Would you charge someone for this?

[Healthnutty]

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I would really appreciate your opinion on the following...
This has been bothering me whether or not I was wrongly charged, so I thought I would visit the dental side of the forum for a bit 🙂

I scheduled an appt with a new dentist and told them that I knew I needed an RCT (I found out about needing an RCT right before I was going to move so waited to do the RCT after my move to a new city).

At the visit, he evaluated my xrays and mouth and offered to do the RCT right then, so I gave him the ok. When he got into my tooth he determined that a RCT was actually not needed, so instead he just cleaned it out and placed a temp crown. A few days later I called with concern about the TERRIBLE pain. I came in for another visit, and he shaved down the temp crown. He said the pain was prob due to the bite and anesthesia. He did mention that if the pain continues that I might actually need to get a RCT. The next week I was suppose to get my perm crown, and a few days before I called in to tell them the pain is very bad and I need a RCT (Dentist told me that if the pain cont to do this). They had me come in and he took another film and told me he was going to refer me out for the RCT.

Ok....so here is my question.... I was charged a comprehensive exam for my first visit. Thats fine, BUT then I was also charged for a limited exam for the last visit when he decided to refer me out. Should I really be charged for this last visit?? He made the call NOT to do the RCT in the first place. I dont feel like I should be charged because if he did the RCT from the beginning, I would have no pain.....so no exam.

Sorry that this is a little long. I am just curious if this is right or not. BTW, the dentist is very nice and I realize he just happened to make a wrong call on this one.
Thank you!

 

[DrNutty]

Seems like he had no intention in doing the RCT. What he did wasn't right. But honestly, I would have done the same. I know that ethically it is wrong, but my student loans need to be paid off. I went into dentistry for the money and lifestyle, but these loans will really cramp my style.

Find a different dentist.

 

[dl9006]

Seems like he had no intention in doing the RCT. What he did wasn't right. But honestly, I would have done the same. I know that ethically it is wrong, but my student loans need to be paid off. I went into dentistry for the money and lifestyle, but these loans will really cramp my style.

Find a different dentist.

lol what a troll..


OP, i think your dentist was right in trying to avoid a potentially unneeded treatment. if the RCT could have been avoided, more tooth structure could be saved and it would have saved you money (unfortunately, it didn't work out that way).

i don't think what he did was wrong. he was just being cautious to save more of your tooth.

i'm guessing what happened was that when he drilled the tooth to take out the caries, he realized the caries wasn't as close to the pulp as the x-ray suggested. so he took the cautious approach and decided to wait and see.

the issue of being charged for the 2nd exam is subjective. i'm not sure if that's something that's normally charged but i don't believe he was trying to rip you off like Dr.Nutty is trying to suggest.

 

[OU11BB]

I am not a dentist but I have worked in an office for 3 years. We charge everytime a person gets into the seat. That is just how it works. It is at the dentist discretion whether or not he decides to charge for the evaluation/filling/crown/xray etc. As far as your pain, the dentist could have performed a root canal and you still could have pain for 1, 2, 3 weeks after. So saying that if he had done the root canal in the first place which would have eliminated the extra visit is not right. he could have done the root canal, charged the 1500+ even when he was midprocedure when he realized it wasnt necessary. At least that didnt happen. I dont see anything strange here other than a guy who thought he could save a patient some money and keep the tooth alive.

 

[KinKs]

I don't think you should have been charged - but this sounds like standard practice in the an office setting. The situation is thus: the dentist's time cost money and if you use it in any way shape or form, you will have to pay.

 

[Healthnutty]

Thank you all for your responses! I really do appreciate his honesty in deciding against the RCT in order to save the tooth, but I still don't totally agree with the charge of the second visit. After reading these responses, it looks like I will just have to get over the other expense then, oh well! Thank you again!

 

[xhamburgersamx]

Thank you all for your responses! I really do appreciate his honesty in deciding against the RCT in order to save the tooth, but I still don't totally agree with the charge of the second visit. After reading these responses, it looks like I will just have to get over the other expense then, oh well! Thank you again!

The second charge is subjective. Personally if a patient is in my chair for more than 10 minutes, i'd probably charge a minimal exam fee. It is billable under insurance.

