Dental offices charge additional fees for pain control, missed appointments

More than half of dental offices charge additional fees above and beyond standard fees for nitrous oxide administration or anesthetics and missed appointments, according to an RDH eVillage survey completed by 362 readers in May 2012.

The survey inquired about additional fees for:

• Nitrous oxide/anesthetics (58% charge an additional fee)
• Missed appointment charges (57% charge an additional fee)
• Home care products (15% charge an additional fee)
• Patient education (6% charge an additional fee)
• Cleaning of implant-restored teeth (only 3% charge additional fees)
• Caries detection technologies (3% charge an additional fee)
• Filling out insurance forms (less than 1% charge an additional fee)

The above procedures or services were the options listed in the survey, but the question allowed readers to list other services that result in a fee. Some of the answers provided include periodontal charting, fluoride root desensitizing, diode laser disinfection, placement of antimicrobial agents, whitening gels, adult fluoride varnishes, chlorhexidine applications, oral cancer screenings, irrigation during root planing, digital photos for insurance estimate approvals, temporary bridges, and sterilization.

Most offices (64%) said the additional charges “help pay for extra time or equipment/materials.” Some comments about the question reflected a variety of opinions.

• Often, people downgrade dentistry, but they are doctors too and their time is valuable and the overhead is high. You can’t walk into any other establishment and get something for free, so why would you get something for free at the dentist’s office?
• I have noticed that some dentists, established and just starting out, are more focused on making money than patient care. I think they see other dentists making a pile of money and they want to hop on the bandwagon and do the same. Sorry, but some of them want to brag about their million dollar practices.
• I think extra charges backfire on offices. I think that, when you work hard to educate and treat patients how you would like to be treated, you gain patients and that will make up for all economic pitfalls. Patients trust you and value your service. If anything goes wrong within their mouth, they will come to you to fix it.

Overall, the dental hygienists expressed a high comfort level with “all” fees being charged to patients; only 28% said “some” fees make them uncomfortable, and 5% said a “majority” of assessed fees make them “very uncomfortable.”

More than 95% of dental offices are giving away free toothbrushes, floss, and/or toothpaste after a recare appointment. Respondents were invited to list other home-care aids that are given to patients. A large percentage indicated that samples of interdental aids are being presented to patients, but other items include lip balm, floss holders, timers, oral health books for children, denture supplies, tongue scrapers, mouth rinses, and mints and gum.

The dental hygienists participating in the survey were asked what services are provided for “free” to dental patients. Some common replies included oral hygiene instruction, filling out insurance claims, oral cancer screening, smoking cessation tips, perio charting, postcard reminders, denture cleanings, forwarding records, and beverages for patients to drink.

The survey concluded by asking dental hygienists to comment on dental fees in general. Some selected comments include:

