Please Help me understand: Dental Treatment

[akaykay]

Pharmacist here who hasn't been to a dentist in about 8 years (yeah I know, I'm a health professional and what am I thinking? Long Story...)

Anyways, I recently went to the dentist and he told me he needs to do my cavities which I've had for a long time, so on my billing statement it says:

Amalgam 2 Surf 5 MO --> $171.00
Amalgam 3 Surf 29 MOD --> $190.00
Comp 2 Surf Ant 6 DL --> $189.00
Comp 3 Surf Ant 10 DFL --> $212.00
Comp 3 Surf Post 20 MOD --> $263.00
Comp 2 Surf Post 21 OD --> $225.00


What the heck do these words mean? I know amalgam is silver but what is Comp and MO/MOD/DL etc

So I end up paying almost $400 out of pocket after my insurance which to me seems high because I don't remember 8 years ago paying this much for fillings but then again it was 8 years ago.

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[psiyung]

sounds about right...dunno why hes doing amalgam on the other teeth...letters stand for tooth surfaces btw

 

[tinman831]

Pharmacist here who hasn't been to a dentist in about 8 years (yeah I know, I'm a health professional and what am I thinking? Long Story...)

Anyways, I recently went to the dentist and he told me he needs to do my cavities which I've had for a long time, so on my billing statement it says:

Amalgam 2 Surf 5 MO --> $171.00
Amalgam 3 Surf 29 MOD --> $190.00
Comp 2 Surf Ant 6 DL --> $189.00
Comp 3 Surf Ant 10 DFL --> $212.00
Comp 3 Surf Post 20 MOD --> $263.00
Comp 2 Surf Post 21 OD --> $225.00


What the heck do these words mean? I know amalgam is silver but what is Comp and MO/MOD/DL etc

So I end up paying almost $400 out of pocket after my insurance which to me seems high because I don't remember 8 years ago paying this much for fillings but then again it was 8 years ago.

Comp = Composite = Tooth colored filling.
All those letters correspond to a specific sides of a tooth.

 

[lemoncurry]

M = mesial = side of the tooth closest to the midline
D = distal = side of the tooth furthest from the midline
O = occlusal = chewing surface of tooth, usually back teeth
L = lingual = side of tooth on same side as tongue
B or F = buccal or facial = side of the tooth facing the cheeks
I = incisal = biting edge of front teeth

so a Comp 3 Surf Post 20 MOD would be a Composite, 3 surface, posterior tooth #20 filling, covering the mesial, occlusal and distal surfaces.

 

[yappy]

Dang OP. Lay off the candy!

 

[Streetwolf]

Not sure what your insurance is like but a lot of plans cover 80% of fillings leaving you responsible for the other 20%. If you have a deductible to meet then you'd have to pay that off first. That could be why you are being billed for almost $400.

 

[bigbadaboom]

start flossing

$400 is about right, actually a pretty good deal of insurance plan you got there.
many times you will have a yearly co-pay amount.
if you've reached your annual maximum limit, the rest is out of pocket. Some plans downgrade all fillings to amalgam and the difference is paid by the patient.

yes, insurance plans is confusing.

insurance companies do this purposely - confusing people. they make it so difficult to understand and so complicated so they make it harder for the dentist to make a claim and explain it to the patient.

insurance companies charge you/your employer a premium, and try not to pay us the dentists, that's how the ins. companies make money.

insurance companies is not your friend, and definitely not ours either.

 

[DrDDSman]

I have little idea how billing and reimbursement works, but this is over $1000 worth of dental work billed. Will the dental office receive 100% of the billed amount (assuming pt pays what ever is not covered)? I think what I'm asking (for example) is that will all $190 of the Amalgam 3 Surf 29 MOD be received?

Also, how much can rates vary between offices in the same area?

 

[tinman831]

I have little idea how billing and reimbursement works, but this is over $1000 worth of dental work billed. Will the dental office receive 100% of the billed amount (assuming pt pays what ever is not covered)? I think what I'm asking (for example) is that will all $190 of the Amalgam 3 Surf 29 MOD be received?

Also, how much can rates vary between offices in the same area?

Whatever the office fee is, the insurance company will pay a percentage of that. So if the fee is $190 for an MOD, then the insurance company pays a percentage and then the patient pays the remaining balance. Most offices collect payment before treatment is done so the patient portion is collected first. The office files paperwork to the insurance company after treatment is finished and the insurance company will write a check to the office about a month later. If an office is slacking and paperwork is missing or incomplete, then the insurance portion may not be collected.