 

[FutureDent020]

Thank you all for your responses! I really do appreciate his honesty in deciding against the RCT in order to save the tooth, but I still don't totally agree with the charge of the second visit. After reading these responses, it looks like I will just have to get over the other expense then, oh well! Thank you again!

He made the correct decision concerning your tooth, but charging you for that second visit was not right. I know time is money, but the second exam should have been at no cost.

 

[panino]

Thank you all for your responses! I really do appreciate his honesty in deciding against the RCT in order to save the tooth, but I still don't totally agree with the charge of the second visit. After reading these responses, it looks like I will just have to get over the other expense then, oh well! Thank you again!

I don't know what I would have done, since I'm not in the real world yet. But at my neck of the woods, if you had sat down in the chair at a physician's office, you would have been billed because that's billable time, but many people don't realize that.

Like you said, you were billed for a limited exam, not a full comprehensive exam.

And I don't think it's right for us to claim whether he was right or wrong just from what we read on a forum.

 

[mike3kgt]

How is this discussion not closed yet? It's okay to talk about your treatment only if it's involving money as opposed to "did x do the right treatment?" Bleh.

I fear the future where my patients actually ask silly questions like these on an internet forum, Yelp, healthgrades etc.

Talk to your dentist if you have concerns about finances, not dental students on an anonymous internet site.

 

[drgioiadds]

I would have not charged for the limited exam. As far as I'm concerned its part of the crown fee. If someone came back to me to adjust the occlusion of a recently done filling - I do not charge for an exam and an occlusal adjustment.

 

[Healthnutty]

How is this discussion not closed yet? It's okay to talk about your treatment only if it's involving money as opposed to "did x do the right treatment?" Bleh.

I fear the future where my patients actually ask silly questions like these on an internet forum, Yelp, healthgrades etc.

Talk to your dentist if you have concerns about finances, not dental students on an anonymous internet site.

I never asked if x did the right treatment. I was trying to figure out if most of you dentists (not dental students) would bill for the limited exam or not. Thats fine if you feel this is a silly question, however I think it is legitimate, especially seeing that some would do the same as others would not. I just wanted to get other honest opinions because I did not know if this is normal. I honestly find these types of discussions interesting on the optometry forum. I want to own my own practice someday, so it is nice to see what others would do. Maybe there is a dental student reading this and learning just that? Feel free to have the thread closed.

 

[UBDent19]

I think this is a good question to ask on this site. It is helpful for you to get feedback and it is also helpful for dental students to learn from your experience. It allows us to run the scenario through our head first so we're ready for it once we encounter the problem in our practice.

 

[DrJeff]

How is this discussion not closed yet? It's okay to talk about your treatment only if it's involving money as opposed to "did x do the right treatment?" Bleh.

I fear the future where my patients actually ask silly questions like these on an internet forum, Yelp, healthgrades etc.

Talk to your dentist if you have concerns about finances, not dental students on an anonymous internet site.

Yup, we're kind of walking the gray line between okay/not okay, but it does seem to have morphed away from a discussion about treatment x into a moral/hypothetical discussion about quick followup visits and billing/not billing for them.

Personally in a follow up visit like that, I'll bill about 50% of the time - total subjective/scenario type things

 

[Daurang]

You may need a RCT without the need for crown, or you may need crown without the need for RCT, or you may need both, or you may need neither. Without looking at it first hand with an xray and poking around, we can't give you a truthful answer. I would not have charge for the second visit out of courtesy.

 

[Healthnutty]

Just to make this clear...I am NOT asking if he did the correct procedure or treatment. Even though it turns out I needed the RCT, I realize that he made the correct decision not to, simply because as a dentist he believed it did not need to be done. Again, I respect his decision.

When I started this thread, I was just curious if other dentists would charge someone for that last visit (when he decided to refer me out). I wanted to see if this was normal/common. Maybe I should have been more careful on my wording and NOT have asked if I was 'wrongly charged' or if I 'shouldnt' be billed.

Thank you again for all the responses. No need to reply for my sake, but continue to post if you like.

 

[jay47]

Just to make this clear...I am NOT asking if he did the correct procedure or treatment. Even though it turns out I needed the RCT, I realize that he made the correct decision not to, simply because as a dentist he believed it did not need to be done. Again, I respect his decision.

