Itemize cost of crown procedure

[John Anthony]

Hi all, newbie here. I'm a 71 year old guy with several broken teeth. I've had a marginally successful small business for 30 years with no dental insurance, so there wasn't much I could do as my old fillings broke apart. I've been semi retired since 2014, on Medicare with HMO Delta Care USA.

I recently had Delta send me the Schedule of Benefits for my plan. It's pretty good, actually. I have a few $K to blow on my teeth so I went in for a consultation with a local dentist that accepts my plan.

He worked up a 5 phase plan with 9 crowns, two lateral veneers, a removable partial, and a couple resin based comps. His fee totals $29,600, my cost would be $8735.

He wants to do porcelain to high noble metal on all the crowns, procedure D2750. His fee for that is $1646, my cost on each is $295, plus $150 "lab fee", plus $150 "zirconia material fee". I put them in quotes because I think these are B.S. fees.

Several teeth he has $150 "core buildup including pins fee". The procedure is D2950, which is covered by my plan. Either his assistant made an honest mistake, or they didn't think I would look it up.

In total, these 25 charges add up to $3750. Removing those would get me below $5k. Don't know if he will move on that.

It turns out that one of my customers has had a dental lab in New Jersey for 44 years. He says he makes crowns, etc for high end dentists in Manhattan. He would like to do me a favor and make emax crowns, the veneers, and a fixed bridge for me for like $3k total. He says all he needs is the full impression after tooth prep.

He says ask the dentist if he will settle for what the insurance pays, total of $20,856, and let me pay him out of pocket to make everything for me. He says the dentist won't like it, but he'll be losing close to $21k if I walk. He says if this dentist doesn't go for it, I should be able to find someone in SoCal that will do it.

I checked with Delta and they said sounds like a good deal, but he's not in the network, and can't go to a lab out of state.

I would appreciate any advice. Thanks very much.

 

[Busybee]

Perhaps you don't need quite so much work? Is there another dentist you can see that also covers your insurance plan?

 

[John Anthony]

Perhaps you don't need quite so much work? Is there another dentist you can see that also covers your insurance plan?

 

[Busybee]

Hi did you mean to reply?

 

[John Anthony]

Oh no, I need all that work. Several teeth are broken down to the nub, with just one side remaining, plus one of my front teeth is descending due to bone loss and will have to come out.

Tooth #15 needs a root canal but I'm putting that off for now, at least until the antibiotics wear off. It's also broken off on three sides. My wife says just get it pulled. The root canal is covered but the endodontist says there will be about $450 in extra charges, so saving that tooth will cost $1150 with the crown. I asked the dentist to pull it but he wanted me to visit the specialist first. I told him I only have $5K to spend and this tooth alone will eat up 20% of that, he looked at me like "so?"

How much time does it take the dentist to prep a tooth for a crown? Just trying to figure out how much of his $1646 fee is labor vs what he budgets for the crown. My cost for porcelain to high noble is $295. I know the $150 lab and $150 zirconia material charges are bogus.

My friend said he uses 89% gold plus 11% palladium. Or platinum, can't remember which. He said "high noble" metal can mean as little as 10% gold. So the dentist's actual cost can vary a lot.

This dentist is 5 minutes away, just around the corner. They did give me a referral to another dentist in the network that may be lower cost, but I want to try bargaining with this one first. I know he's good. Just a crook.

 

[Busybee]

Preparation time depends on complexity. It's usually about an hour to an hour and a half with the temp. As well as his time, the crown material, lab costs etc, his fee will include a portion of his overheads for rent, equipment, utilities, staff etc. I'm not sure if it's still the case but zirconia used to have to be cut in a special way. But I don't think it makes it more expensive at least not in the UK.

I think if you know the dentist is good and so conveniently five minutes away if anything goes wrong, then I'd value that above cost of work.

Dentists have close working relations & communication with their technicians so your dentist may not want to use someone else or just rely on them to guess what's required for your particular issues. They will have agreed tariffs and all sorts of arrangements in place with the one they use more often. Don't forget that your customer is out to make money too. If you insist the dentist uses that lab and something goes wrong because of the technician's work, then where would that leave you? You could fall out with both the dentist and your customer. Seems more than a bit risky because the dentist tells the technician what is required and sends it back if it's not good enough. How will you do that with a customer? I'd steer clear of that but obviously up to you.

 

[John Anthony]

Preparation time depends on complexity. It's usually about an hour to an hour and a half with the temp. As well as his time, the crown material, lab costs etc, his fee will include a portion of his overheads for rent, equipment, utilities, staff etc. I'm not sure if it's still the case but zirconia used to have to be cut in a special way. But I don't think it makes it more expensive at least not in the UK.