• We do charge for missed appointments ($25). We feel this fee is acceptable and tells us if the patient values our time or not. We waive this fee in instances of family emergency, first offense, or if they fill a cancellation last minute for us.
• I have worked in offices that do charge for everything (and I mean EVERYTHING) that they do extra. This includes any OHI instructions, aids, video watching fees, cancellation fees, Arestin, mouthwash pre-rinse before S&RP, and the list goes on. I feel like you should price your fees fairly for the services you are willing to offer to help prevent confusion and respect between patients and professionals.
• I don't agree with charging extra for periodontal charting. I believe this is part of the exam the patients are already paying for.
• In comparison to what we see on treatment plan estimates new patients bring from other offices, we are excellent. We have seen fees for cleaning the room, cleaning the instruments, oral hygiene instructions, and, shockingly, an additional fee if you want your crown to be more esthetically pleasing!
• I believe charges for fluoride treatments are excessive. Our office charges more for one fluoride treatment than what the entire bottle costs. I believe most people would gladly purchase the treatments out-of-pocket, if the fee were closer to $10 than $30+
• Anyone who is uncomfortable with the charges has never been self-employed. Every year there are new regulations and increases in overhead. Most employees have no idea what it costs to run a business. The "free toothbrushes" aren't free. If dentists charged less, most would be out of business. Third-party insurer arrangements are decreasing while office insurance (building, rent and personnel) are increasing.
• Fees for dental work can be very expensive and I don't see the need to "nickel and dime" the patients to death. Does that really serve a useful service? Your fee schedule usually has "extras" figured into them anyway.
• An adult prophylaxis charge for an "easy" 14 year old is the same as a difficult prophy on an older adult. I believe the hygienist should be able to charge on a sliding scale. I prefer to give patients a sample cleaning tool when I introduce it, and thereafter the patient should buy it themselves.
• I have, worked in the past for someone who I felt took advantage of the patients with very high fees for N2O, and Arestin amongst other things and who gave the patients the cheapest toothbrush she could find. She did not give out any dental floss or toothpaste. I no longer work there.
• I think when you "nickel and dime" people, they will get irritated enough and possibly leave your practice. Everyone is trying to recover from the economic crisis. We believe in great customer service and providing for them the best care and treatment we can give.
• Our hygienists are involved in reviewing and setting their fees. There is conversation about their time, materials, expertise and the value to the patient. Fees are a value proposition and unless team members value and are comfortable with what we are offering, either for free or for a fee, how will the patient? There has been no change in our fees to make up for changes in insurance coverages or "the economy."
• Even though we moved into a much larger and fancier office, we have not raised fees in over 3 years. My employer sometimes does pro bono work for local church and allows staff to use our own judgment for fees on patients who are out of work, disabled or otherwise financially in trouble. He really cares about his patients. I believe he is one of the rare ones.
• We are a practice in a very high income community. We do not participate with ANY insurance plans though we do submit claims and accept the insurance toward our full fee. Therefore, most of our patients are not extremely price sensitive. This is definitely a unique practice. Our fees are high compared to many practices in our area because we practice the absolute highest level of care with no shortcuts. Our patients realize this and many have left due to our fees but returned after receiving care elsewhere and noting the difference in the level of care. The only fee of our practice that I believe is excessive is for our custom whitening trays. Our fee is $650 but it does include as many bleaching syringes as is necessary for the patient to achieve their desired result. Otherwise, we are able to offer hygiene related services without accessing the patients "extra" fees.
• About a year ago our office started assessing a late fee for patients that have missed three or more appointments. We do send a letter after the first and second letting them know how important keeping their appointments are and that if they continue to not show they will get billed. I do feel this is OK as we warn them and if they don't show, we can't fill their slot last minute; it helps recoup lost income by their failed appointment.
• Getting the patients in the office is hard enough without squeezing every penny out of them.
• I do not like being " held hostage" by insurance companies, not allowing a service to be covered. Yet then they ask you for this in order to process the claim. Our patients’ BEST AND MOST COMPLETE CARE is our responsibility. I always explain what may not be covered to a patient, and I have yet to have them absolutely refuse the service. Patients will respect and appreciate your honesty and commitment to excellence. Give them the information, let them be a part of the decision process, and out of pocket fees usually are not such a big deal then.
• When I go to the MD, hospital, etc., I am charged and have to pay. Why should dentistry be any different? Nothing in life is free. REASONABLE charges make sense. I have to get a paycheck and I am paid because of the services that I provide and the services provided by all staff members in my office. Dental supply costs are astronomical, overhead is ridiculous. ... REASONABLE fees must be charged to cover costs of operating a dental practice.
• I think that insurance companies have created a culture of cheap, fly-by-night dentistry that is very competitive. While they claim they are keeping cost down for the consumer, what they are really doing to giving the patients the impression that they can get more for less. Good dentistry costs money to provide and you need to be able to make a living.
• I often feel that dental procedure fees are "off the charts." I know that there is no way my family could afford many of the necessary procedures performed in a dental office, without the benefit of working in one and getting free or greatly discounted treatment. I am by no means knocking capitalism! I am a GREAT supporter of it. But I feel that the "interference" and mere existence of insurance companies have created a false sense of cost and value for medical and dental procedures. I feel that if insurance companies were out of the picture then medical and dental prices would naturally fall into a competitive range. In other words, value based on need, desire, and affordability. Insurance plans are a little bit like credit cards.....It's easy to get lulled into a false sense of being "rich" and eventually not appreciate the hard work it takes to make a buck, and that goes both ways....the doctor AND the patients are too dependent on insurance. In my book, dependency is never a good thing!
• I feel as a hygienist working in a state of the art practice with exceptional knowledge and care for our patients, any and all fees are justifiable. Our patients are our friends and as their friends with dental knowledge, we care!