why can dentists charge more than what is "reasonable and customary?"?

Question

insurance companies will only pay a certain amount on dental procedures-why is this and how do dentists get away with charging such ridiculous high prices?

to the dentist who thinks i am just being "cheap" well kiss my you know what! we shouldnt have to decide whether or not to have a roof over our heads (in my case a paid in full mobile home that is from 1971)paying our other bills or having teeth in our heads this is a no brainer-its highway robbery and you all should be hung out to dry!!!

Answer 1

i know what you mean , i'm still paying the bills over many years i hate dentist they just don't have heart to pay us cheaper lol they are very greedy with peopls who dont have that kind of money for them to fix our teeths you know i rather let it fall out not paying them lol

Answer 2

You don't say where you live, but this is how it works in Ontario. The Ontario Dental Association puts out a fee guide every year that tells you what you can charge for things. The insurance companies pay a percentage of these fees, and may even allow rates based on a past fee guide. (My hubby gets 80% of fees charged in 2006) Some fees go up, some stay the same and over the last few years some even went down. But most dentists will give you a reduced rate if you have no insurance, and some times this is cheaper than paying your premiums plus the co-pays.

Answer 3

You must first understand where insurance companies get these so-called "reasonable and customary" fees. Each company surveys a certain arbirary number of dentists - including low-end HMO clinics. They then average these fees and come up with their own UCR. They could be way off of what a private practice office could charge.

Dentists do not "get away" with charging what they do. Each health care provider comes up with fees which reflect the value of the service they provide, including enough margin to pay the staff and themselves. If they are charging more than their services are worth, the free market will take care of them.

People like good service and high quality care. You can't get that at Walmart prices.

Answer 4

Any doctor can get away with it. It is unfortunate that we don't find out until afterward, but they certainly can get away with it. On the other side though, insurance companies are not practical about their UCR (usual, customary and reasonable) rates. A friend of mine had an MRI done. The insurance company said that it was several hundred dollars over the UCR. Well, at that time, there were only two places in town that did MRIs. She took the procedure code and called the other place. They charged the same price, so she challenged the insurance company on that and they paid quite a bit more.

Answer 5

This is a great question. Actually usual and customary fees are the way that dental insurance companies get away with not paying your claims. You can fight your insurance carrier on their fee reimbursement amounts. Usually dental insurance companies only pay on what is know as the 60th percentile rate. Usual and Customary rates are determined by a general pole of the zip code area (about 10 offices) and I guarantee they havent updated their reimbursement percentage for at least 10 years. Materials in dentistry have gotten way expensive and lab fees are outrageous. It is not the dental offices overcharging its your insurance company not paying out for the services warranted...

Answer 6

I'm a dentist.

I have to tell you, that attitude really f-ing pisses me off. It shows how incredibly selfish and cheap you are.

When you have a cavity and we put a filling in it, we charge you between $150 to $200 for it. Yet, that filling will likely stay in your mouth, enduring your abusive eating habits, for a minimum of five years. Very likely it will last longer than that.

That's at most $40 a year to keep that tooth healthy, you miserable cheapskate.

Root canals, crowns, etc. are very difficult to perform. It may be easy for you--all you have to do is sit your *** in the chair, keep your mouth open, and hold still--but it's difficult and technically-involved work for us. As such, we're going to charge you appropriately for it.

Yet, you seem to think that the work we do is like the work a hair salon or nail salon performs, and that we are charging horrendously high prices for it.

The fact that you trust insurance companies to dictate the "fair" price proves to me that you're clueless. The reality is that insurance companies pay only a certain amount for dental procedures because they are unabashedly willing to rip us off at every opportunity. It has absolutely nothing to do with what they think is a fair price. That's why dentistry has resisted managed care far more than medicine. We are not willing to put up with insurance companies ripping us off.

When you see your dentist, you are seeing a doctor who is performing on you a surgical procedure meant to maintain or improve your health. It is no different than a trip to your physician for an angiography. How do we "get away with" charging such "ridiculous" high prices? I truly wonder how much you'd ***** and moan about the price of an angiogram.

We don't "get away with" anything, sweetheart. We charge what we think is appropriate. You think it's too expensive? Don't go to the dentist...and see what happens.

Answer 7

I know , its crazy. It's propably for those who dont have insurance. The insurance will only pay whats R & C............. But I believe if your plan has in & out of Network Dentists that fee is lower and called the Contract Rate. Most Dental Plans today, you can go to any dentist and the R & C apply.

Answer 8

because dental prices are not regulated by the government. You can always search for the best priced dentist on your own if price is a concern for you.

Answer 9

I SECOND EMMALUE'S POSITION.THE ACTUAL COSTS THAT ARE INVOLVED IN DELIVERING QUALITY DENTISTRY GO FAR BEYOND JUST A PRICE FOR ANY GIVEN PROCEDURE.