Why?

They know that the reimbur{*filter*}t of $3. per month plus the
$2. patient co-pay spells trouble for the patient. What kind
of trouble?  Read on.

I drill out the cavity and then I use a spoon excavator to
carefully remove the rest of the decay. Why? There's a nerve
down there somewhere. I want to avoid an intentional exposure
of the nerve.

If it is exposed, and many times the dentist cannot avoid
this, then its root c{*filter*}time, which makes everything
infinitely more complicated. Root canal, post, crown, tooth
lengthening, and God only knows what else.

So pay me for what I'm doing and I'll do my best. Don't pay
me and who knows? Its just human nature. Give your dentist
the $3. co-pay and all bets are off. What did you really
expect for $3.?

The pulp (or nerve) is pretty large in young people and
it recedes as we age. In addition, in many people, the pulp
recedes a little faster than the decay proceeds, so sometimes
I'm excavating away and no pulp! Its down there somewhere and
this is good. Nature has conspired to help you avoid root
c{*filter*}therapy.  Other times, nature is not so kind.

Now if you have managed care and you give the dentist $3.,
something else conspires to increase the chance that you WILL
need root c{*filter*}therapy, the post, the crown, and the crown
lengthening for a nice fat $2,600.

Get what the problem really is?  With managed care, its earn
$3. or earn $2,600. There's not much in the middle.

Cheers,

Joel

Joel M. Eichen, D.D.S.

Because the root canal, post and core, crown lengthening, and crown are all
expected to be performed for the same $3, up to the maximum allowable
benefits, if any.

Why bother?  Especially if the patient has poor self care, and may not
maintain your fine work, and has 3 other teeth in the same situation.  The
patient is informed that the tooth has a very poor prognosis, and out it
comes!

The managed care plan only provides for what the doctor decides can be done,
or for the least expensive alternate treatment, depending on the wording of
the contract.  If the patient doesn't like the extraction option, he can pay
for the treatment with the questionable prognosis. How often does that
happen?  Rarely.  Is that poor treatment?  I don't think so.  Many patients
without managed care make those same treatment decisions all the time, and
extraction is not malpractice.  The patient is still healthier than he was
before he came into the office.  He got the minimal care for which his
employer bargained, although the patient was no doubt bamboozled by the
promises of great coverage.  The difference with managed care is that the
patient does not get any coverage at all if the doctor and the patient
disagree about the treatment plan, and the patient is not free to get
treatment elsewhere without suffering the delays and uncertainties of
choosing another primary provider.  His money doesn't talk, because he gave
up his choices by opting for managed care.

Managed care is like having one big ant colony; fee for service is like
having the individual ants.  In the former, you make your decisions based on
the welfare of the entire colony.  In the latter, you take care of each
little ant's needs as they present themselves.
--

Elaine Giarrusso, DMD
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