Thanks for your reply. That's quite a while in the chair, and I understand he needs to get paid for his skill and it must cover his operating expenses.

My customer and I were thinking no temp crowns, just prep the teeth. I could live on beans and rice for a week or so while he makes the crowns. He says all he needs is a full mouth impression. And he said, "tell him not to skimp on the material". He said he can't understand why some dentists send him "just barely there" impressions, like the material is precious, when it's just a few dollars.

He says the $150 fee for "zirconia material" is nonsense. You have either a porcelain to metal crown, or you have a zirconia crown. You don't add zirconia material to a PFM crown.

He says the $150 lab fee is just padding the bill. The technician's fee to make the crown is the fee. The technician doesn't add a separate lab fee.

Yes, my guy is not giving it away. He's charging me the same as he would charge a dentist, about $3k for emax, vs porcelain to high noble.

I think the dentist is very good but I object to being gouged. If I had the money I wouldn't even look at the bill, but I can't afford what he wants.

 

[Busybee]

No temp crowns sounds crazy. Your customer doesn't know how a dentist runs a business and you don't know how much he charges the dentist. There's no way to tell whether he's telling you the truth. This is a really unwise course you are thinking of taking. All I can see is risks for you and avoidance of liability by those you would be paying. I don't know what kind of laws you have governing this in the US but either they are not sufficiently robust to protect the patient, or your customer is breaking them. I'd steer clear of the customer. This is unethical.

Ask the customer what kind of contract he is proposing to write to cover liability etc. What will he do if the crowns don't fit etc.

 

[John Anthony]

No temp crowns sounds crazy. Your customer doesn't know how a dentist runs a business and you don't know how much he charges the dentist. There's no way to tell whether he's telling you the truth. This is a really unwise course you are thinking of taking. All I can see is risks for you and avoidance of liability by those you would be paying. I don't know what kind of laws you have governing this in the US but either they are not sufficiently robust to protect the patient, or your customer is breaking them. I'd steer clear of the customer. This is unethical.

Ask the customer what kind of contract he is proposing to write to cover liability etc. What will he do if the crowns don't fit etc.

During my initial consultation, I told the dentist I was considering getting the work done in Mexico. My Mother lives in Yuma, AZ half the year, and said lots of snow-birds go across the border to get their dental work done in Mexico for one third the cost. He said don't do that, I'll come up with a plan. I told him I didn't have much to spend.

A couple of days later his receptionist gave me the proposed plan, of which my end is nearly $9K. My initial thought was, not bad but still double my budget.

I looked at my schedule of benefits and saw there were a couple crown types that were no cost to me, so I asked if we could use one of those types instead of porcelain fuzed to high noble metal. He said our lab doesn't do those.

Then I remembered that twenty years ago, one of my customers told me he had a dental lab and made crowns. I called him to ask about the different types of crowns. Then I asked if he would look over my paperwork. I emailed him my x rays, photos, the proposed treatment plan, and my schedule of insurance benefits.

Right away he asked what are all these lab fees? And what are these charges for zirconia material? You either have PFM or zirconia, but not both. So right away we knew the dentist is padding the bill by $3750. He started brain storming, and said I can do all your work for less than that. Just have the dentist prep your teeth, send me the impressions, and I'll send you the finished crowns. I've never met him, he lives in New Jersey and I've never seen his work. I just know what he's told me. But I know a lot more now about my dentist, and I don't like it.

So that's where we are. Just talking about it. I haven't been back to the dentist to go over the charges with him yet. The last time I was there, I asked him to pull #15. He refused, saying I want you to see a specialist. We can save that tooth. It was at that point I told him I have $5K to spend, and saving this tooth would eat up 20% of my budget. And he gave me the wide-eyed "so?" expression, shaking his head.

Most root canals are fully covered in my plan, but after consultation, the specialist said there would be $400 in uncovered charges, so I got out of the chair and left. I'll go back to my dentist when the antibiotics wear off and it starts hurting again, and have it pulled.

 

[Busybee]

John, I have porcelain fused to zirconium crowns. So they definitely make them. Maybe your customer doesn't do them just like your dentist's lab doesn't do other crowns.

If you don't trust your dentist go to another dentist, but don't try to make deals directly with a lab to try to cut the price. You will end up regretting it. You have no idea of the quality of his work and it appears you haven't discussed any form of contract.

It is always better to save a tooth than pull it. $400 is not a big excess to try to save a tooth. A tooth that is saved by a good specialist and left in situ is priceless. But I'm sure you can find a dentist who will pull it for you.

Go back to your dentist and ask if there is any way to reduce the cost without affecting the outcome. Bear in mind though that a good dentist is worth the money.