bait-and-switch billing practice that I'm objecting to.

I'm paying out of pocket, so insurance is not involved at all. I'm fairly sensitive to price, especially since I'm going to need several thousand dollars of dental work this year. Because of this, I had previously called the office and asked how much they charge for fillings. The prices on the treatment estimate were already higher than what they told me over the phone, but I didn't say anything because I trusted the quality of care I was getting more than the other dentists where I'd gotten a first and second opinion (this one was my third). So even with the treatment estimate, it already felt like I was already paying more than I was expecting to.

I walked away having paid the price from the original treatment estimate, without the extra filling, but I'll be back next week for more work and presumably will need to settle up then.

Maybe I can ask them to reduce the price for the filling, since (as they themselves say) they were already in the area and it only added a few minutes to the procedure? Are there other options here? Location is California, USA.
posted by Questolicious to Work & Money (22 answers total) 3 users marked this as a favorite
If I received a treatment estimate for two fillings, consented to two fillings, and three fillings - an extra surgical procedure! - were performed and billed - I would be disturbed enough by the result to potentially leave the dentist regardless of their justification. I would certainly expect them to pre-emptively offer an explanation and waive the charge without me asking. If I were you, I would not settle for anything less than no charge, with an apology.

My dentist won't even give me fluoride without explicit consent.
posted by saeculorum at 1:14 PM on June 10 [27 favorites]

Surprise filling, full charge, and you're giving them several thousand dollars' worth of business this year alone as a self-pay patient?

Get a fourth opinion.
posted by Iris Gambol at 1:26 PM on June 10 [11 favorites]

Here’s an example from my dentist:

“We have an anti sensitivity treatment. It is kind of expensive.”

me: “that’s fine” (expecting like $100)

“it’s $25”
(At checkout to the front desk) “hey the treatment is actually $35, but I said it was $25 so ring her up for that.”

So yeah - if I got a surprise filling I would be upset. Personally I would want all the work to be done - but they didn’t ask you. They didn’t give a discount for the surprise. And I’m unclear why they didn’t check properly for the treatment plan anyway and found a surprise filling. Was it between teeth or something?

All medical procedures need informed consent. It may be different if you clearly said and consented to “get all the work done” and were say, under IV sedation. But then they should have given a proper treatment plan with the possible highest cost that it could be. And you would have been consenting to complete treatment.

You were not offered informed consent, a treatment plan estimate, nor adjustments after the fact and that would be a dealbreaker for me.
posted by Crystalinne at 1:33 PM on June 10 [11 favorites]

Ok this is completely outside my area of expertise but I can imagine that your dentist was taking care of your tooth and just filled whatever needed to be filled. And then logged it into an electronic medical system, which then produced the bill sort of automatically. Point being, your dentist might not even realize that you are being charged extra for the work, and might not have been thinking about that extra work as extra or beyond what you discussed. If you like her, it is worth speaking to her directly about what is happening.
posted by Viola Swamp at 1:36 PM on June 10 [12 favorites]

I'd ask a loaded question:

"Is it standard policy around here to tack on an extra filling even though the original plan was only two?"

If they cannot give you a satisfactory answer, it may be time to find another dentist, as clearly that's how they appear to be "cheaper" than the other dentists... they nickel and dime you to death later.
posted by kschang at 1:47 PM on June 10 [6 favorites]

Yes, I would address it with her. It sounds like you needed it, and it's definitely been the case when my dentist has gone in that he's identified something that needed to be done that we hadn't discussed beforehand. So I don't think this was necessarily an example of incompetence. But, still, you specifically planned around the estimate. Adding an entire separate expensive procedure without explaining the billing is not good. I would expect her to at least offer you a meaningful discount, especially as a cash-pay patient.
posted by praemunire at 1:48 PM on June 10 [2 favorites]

Just to provide a counter-example here, the dental filling estimates I've received have all had the tooth number listing on them. The dentist has then confirmed the tooth number from the hygienist working with them prior to the operation.

As a practical matter, even though you're not on insurance, the tooth number is recorded for billing validation (ie, demonstrating that the same tooth isn't filled multiple times per year).
posted by saeculorum at 1:51 PM on June 10

In general, I like this dentist a lot. She does great work, she explains things patiently and well, and I trust her opinion.

