Wednesday, May 13, 2015

To Paraphrase: First We Kill All the Dentists!

OK... perhaps not all the dentists... but definitely it's time to "cull" the endodonists.

$1,200 - for one root canal... are these people friggin' high...?!

Yes, folks... I'm now aware... that's "the going rate." Well, folks... I'm here to tell you... that's simply unacceptable and it's yet another sign that America has become a nation of Sheeple who simply "accept" whatever "the powers that be" tell then is acceptable - even when it's clearly not.

Allow me to share my sad tale from the beginning...

The wife and I hadn't seen a dentist in awhile. Our "old" dentist is in the City and since having completed major dental work with her and her associates years ago we fell into a pattern of "out of sight, out of mind." (In other words, no pain... no toothaches... no apparent "problems" - we procrastinated.)

In any case, awhile back - earlier this year - I noticed that one of my front teeth was visibly stained. This served as an "alarm" and at that point I knew it was time to find a local dentist - which I did.

I chose a dentist basically at random, based upon his ad in our local weekly newspaper advertising supplement. "With coupon" new patients were entitled to a $69 initial consultation, exam, and cleaning. (And, yes... it's a reputable practice; several of our friends and neighbors use this dentist.)

Anyway... Mary and I both "signed up" as new patients and we both took advantage of their "new patient special."

Fine! Great office! Very hi-tech. Pleasant - and competent - staff. We both liked the dentist.

Our exams and cleanings went off without a hitch. "Problems" were found of course, but we'd expected that. It seems that we're both going to need multiple root canals and crowns. (Two for me... two for Mary.) Prior to that, though - first order of business - I required a cavity drilled out and a filling placed. No problem! Perhaps forty minutes in the chair and I was good to go! Cost: $134.

Now... to backtrack... allow me to note that one of the things I like about my new "general" dentist is that when I first called to make our initial appointments I was asked if we had dental insurance. When I told the staffer we didn't her response was to advise us to look into Careington Membership Dental Plan. This plan isn't insurance; what it does is give you set rates for member dentists (my dentist is a member, obviously) that in theory save you anywhere from 20% to 60% off services rendered. There's a fee schedule allowing members to see exactly what the negotiated fees are.

Here's the problem: The fee schedule (which lists root canals as ranging in price between $366 and $557) applies only to Careington Plan "general" dentists - not specialists. For member specialists... endodonists for example... the Careington discount is 20% off of "normal" fees.

And what are "normal" fees...??? Ah... now that's the question, isn't it...?!?! And to continue with my story, that's where the problem comes in!

So... where was I? Oh, yes... initial exam and cleaning $69 - incredibly reasonable! (Remember, though, this was an "in-house" special - not the Careington Plan rate.) One cavity filled - $134 (absent the Careington Plan discount it would have cost $139 I believe. Not the greatest discount, but every little bit helps). Bottom line, though, whether $134 or $139, I find this fee quite reasonable. We're talking a half hour - perhaps 40 minutes - of the dentist's time and effort plus his assistant. Hell... my mechanic's labor rates are posted at $110/hr. so I'm not complaining about my dentist charging roughly double!

Ah, but now back to the root canals...

Though having gone to medical school and then dental school himself, my new "Careington" dentist told me he wanted me to have a specialist - an endodonist - perform my root canals. Fine! What did I care? As long as we were talking an endodonist who accepted the Careington rate schedule... fine!

Well... well... well... yesterday I saw this particular endodomist. It... did... not... go... well.

All started off well enough. I arrived at her office (in a private home; in-ground pool and all!) a half hour early so as to fill out the paperwork and make a good first impression.

Right on time the hygienist came out to the waiting room to introduce herself and escort me into a procedure room where she took a couple X-Rays (even though they should have already had duplicates of all the pertinent X-Rays my "general" dentist had taken). Next... the doctor came in. She introduced herself. She visually inspected the tooth (#3) she was scheduled to work on that day and, after waving away the X-Rays the hygienist had just taken, she preceded to numb my gum and tooth nerves with local anesthetic - two or three shots I believe. Following this she announced that she and the hygienist would be leaving me alone for five minutes or so while the anesthetic took full effect.