When I started this thread, I was just curious if other dentists would charge someone for that last visit (when he decided to refer me out). I wanted to see if this was normal/common. Maybe I should have been more careful on my wording and NOT have asked if I was 'wrongly charged' or if I 'shouldnt' be billed.

Thank you again for all the responses. No need to reply for my sake, but continue to post if you like.

I'm pretty sure that this is common practice, but it always comes down to a call by the dentist. You have to remember, he is paying probably 5+ employees, and you have to have revenue to cover those employees. For example, 2 assistants, 2 hygienists, and 2 office staff cost a lot per hour. Heck, let's figure it out.

Hygienists, assuming salaried and not per hour, at $50,000 a year working 50 weeks a year for 8 hours a week= $50,000/ (50weeks*5 days week*8 hours day)= $25 bucks an hour. Plus, you have your office manager, let's say she's making $50,000 a year too, that's another $25 an hour.

Assistants, you have 2 making $12.50 an hour. Then you have rent, electricity, internet, maybe cable, taxes, oh, and don't forget disability, professional and liability insurance. Oh, and worker's comp, and employee benefits packages (if offered)....

Total an hour, excluding running costs like electricity, etc... total around: $125 an hour. Just tack on another $25 for running costs and your are around $150 an hour. You may see like 2-5 patients an hour, and many of them will be recalls, etc.. where you don't directly make money. If you sit in chair, you have to respect what it takes to be able to run the chair first.

Now hopefully you will make your decision to stay or leave this dentist from a more informed perspective. I am also assuming the charge for the visit was not extravagant. I am a really nice guy, and sometimes I think I would feel bad for charging someone for just a visit, but I have obligations to my employees and my office; and these sorts of things cost money. Unfortunately, it just doesn't grow on trees.

Working dentists, do these numbers seem reasonable?

 

[tinman831]

It simply boils down to money. Time is money and he is legally able to bill for his time and expertise. As far as it being common practice amongst dentists, who knows? It all depends on how well you can sleep at night after doing it. I know I wouldn't charge for it. But that's just me. Ethically you aren't supposed to be critical of another dentists work. So take it with a grain of salt. 😛

 

[UBDent19]

Ethically you aren't supposed to be critical of another dentists work.

Is that an official rule? If so, how are you supposed to suggest fixing work you think was done poorly?

 

[DrEndo]

Is that an official rule? If so, how are you supposed to suggest fixing work you think was done poorly?

It's very easy to criticize someone else's work. However, one shouldn't judge without actually being there when the work is being performed.
You can make an educated guess once you see the consistently bad or good work coming out of a particular dentist, but still you shouldn't express that opinion to the patient. Some patient prefer the price over quality. I've seen $500 composite veneer that looked better than $700 porcelain one, and I've seen $40 fillings that were replaced 4 times in the previous 24 months and others that stayed for 6 years. I've seen $1000 crowns that fell out days after cementation and gold inlays that stayed for 82 years (original price I would be guessing being cents)
For example, you can see terrible filling done on a lower molar under contoured, overhanged, zero contact, patient tells you it was done 6 months ago. You tell them that filling needs to be replaced 'cause it's crap. Patient agrees. You anesthetize, start by removing the old/new Ag/comp. 5 minutes passes ....... and the mouth is starting to close giving you half an inch of clearance. You do what's best and realize that the original filling looked 10 times better.
Now will you criticize your own work and suggest it'll be replaced.
What I do is suggest treatment plan based on findings, when asked to judge someone else's work I say, "I wasn't there so I can't comment, all I can say I recommend you have the following done". I usually start with one of the easiest fillings after I address the urgent need.

 

[Daurang]

Is that an official rule? If so, how are you supposed to suggest fixing work you think was done poorly?

It's an unofficial rule. Patients do not trust you more when you criticize other dentists and it may even backfire because it shows your desperation. Tell them your clinical findings and let them decide for themselves.

 

[DocJL]

I would really appreciate your opinion on the following...
This has been bothering me whether or not I was wrongly charged, so I thought I would visit the dental side of the forum for a bit 🙂

I scheduled an appt with a new dentist and told them that I knew I needed an RCT (I found out about needing an RCT right before I was going to move so waited to do the RCT after my move to a new city).