Don't focus on the money. You have found a gem. A true diamond. There are a lot of crappy dentists out there, and this one you trust. Don't let a misunderstanding that ultimately (1+ years later) may not matter ruin a good business relationship that is hard to find.
posted by Geckwoistmeinauto at 2:00 PM on June 10 [9 favorites]

I've never understood why dentistry is seen and treated as separate from medical care. Your dentist may be a gem to you, but this behaviour is egregious. You were not informed of the procedure and were therefore unable to consent to it. Furthermore, being billed for it? Out of pocket?! Unbelievable.

Imagine instead that this was a medically necessary skin treatment on your face. They were removing two growths and decided to remove a mole too, because why not, your face was right there already. And let's say it healed badly and got infected, resulting in treatment, embarrassment, and further cost. What would you think then?

Point is, while it may be fine for you -- advantageous even -- it's dangerous and irresponsible practice and may not go as well for others. Somebody else may not be able to afford the additional cost and is not in a position of privilege to contest it, however justified they may be.

This needs to be addressed and it shouldn't happen again to anyone.
posted by iamkimiam at 3:33 PM on June 10 [3 favorites]

I would certainly ask some more questions before just paying up. I recently had three fillings done at once and my dentist was very clear that if I tapped out, they'd only charge me for the fillings they'd actually done that day. She verbally confirmed before each step of the procedure what was next and that I was okay to proceed. She was clearly being very careful that there'd be no surprises for me at any stage, which is one of the reasons I keep going back to her.

Also, I have had a "two surface" filling which might be similar to this but it was bundled as single treatment to a single tooth -- perhaps because the overall area was within an acceptable range. But this was explained to me before the treatment. In fact, I think every dentist I've ever visited has come up to the desk after the procedure to confirm what they did before I paid, too.
posted by sm1tten at 3:36 PM on June 10

This is so weird because this exact thing happened to me just yesterday. When the dentist was getting ready for the procedure, she confirmed with the hygienist which two fillings they were going to do, and then she sort of mentioned offhand (to the hygienist, not to me) that she saw a third tooth she wanted to treat. It wasn’t a question, and I didn’t particularly feel in a position to discuss it or to object. She did all three, and the bill reflected a full fixed price for each.

Ultimately, it didn’t bother me, because I’m fortunate to have good insurance coverage, and I like the dentist otherwise, and trust her judgement about what needed to be done, but now that I see your question it does seem weird to expand the scope of a medical procedure without any consent like that. In your position, I would definitely talk to them about it and see if you can get clarity on the policy and/or a cost reduction.
posted by Ryon at 3:51 PM on June 10 [1 favorite]

I'm amazed some people are taking this lightly. Aside from the financial aspect, doing a procedure without informed consent is unethical and illegal. I would report this behavior to their governing board, and find a new dentist.
posted by Flock of Cynthiabirds at 4:09 PM on June 10 [10 favorites]

What Flock of Cynthiabirds said. Jesus, really tacky.
posted by zenpop at 5:32 PM on June 10 [1 favorite]

This is absolutely not ok.

Being a patient actively undergoing a treatment is a vulnerable position and getting consent to add on treatments in that situation requires like, a tooth basically falling apart, and even that would require additional diagnostic images to ensure that the appropriate course of action is taken.

“The area was already numbed” yes, ok. But they had an opportunity to present that set of treatments as a one visit package. Instead they presented two fillings.

These guidelines are for the financial industry, but you will possibly find them illuminating:

My guess on why this happened is that a change in the schedule freed up the time to do the third filling. That change in scheduling impacted (reduced) what is called “production” and what you amd I would think of as “the amount of money being billed for procedures.”

The practice has daily/weekly/monthly production goals.

I am appalled that you appear to have been taken advantage of by someone in the practice with an eye on the numbers ABOVE the trust and ethical relationship with patients.

I would not return to this practice.
posted by bilabial at 6:05 PM on June 10 [6 favorites]

Oh, and it’s likely that if the schedule originally had an available appointment long enough to take care of all filling in that quadrant, the scheduler would have offered it to you and notified you in advance that it would be for all 3, if all were already noted as needing treatment.

Sheesh. I am so mad about this.
posted by bilabial at 6:06 PM on June 10 [1 favorite]

Ok this happened to me exactly the same way. I went in for two fillings, had several other problems (teeth “on watch” maybe like your pending future work) and while numbed and in the chair, dentist went and did a third. Dentist is apparently a sneaky ninja dentist, he works extremely fast and it barely took five minutes.

I paid but felt taken advantage of. I dislike confrontation so I left the practice and sought out another dentist in another city to do my next exam and asked if I was being taken for a ride by ninja dentist.

