Thursday, March 26, 2015

Is Dentistry A Racket?

$1400.  That's how much I paid last month in dental expenses.  I know what you're thinking.  Sucks not to have insurance.  Wrong!  This expense was with insurance.  Educators are known to have some plush benefits.  Ah…but there are trade-offs.  Teachers and administrators who have top county ranking salaries usually have middle-to-low ranking benefits packages.  The opposite is true.  Educators who pay little for excellent benefits, usually do not have the top salary schedules around.  As they say…"You can't have your cake and eat it too."

I selected the cheapest benefits package during open enrollment.  For Kaiser, Delta CareUSA HMO, and Vision, I am subtracted only $197.66 each month from gross pay.  By the way, this plan covers me and ALL of my family.  Compare that to what most Americans pay for their health plans: About $6025/year or $502/month for single coverage.  Yikes!  Paying well below the national average for health insurance for my entire family is one of the many perks of being an educator.  Best part is I don't need to worry about Obamacare.  Don't all of you go rushing to enroll in a teacher ed program now…the pay is still crappy, taking the demands of the job into consideration.

Perhaps if I'd gone with the PPO option I wouldn't have been so much out-of-pocket last month.  It just so happened that Jessica and I both needed a crown at the tune of $700 per.

If I paid $700 out-of-pocket then the total cost was over $1000, easily.  Say the dentist I go to charges $1350 for each crown.  The insurance therefore covered only $650.  This would be Delta's set coverage amount for this procedure (hypothetical figure).  Coverage varies with policies, obviously.  Another insurer may cover $800, $1000, etc.

The smart dentist knows the average coverage amount for each and everyone of their procedures, and then decides how much to charge beyond this average amount.  How do I know this?  Dentist belong to a true profession.  They all have to do continuing credits of education every year to stay legal.  They have conventions, standards, an up to date body of knowledge, codes of conduct, you name it.  Unlike the often questioned and doubted profession that is teaching, dentistry is on a difficult to take down pedestal.  People still try, however.  See: Boards Straightdope.

So is Dentistry a racket?  This is what makes dentistry "racket-like":

  • You go to one dentist office and they tell you that you need a crown.  You go to another one to get a second opinion and they tell you that you simply need a filling.  You go to a third one and the dentist says you need a root canal!  Who is right?  Shady, shady, shady!
  • Some dentist charge more for the same procedure!  Why do some dentist jack-up their service prices?
  • Everybody has perio disease.  I mean…seriously!  Perio disease means you'll have to get deep cleaning done.  That will cost you a pretty penny.  But hey, the alternative is losing gum tissue and your teeth becoming so loose they'll fall off on their own.  Or you can die from a heart attack because poor buccal health is tied to heart disease now.
  • X-rays…conveniently there is no uniform online system to store these.  I can have X-rays done at one office (and now they are electronically uploaded…no more film types) and it will do me no good if I go to another dentist a month later.  All dentist want their own X-rays of your mouth.  $$$flows.
  • Cleanings…multiple each year.  It's like my mouth is a car and needs oil changes periodically.  Maybe my mouth is as dirty as the car's engine oil?  No matter.  I'm still paying $51 out-of-pocket for each 4 month cleaning visit.  How much do you pay for a routine cleaning out-of-pocket?

I'm not just going to give you one side of things.  My wife, Jessica, was a dental assistant for 10 years and she shared many stories with me about the business of her employer in Carlsbad.  Let's examine the business of dentistry…

Dental School is extremely expensive!  Yes, each dentist went to an expensive dental school and if still young, they are most likely still paying for their loans.  School debt is pushing many dentists away from private practice: Pjstar.  Over $200K for a four-year dental school education.  OMG.

Overhead.  Running a private dental practice is hard!  Here's the problem.  Dentists go to school to be Dentists!  Not business owners.  Many of them fail running their own practice because they have no business sense.  How much to pay hygienists, dental assistants, and clerical support don't even begin to describe all that running a dental practice encompasses.  Most recent dental school grads don't have the money to buy a private dental practice from a retiring dentist.  At least an established practice has financial history and ledgers to use as guides. 

Rent.  Only a minority of dentists own their own shop, so to speak.  Most have to pay commercial or residential rents to house their business.

The bottom line is this.  There are multiple "stressors" that determine how a dentist will charge.  Most people only see the face of the practitioner.  They don't see in its entirety (because they don't fully grasp) the face of the business owner.  I realize it's not the consumers fault for any of this; I mean, no one forces a dentist to buy the latest equipment, raise the monthly salary of an employee, decide on the type of anesthetizing medicine to use, get a mortgage on a building, etc.  

Last molar you can see in this pic is the crown

Keep in mind that it is your responsibility to choose the care you want from a dentist you like and trust.  I am very happy with the service I receive at Dr. John's office Andrew John in Oceanside.  The $700 x 2 in out-of-pocket expenses hurt, but the crowns were well done.  In some cases, finding the perfect dentist can be worth the fees!  Shout-out to Suzie and Heather!    

Thanks for reading. 

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