At the visit, he evaluated my xrays and mouth and offered to do the RCT right then, so I gave him the ok. When he got into my tooth he determined that a RCT was actually not needed, so instead he just cleaned it out and placed a temp crown. A few days later I called with concern about the TERRIBLE pain. I came in for another visit, and he shaved down the temp crown. He said the pain was prob due to the bite and anesthesia. He did mention that if the pain continues that I might actually need to get a RCT. The next week I was suppose to get my perm crown, and a few days before I called in to tell them the pain is very bad and I need a RCT (Dentist told me that if the pain cont to do this). They had me come in and he took another film and told me he was going to refer me out for the RCT.

Ok....so here is my question.... I was charged a comprehensive exam for my first visit. Thats fine, BUT then I was also charged for a limited exam for the last visit when he decided to refer me out. Should I really be charged for this last visit?? He made the call NOT to do the RCT in the first place. I dont feel like I should be charged because if he did the RCT from the beginning, I would have no pain.....so no exam.

Sorry that this is a little long. I am just curious if this is right or not. BTW, the dentist is very nice and I realize he just happened to make a wrong call on this one.
Thank you!

OP,

There are many great dentists, and there are many not-so-great dentists. Only you, as a patient, can decide which your dentist is, based on your experiences with them.

I will say several things in your post would concern me as a patient, and I will give you a frank, professional to professional opinion.

1. You had at least one other dentist tell you an RCT was needed, and this dentist concurred with the diagnosis, which was part of your acceptance of treatment with him.

2. The clinical symptoms you experienced after the crown preparation confirmed that the tooth DID INDEED require an RCT.

3. It was made obvious at your second visit with this doctor, that he was not qualified to perform the RCT treatment. Why does he now want to refer you? when at your initial visit he told you he would be performing the RCT?

Looking at these points, I believe it is clear that this dentist 1)knew you needed a RCT, and knew you were aware of this from your symptoms and your visit with a prior dentist, 2)knew he was not qualified or experienced enough to perform the RCT (let me guess, it was a molar😉), 3)wanted to convert you to a patient, and get the fee for the crown, and was afraid he would not have this opportunity if he immediately did the ethical thing and referred you to a dentist competent in performing molar RCT treatment.

If (as some have suggested) his rationale for NOT performing the RCT at your initial appointment was simply to "save tooth structure" or "not perform unnecessary treatment", then why, once your symptoms have confirmed the necessity of RCT treatment is he NOT providing the service himself? As you are someone outside the dental field, I will add this, performing a molar RCT requires much more skill, and time, than preparing a tooth for a crown, and many dentists never become very good at it, those who are not very good at it (but are ethical) usually refer these treatments to an endodontist.

The fact that he then "nickel-and-dimed" you by charging for a limited exam when seeing you for your second visit, just makes it even more clear that his monetary "production" trumps any notion of care for you as a patient or individual he might have.

Good luck and let us know how it turns out.

 

[ItsGavinC]

Seems like he had no intention in doing the RCT. What he did wasn't right. But honestly, I would have done the same. I know that ethically it is wrong, but my student loans need to be paid off. I went into dentistry for the money and lifestyle, but these loans will really cramp my style.

Find a different dentist.

🙄 What wasn't right? He should have done the endo when the tooth didn't need it? Sheesh.

Billing for a limited exam is 100% right. That's what he did, a limited exam.

 

[ItsGavinC]

He made the correct decision concerning your tooth, but charging you for that second visit was not right. I know time is money, but the second exam should have been at no cost.

It costs me $20 to set up a room for an exam. Why would I NOT bill for that? A limited exam code exists just for this purpose.

 

[ItsGavinC]

If (as some have suggested) his rationale for NOT performing the RCT at your initial appointment was simply to "save tooth structure" or "not perform unnecessary treatment", then why, once your symptoms have confirmed the necessity of RCT treatment is he NOT providing the service himself? [/B

The fact that he then "nickel-and-dimed" you by charging for a limited exam when seeing you for your second visit, just makes it even more clear that his monetary "production" trumps any notion of care for you as a patient or individual he might have.