 

[Streetwolf]

Whatever the office fee is, the insurance company will pay a percentage of that. So if the fee is $190 for an MOD, then the insurance company pays a percentage and then the patient pays the remaining balance. Most offices collect payment before treatment is done so the patient portion is collected first. The office files paperwork to the insurance company after treatment is finished and the insurance company will write a check to the office about a month later. If an office is slacking and paperwork is missing or incomplete, then the insurance portion may not be collected.

If you are a preferred provider (or perhaps other circumstances too), it could be in your contract with the insurance company that your fees are reduced for patients under that plan.

So if your fee for an MOD amalgam is $190, the insurance company may say you can only charge $150. From there they'll pay $120 (80%) and the patient is responsible for $30. You're missing out on $40 but hopefully by accepting the insurance plan you are able to treat a greater number of patients in your practice.

 

[Demeter]

If you are a preferred provider (or perhaps other circumstances too), it could be in your contract with the insurance company that your fees are reduced for patients under that plan.

So if your fee for an MOD amalgam is $190, the insurance company may say you can only charge $150. From there they'll pay $120 (80%) and the patient is responsible for $30. You're missing out on $40 but hopefully by accepting the insurance plan you are able to treat a greater number of patients in your practice.

And when volume increases, dentists often have to cut corners or lower their overhead by buying cheaper dental materials.

 

[DrDDSman]

And when volume increases, dentists often have to cut corners or lower their overhead by buying cheaper dental materials.

If you're a practicing dentist...is the tradeoff worth it?

 

[tinman831]

If you're a practicing dentist...is the tradeoff worth it?

That's very subjective and each dental provider will have to evaluate the tradeoffs and whether or not it's worth it to themselves.

 

[akaykay]

actually I don't eat much sweets. I use to and these are cavities that I had since I was a teen but the dentist now wants to redo them.

So I decided to keep two composites (anterior ones) and the other two amalgam. The dentist looked like he was not happy with me. And so did the dental assistant. Guess I won't be going back there again.

 

[doc toothache]

Pharmacist here who hasn't been to a dentist in about 8 years (yeah I know, I'm a health professional and what am I thinking? Long Story...)A

Much change in the cost of Rx over the past 8 years?

 

[akaykay]

Much change in the cost of Rx over the past 8 years?

Yeah so many medications are now $4 and we have a much lower reimbursement rate with medicare/medicaid patients. So our prices have went done but what about dentists......

We make up for it with volume

 

[bigbadaboom]

Yeah so many medications are now $4 and we have a much lower reimbursement rate with medicare/medicaid patients. So our prices have went done but what about dentists......

We make up for it with volume

insurance companies raise premiums year after year
but the benefit they provide stay the same, or decrease.


as an example, a PPO dental insurance has a maximum of say 1500 limit per year. 5 years later, while the insured is paying more for the premium, the 1500 limit stays the same. Don't forget inflation too!

 

[dmd11perio14]

just keep in mind that the dentist recommended replacement of those fillings for a reason, they could be open or broken or faulty and replacing them in a timely manner could save you thousands of dollars in the near future. trust me the dentist would rather you not replace the filling and have more complications which will result in treatment exponentially more complicated as well as expensive. Root canals, crowns, implants to replace these teeth that could have been maintained, will cost you thousands. Also keep in mind that if you are not happy with your current dentist there is nothing wrong with getting a second opinion. good luck. hope my advice helps a little

 

[djeffreyt]

sounds about right...dunno why hes doing amalgam on the other teeth...letters stand for tooth surfaces btw

There's still lots of times when amalgam is a better solution than a composite. Trying to save a tooth with root surface proximal caries for example. If these are replacements, these could have been relatively long towards the cervical and the dentist felt they could still be restored with fillings but didn't think the isolation in the deep cervical would be adequate for composite. There's other reasons, but it all has to do with the dentist, what he or she thinks is best, what they are best at doing and their experience. I haven't done an amalgam since school, so I don't go to it very often.

So I decided to keep two composites (anterior ones) and the other two amalgam. The dentist looked like he was not happy with me. And so did the dental assistant. Guess I won't be going back there again.

Meh, I get patients all the time who don't get all their treatment or ask me which filling they should do cause they can only afford one or two and want me to do the worst one. I don't take it as an offense. I'm surprised that the dentist you saw would, but I wasn't there. But the below quote is pretty much right on.

just keep in mind that the dentist recommended replacement of those fillings for a reason, they could be open or broken or faulty and replacing them in a timely manner could save you thousands of dollars in the near future. trust me the dentist would rather you not replace the filling and have more complications which will result in treatment exponentially more complicated as well as expensive. Root canals, crowns, implants to replace these teeth that could have been maintained, will cost you thousands. Also keep in mind that if you are not happy with your current dentist there is nothing wrong with getting a second opinion. good luck. hope my advice helps a little