Fees, Overhead, & Insurance

Dental care is not a commodity. It's not laundry detergent or breakfast cereal  or wireless minutes. Dentistry is a professional service that's both art and a  science. Yes, there are excellent dentists and not-so-great dentists. Often, you 
get what you pay for.

Overhead costs are huge. Anywhere from 60% to 80% of what a patient pays goes  toward the expense of running a modern dental practice. Dentists pay for rent or  mortgage payments on their office space, payroll for hygienists, office managers  and receptionists, health insurance, taxes, supplies, business insurance and  technology - just to name a few. "A lot of people would be surprised to know how  tight the profit margins are," Dr. W. says. And many dentists are still paying  student loans from dental school.

Labs differ in the quality of the products they produce. We all want our  dentists to be using high-quality labs for things like crowns and dentures.  Should we have to ask about the labs? No. We should trust our dentists to select 
a good one. "In my view, you always want to use a good lab," Dr. M. said,  "because if the crown breaks, I'm the one stuck redoing the thing for another  hour and a half for free. It's important to make sure I'm putting good stuff in  people's mouths, because the last thing anyone wants to deal with is a redo. It  doesn't make me look good, the patients get angry, insurance doesn't cover it,  and it's a waste of time. You want to do a good job." Dr. M. has invested in a 
$100,000 machine that lets him make the crowns himself and cement them in one  visit. He says patients love it and it allows him to control the process and do  a better job. His fee, however, is higher than many in the area.

Insurance isn't really insurance. Dental insurance, the dentists told me, is  nothing like health insurance or auto insurance. It's a maintenance plan that  will cover cleanings and x-rays, maybe half the cost of a crown. It will not  protect you if you need a lot of work done. The maximum annual benefits, $1,000  to $1,500, haven't changed in the 50 years since dental insurance became  available. "It's a minor cost assistance, and there's a widening divide between  patients' expectations of their dental insurance coverage and the actual  coverage that's provided," says Dr. W.

Dental insurance drives docs nuts and they wish they didn't have to use it. "The  number one most complicated aspect of running a dental office, bar none, is  dealing with dental insurance. You wouldn't believe how long it takes to get 
through to a rep, make sure the patient does have benefits, calculate a copay,"  says Dr. M. And the largest insurance plans in the country discount most  dentists' fees by 10% to 20%. If you're paying out of pocket, ask for a 
discount. (You might discover the dentist is giving you one already.)

Dentists wish patients would value their teeth more. Teeth are a crucial part of  health and appearance. Untreated gum disease, for instance, is linked to heart  disease. (Would you choose a cardiologist based on price?) "With time, you will 
come to realize that shopping price is a minor concern when it comes to your  health," says Dr. W. "Any minor cost differences amortized out over a lifetime  will become insignificant. You will get the best results and have the most 
long-term satisfaction getting care from someone you trust."

So if you're convinced dentists are worth their fees, how do you find a good  one? The dentists had some suggestions:

Ask if he or she uses specialists. Who does your root canals? If the person on  the phone says, "We do everything here, that would scare me," Dr. M. says.  Especially orthodontia.
Ask your primary care physician which dentist she uses. Ask your lawyer. Ask  your boss. In other words, ask professional people whom they trust with their  mouths.
Ask a dental specialist, like an endodontist. One specialist wrote to tell me,  "The best way to find a good dentist is to find a specialist who sees  everyone's patients on a referral basis. He or she will know who is good and  who isn't. Trust me, as a specialist, I know who is doing what, because I see  their work every day."
If a dentist doesn't take insurance, because he or she doesn't need to, that  will be a pretty good dentist. Those pros can book you for longer, and they  don't have to work under the constraints of insurance companies. Be prepared  to pay higher fees. 
Look and look some more. Interview dentists, if they'll let you. Take the view  that your teeth are a lifetime investment.
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