Good luck and let us know how it turns out.

Your post is so one-sided that it's almost laughable. How does charging somebody for a limited exam equate to "nickel-and-diming" them? Do you not value your time or your skills? Are your supplies free for you? Does your staff work for free? Do you not have paying patients sitting in other rooms at the same time that are also waiting for treatment? Not charging patients simply makes the patient devalue your services. People don't care about stuff that's free. That's the whole problem with our Medicaid system (and why 50% of the patients I take to the OR to do full mouth treatment on will return to be put to sleep again for new cavities within 3 years).

Maybe he decided that he didn't want to do the RCT because the patient is a pain-in-the-ass. We've all met those patients. I'd gladly refer out $2k worth of treatment if it eliminates a headache for me. Who knows, but you can't make a judgement call on the guy's motivations or skills based on an internet posting by one of his patients.

 

[DocJL]

Your post is so one-sided that it's almost laughable. How does charging somebody for a limited exam equate to "nickel-and-diming" them? Do you not value your time or your skills? Are your supplies free for you? Does your staff work for free? Do you not have paying patients sitting in other rooms at the same time that are also waiting for treatment? Not charging patients simply makes the patient devalue your services. People don't care about stuff that's free. That's the whole problem with our Medicaid system (and why 50% of the patients I take to the OR to do full mouth treatment on will return to be put to sleep again for new cavities within 3 years).

Maybe he decided that he didn't want to do the RCT because the patient is a pain-in-the-ass. We've all met those patients. I'd gladly refer out $2k worth of treatment if it eliminates a headache for me. Who knows, but you can't make a judgement call on the guy's motivations or skills based on an internet posting by one of his patients.

Gavin,

I base my post on the evidence presented. Read the areas of the OP's post that I highlighted. From your posts you appear to be a successful pediatric dentist. I am a successful general dentist, so I am also basing my opinion on my own many years of experience. Just as one observation from the restorative side, when I worked in a large corporate practice, I noted that the dentists who were not very competent with molar endo, tended to have a LOT of pts requiring endo AFTER they had their teeth prepared for crowns. I think in hindsight it is safe to say these pts would have been better served if the endo were done before the crown was placed, as they would not have had to suffer a toothache, and would not then have a crown with a crappy composite "access fill". And no the same dentist did NOT perform the RCT (as stated, it was always the guys who sucked at endo - the RCT was typically either referred out of the office to an endodontist, or handled in-house by a more experienced general dentist with more skills in endo (and that would have been me.....lol!) Bottom line, if a tooth needs a root canal 2 years or 12 years after a crown preparation, oh well, but if a tooth is symptomatic IMMEDIATELY AFTER a crown preparation, it was MISDIAGNOSED.

I also stand by my assessment that the dentist in question is "nickel and diming" the OP. If a pt returns to your office to be seen for pain that is directly related to a procedure you just performed, particularly when it was an EXPENSIVE procedure you charged the patient for (the OP probably paid $1000 or more for his exam, BU and crown that day), I don't see how you can ethically feel "entitled" to a second exam fee a few days later.

I also understand many "pain in the ass" patients are best referred, but the OP does not come off in his post as this type of patient. He doesn't appear to be trying to be the judge, jury and executioner for this dentist. Seems to me to be more of a cash strapped college student wondering if he's being overcharged, and to that I again say YES he is.

 

[OceanDMD]

Have you ever walked out of a Dr. appointment, or walked your dog out of a VET appointment and not had a bill? I personally have not. However, I am guilty of the no charge "look see" appointment many times. What is it with us dentists? Our time is valuable, and our education probably cost more than the attorney down the street that bills you $175/hour to get your name address and issue.

 

[DocJL]

Have you ever walked out of a Dr. appointment, or walked your dog out of a VET appointment and not had a bill? I personally have not. However, I am guilty of the no charge "look see" appointment many times. What is it with us dentists? Our time is valuable, and our education probably cost more than the attorney down the street that bills you $175/hour to get your name address and issue.

When I have seen my vet (who has made a small fortune off of me over the years, lol!) and when I have seen a physician for follow-up visits after a procedure that was paid for, I have NOT been charged.

 

[DocJL]

Healthnutty (OP)

How about an update?