The dental practice I go to has changed ownership and I guess they have
a new way of doing things. At my past visit, my regular dentist's office
insisted (and billed) my "regular" cleaning be charged as perio
maintenance "since was a perio case, i require extra care etc etc." In
addition to the perio maintenance charge, they are charging me the
periodic {*filter*}exam that the insurance insists should not be charged
separately and is part of the perio maintenance procedure. The dentist
office claims that they did a more thorough exam and not the same exam
that the periodontist does and while I agree it is probably not the
same, I don't think there is a big difference. The other bad news is
that the perio maintenance charges from the regular dentist (which
really "covers" the cleaning part of my  visit per their new charging
policy) is even higher than the periodontist's.

As I premised above, I am a stable perio case -- the periodontist has
consistently had no concerns about things sliding etc -- and so I am
very uncomfortable and annoyed with the recent scare tactics that I am
hearing from the zealous office staff selling me about all the special
care they are providing -- that it is sounding like I need more care and
I am in bad shape etc. While this is very stressing and upsetting to me,
I want to be fair -- but like everyone, I also don't want to "con"'ed
and definitely do not appreciate the scare tactics. Financially it hurts
a lot, since perio maintenance is only covered at a much lower
percentage, and I end up paying much more with this new billing scheme
(and times are tough this year...)

Is it more common to have people visit their regular dentist and get a
perio maintenance + periodic {*filter*}exam charges? Or should I be able to
go for my regular and perio alternating like before -- the office staff
even said they would be committing insurance fraud if they charge my
visit as a regular visit!? Should the regular dentist's periodic {*filter*}
exam really be part of the perio maintenance. Should I seriously
consider changing dentists? Appreciate any advice, experience sharing
and insights you can provide.

Wanda, Erehwon, U.S.A.

{Note that the following is typed with a world-weary smile and is meant to
give you a glimpse into what it's like to be a dentist. I aim no sarcasm or
derision at you. You are reacting exactly the same way most people would
react in the same situation. ;) }

People who have a history of periodontal disease need longer appointments
and more care because the cleanings are more complex and time consuming.
Pockets have to be monitored more carefully. Cleanings aren't limited to
supragingival scaling. Even if it seems the same to you, the
dentist/hygenist has more responsibilities and bases to cover with a perio
patient. Consequently, your cleanings should take longer than a healthy
patient's cleanings and cost more. If the dentist comes in the room and
checks your teeth and gums and reviews your x-rays, then you should be
charged for a periodic exam as well. Bundling the exam in with the perio
maintenance procedure means that the dentist is now getting paid less for
your cleaning than he would for a routine cleaning. Note too, that
diagnosing decay is not really of much interest to your periodontist. He is
only responsible for your perio condition. Your dentist is responsible for
catching and treating decay and he cannot do that without doing an exam.

Having said that, I virtually never use the code.

Here's how human psychology works:

My perio patients get 4 standard cleanings a year at $60 each. Two are paid
100% by the insurance. The other two are out of pocket. Total patient cost:
$120. Very few complaints. Good compliance... er, participation.

The alternative: (using very typical insurance benefits)

4 perio maintenance procedures at $90 each. Total cost: $360. Take out the
$50 deductible and the covered portion is $310. Eighty percent coverage
means $248 in benefits. Total cost to patient: $112.

It would seem like a win-win situation to both the dentist and patient.

Wrong.

The majority of people would rather have their teeth pulled without
anesthetic than give up their two 'free' cleanings a year. My receptionists
would rather pull their teeth out without anesthetic than explain again and
again and again why insurance didn't pay 100% for their cleaning. It's like
having a pit bull latched onto your leg. You can literally club the thing to
death and you'll still need the jaws of life to pry it off your leg. People
gotta get their free cleanings. People get angry, they think they are being
conned and ripped off and leave for other dentists. Eventually you get worn
down by the grief and you do it the first way. The receptionists smile. The
patients smile. The dentist chalks up the lost income to goodwill. And, as
usual, the insurance company laughs all the way to the bank.

Always remember that the insurance company doesn't give a {*filter*}about your
health. They only care about retaining as much of your money as possible.
Their job is to keep as much of your money as possible. Just ask their
shareholders. They have no qualms about making your caregiver look like the
bad guy if it means more money for them.

Your new dentist is just trying desperately to do it the right way. They are
clubbing you with scare tactics because you have your jaws locked on the
free cleanings. Eventually, he will probably get worn down and do it the way
you've come to expect.

I'm setting up a new solo office and I would love to retrain my patients
into doing it the proper way. If anyone has a magic formula for explaining
it to patients, I would love to hear it.

Jim Margarit, DDS