So... here I am... in the chair... twiddling my thumbs... waiting for the doc to come back and start drilling... when in comes one of the front desk ladies - one of the clerical staff. Out of her mouth come the words, "Mr. Barker, I'd just like to discuss billing with you." I nodded. Her next words were, "Today's procedure will be $1,200."


(To remind you, folks, I'd been expecting the Careington rate of $557 maximum.)

I admit... I did not take being told "today's procedure will be $1,200" well. Let's just say... at this point I was... um... "agitated."

I of course started going on about the Careington rates and verifying that the endodonist was indeed a "Careington provider" and the staffer's response was to assure me that I was indeed getting the Careington discount. She told me that absent the Careington discount the procedure would actually run me $1,500. (It seems that when one reads the small print of the Careington agreement, endodonists are "specialists" in the same sense, say, periodontists are; meaning... rather than abide by the scheduled rates a "regular" dentist would charge, they can simply make up their own and then - supposedly - discount their "rack rate" by 20%.)

Folks... I was furious.

At this point rather than argue with the staffer I just excused myself, telling her that I needed to go to my car, grab my cell phone, and call my wife to confer. I called Mary. She too was flabbergasted. From her desktop she brought up the Careington website and confirmed the "small print." (Like they say, folks, the devil is in the details.) She then called our new "general" dentist's office to see if they would be able to do the work in-house, but she couldn't reach the dentist himself immediately. While all this was going on the staffer came out and said that if the endodonist was to do the procedure I needed to come back inside so that she could start and finish before the anesthetic wore off.

Anyway... at this point was totally stressed. Mary didn't know what I should do; I didn't know what I should do; half my face was numb and all I could think of was how were we going to afford four root canals between the two of us at $1,200 a pop - PLUS the necessary crowns?!

After Mary couldn't get hold of our new general dentist we decided to bite the bullet. Since I was there and numb already we decided we'd get this first root canal done there and then - for $1,200. I returned to the chair. The endodonist and hygienist came back in and I was asked "is everything alright now?" My candid response, "no, not really; but what choice do I have?" I then continued, directing myself to the endodonist, "Why did you numb me BEFORE appraising me of the cost; you KNEW I was a "Careington" patient?!" Her reply? "Well, it is the patient's responsibility to know what their insurance covers."

(Nice, huh?)

That did it, folks. I told her point blank that this wasn't the proper and ethical way to do business. Why have the clerical staffer come into the procedure room to talk with the patient prior to the procedure being done in the first place if they felt no responsibility to confirm pricing? Why do so only AFTER the patient has been numbed? Why not have "the billing discussion" before the new patient (in my case a KNOWN "Careington patient") sets foot in a procedure room and sits in the chair? Hmm...?!?! (I believe the answer is pretty obvious.)

I've had root canals before. I know how long they take. We're talking two hours tops! How in God's name does one justify charging (regular rate) $750/hr. or even a "discounted" rate of $600/hr.?

Folks... that's what we're talking! And, folks... that's outrageous! That's insane!

You know what I keep hearing? "That's the going rate, Bill." Yeah. As if that's a justification as opposed to an excuse... a total cop-out. No matter how many people allow themselves to be robbed blind, sheer numbers don't make such behavior acceptable... moral... or ethical.

The individual median American hourly wage is approximately $17.09/hr.

The individual mean American hourly wage is approximately $22.71/hr.

Granted, endodonists are highly skilled professionals. Medical school... dental school... specialized training. They should be highly compensated! But $750/hr.?


(Or, heck... even a "mere" $600/hr.?)

I'm sorry, folks, but with all due respect to endodonists... 33-times the individual mean American hourly wage... THIRTY-THREE TIMES... seems a bit... er... excessive to me.

Ten times? Twenty times? $200... $300... even $400/hr. - that seems... justifiable. (But 33-times...?!?!)

Can I "afford" $1,200 for two hours dental work? Sure. (At least in the sense of "do I have the money; can I get my hands on the money?") But that's not the point! The point is that for the long haul any dental service beyond a basic filling or extraction is becoming unaffordable for "regular" people. This is not "cosmetic" surgery. Root canals are not "aesthetic" in nature; they're a procedure designed to save one's tooth!