New dentist said the quality of work from ninja dentist was outstanding, and it is common practice to do “quadrant dentistry” e.g. the Novocain numbs out an entire quadrant of the mouth, for basic fillings the numbing shots and aftereffects are the most painful, so take advantage of the numb quadrant and do all of the work that is needed.

I returned to ninja dentist and said he made me feel uncomfortable and never do this again.

He never did and I have had a few more fillings from him and all has gone well.
posted by sol at 6:49 PM on June 10 [3 favorites]

There’s some of the usual AskMe black-and-white thinking here. It sounds like you haven’t yet had a chance to talk to the office about this bill. Maybe there is a perfectly good explanation, like they thought you were 100% covered by insurance and practice policy is that consent for treatment is given on a tooth-by-tooth basis (who knows!) Maybe the dentist is horrified her billing team is doing this! Maybe they say something shady AF and you report them to the local news. But do give them a chance to explain/make right.

These recommendations to fire a seemingly good dentist without first having that convo seem like an overreaction.
posted by whitewall at 9:29 PM on June 10 [5 favorites]

I would bring it up in terms of concerns for moving forward. It sounds like they gave you a fairly comprehensive treatment plan and an estimate, and the very first thing that happened was, your treatment went a significant percentage over the estimate. If you need more work they didn't anticipate, how are they going to present this to you? I might even do this in an email.
posted by BibiRose at 4:04 AM on June 11 [1 favorite]

I'll N'th that I would not return to a dentist who performed additional procedures without consent. WT actual F.

Yes, sometimes unexpected things happen at the dentist; they're expecting to do a filling, the tooth crumbles and you need to get a temporary crown. But they don't just "accidentally" do an extra filling. If nothing else there's the extra time to do it; this 100% needed to have been run by you, and approved.

Even if you go to one of the chicken dentists where they do work while you're under, short of emergency work (tooth crumbling), they should not just do extra non-scheduled stuff because they can.

Heck, at my *vet*, a few times they've accidentally run an extra test that wasn't pre-approved, and they're always comped it (with *them* noting it, and explaining why I'd see it listed at 0 on the bill), rather than my playing catchup.
posted by nobeagle at 7:21 AM on June 11 [2 favorites]

Response by poster: So I talked to the dentist today. She did apologize and said things like "I completely understand," but she was also pretty adamant that "once we're in there, if we see work that needs to happen, we're gonna do it." Just... wow. She was willing to inform me of any surprises as they come up, but not willing to let me be part of the decision-making process, and not really interested in telling me about the likely scenarios ahead of time. I was kind of shocked that she was so matter-of-fact about it. She said, "I just don't think we're going to see eye-to-eye on this." Ugh.

To confirm my hunch, I then tried to talk to her about today's work, which would have been replacing a filling that could end up being a crown depending on what she found when she opened up the tooth. I had an estimate for the filling, and she seemed incredulous that I wanted an estimate for the crown as well. Good thing I asked, because the crown estimate was $400 higher than I had been quoted over the phone (the receptionist hadn't included the buildup in the price, even though I'd specifically asked about that). And she didn't seem particularly reassuring that she'd talk me through what was happening and why. I opted to not get any work done today.

A wrinkle here, which I'm realizing is key, is that the older, wonderful dentist I saw and loved at the consultation is now completely retired and not doing any of the work (except consultations). The dentist I saw today and last week is the one who is fully taking over the practice, as of about a week after my consultation, and I don't like her nearly as much. Given that I can't actually work with the dentist I like, I have every reason in the world to take my business elsewhere.

What a mess. At least they didn't make me pay for the extra filling from last time.
posted by Questolicious at 2:31 PM on June 17 [3 favorites]

Wow. Well you got to see how much your dentist values feeling right over ethical practice, consent and price gouging. I hope you find a wonderful new dentist soon!
posted by iamkimiam at 3:29 PM on June 17

I would consider giving feedback on this dentist and her practices to the dentist who previously owned the practice and only does consulting now (if I understood that correctly). Maybe he is aware/doesn't care/can't do anything about it but perhaps he would like to know that your experience was so unsatisfactory especially since it sounds like you had a good rapport with him.

(Also, I always get my estimates in writing (with a breakdown of the work included) and I have never had to ask for this -- it's been standard operating procedure even at the crappiest dentist I saw.)
posted by sm1tten at 6:49 PM on June 17 [2 favorites]

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