To those who say "it is what it is" my rejoinder is "well... it shouldn't be." To those who have this misplaced sense of pride towards being able to absorb insane pricing I say to you, "being a dupe and getting ripped off isn't something to be proud of."

Anyway... to end my sad tale... after the endodonist and I had our... er... frank exchange... she said to me, "I can see you're still upset. Perhaps you may want to consider the situation and your options?" I thought about it and... after taking a deep breath... replied, "yes, I think that's best. Let me discuss the matter further with my wife and my general dentist and I'll let you know what I decide. In the meantime let me take care of today's charges for the pre-procedure (which never occurred) numbing."

Folks... anyone wanna guess what I was charged? (And of course at this point I was at the reception desk and the endodonist was in her office with the door closed.) 

I was charged $157.

One hundred and fifty-seven dollars... for X-Rays that shouldn't have been taken in the first place... a numbing that (it turns out) shouldn't have been administered... and of course the perhaps ten minutes total of her actual "services."

I paid it. I didn't argue. Here's the thing, though: I never should have gotten past the reception desk in the first place. They know I was a "Careington Plan" patient - a new "Careington Plan" patient. Pricing should have been outlined up front, not after I had been numbed in preparation for a $1,200 procedure that I had been expecting to pay no more than $557 for.

Notice, folks; except for the Careington Plan I'm not mentioning any names. I'm not noting who this endodonist is; I'm not revealing who my new "general" dentist is. So... keeping this scenario "generic," do any of you reading this wonder what I'm wondering - namely... is this a legal scam of sorts?

Get folks to sign up for the Careington Plan; entice them with low published "general" rates; the catch being that while new members are focused on the procedure cost list they may very well "overlook" the "small print" concerning Careington Plan "specialists" (most commonly endodonists) to whom Careington Plan "general dentists" refer their patients.

Call me a cynic, but, say you're a general dentist that accepts the Careington Plan - indeed you use your acceptance of it as a marketing tool. Patients who follow your advice and sign on see root canal rates ranging from $366 to $557. You of course don't want to do such procedures for such a "low" reimbursement... so... you refer your patients to a Careington Plan endodonist - knowing full well that many Careington Plan members will be focused on the general rate chart (which applies ONLY to "general dentists"), mistakenly believing that the root canal rates advertised apply to the procedure - not the "dentist" per se. (Hell... if I were a real cynic I might even wonder if there were formal kick-backs... "referral fees" involved.)

Oh... and a sweet gig for the "Careington" endodonist as well! They get patients expecting at the very least a "Careington 20% discount" - but these same patients (who again, in many - perhaps most - cases are focused on the SPECIFIED "rate chart" pricing rather than general "20%-60% off" Careington marketing) are put in the endodonist's chair not having the faintest clue as to what "normal endodonist's rate" is being discounted by 20%!

Do I suspect laws were broken? No... not unless you count "moral" law... the "law of ethics."

Could I sue and win? Doubtful. Could I even get the attention of state or federal regulators? Ha! Fat chance. Doctors, dentists, and outfits like Careington no doubt lobby and generously donate to politicians across the ideological and partisan spectrum.

As to Careington...

Again... not to be too cynical... but now that I ponder how this whole thing played out... I find it... um... "interesting"... that while Careington and their member practices aggressively tout their "general dentistry" rate chart (and the prices ARE good; I verified this with a dentist friend of mine prior to signing up)... they don't have a "specialist" rate chart. I mean... think about it; if a rate chart is good for "general" dentists' rates WHY wouldn't the same logic apply to "specialist" dentists' rates?

Ah... questions...

What are my options at this point? Well, I spoke to one of the staff at my "general" dentist's office last night. "My" dentist wasn't in, so I laid out my experiences and concerns with the staffer and asked her to relay them to the dentist and have him to give me a call. In short... I want one of the dentists at my "general" practice to perform the necessary root canal for $557. Hopefully either "my" dentist or his boss (the principal dentist of the practice) will agree. If not... I don't know what I'll do.

Four root canals between my wife and I. Four crowns. Not that over $1,000 per tooth (all said and done) isn't expensive, but we can bear four or five grand over the next year or so; but if we're talking eight thousand... nine thousand... ten thousand... that's simply unaffordable... and frankly... unjustifiable. 

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