Dental Implant Ripoffs

I saved $1500 on two "Crowns and Abutments" for my Dental Implants by going to a Dentist in Indiana that also accepted my Delta Dental PPO Insurance.  

More of this story: 

            After having had two implants put in by an Oral Surgeon in Naperville IL.  I had to wait 6 months for these to heal before seeing a local Dentist to have the Abutments and Crowns placed on the implants.  During this waiting period I had met with my local dentist and had a Predetermination request turned in to my insurance carrier for the abutments and crowns which I had planned to have put in during December of 2012.  As it turned out, I had needed some other dental work done in the interim and ran out of available insurance before December. I decided to put the Abutments and Crowns off until Jan. 2013.  This action required that a new predetermination be approved by my insurance company. The new predetermination showed a considerable increase in out-of-pocket costs for 2013, so I started to do some checking on it. 

Here is what I found:

            Late in 2012 our Illinois State Government passed a bill (Google:  Bill Status of SB3242  97th General Assembly) that gave a wonderful break for Illinois Dentists.  It basically allows them to charge whatever they want for any services that are "not covered" by an insurance company coverage's (that they have previously  agreed to accept) without having to disclose what the insurance company would have allowed as an acceptable fee.  Can you guess where this is headed?

            In my case using Delta Dental Insurance:  Delta Dental does not cover the costs for Dental Implants.  The two Implants that I had put in by an Oral Surgeon under anesthesia cost me $1500 each out-of-pocket (As far as I can tell, this was a very good price for what I got; more on this later). The "Abutments" that my regular Dentist needed to screw into the implants as a base for the Crowns to be installed onto were also not covered by insurance, however my 2012 predetermination reflected that the amount billed by my dentist as being $750 per Abutment and the amount allowed under my insurance plan accepted by the Doctor was $465 meaning I would have had to pay the lesser amount of $465 for each Abutment.  That all changed on Jan. 1st 2013.  Because of the bill that was passed, the "insurance companies" are no longer allowed to disclose an "Allowed" amount on their predetermination statements for any item they are not going to cover and the Doctors are allowed to bill you for the entire amount.  The net affect was that my cost went up from $465 per Abutment to $750 each, (times 2 in my case) because of this Illinois Bill that was passed. 

            Moving on to the Crowns:  In my case: Delta Dental normally pays 90% of the cost of a crown, but only covers 70% of the cost of a crown that is being put on an Abutment.  I later found out that this distinction is made for a reason.  Up until this point (Having had the implants put in and looking to have the crowns put on) it had always been explained to me that my next step was that: I needed to go to my regular Dentist to arrange to have the Abutments and Crowns put on.  Without doing any further research; I pictured this as a two step process.  Here is what actually takes place:  The implants were installed in the jaw bone below the gum line and a short healing post is screwed into the top of the implant that extends above the gum line as an access cap.  This is healing post is put in near the end of the 6 month healing process for the implant surgery.  When the Dentist is ready to do the impressions for the Abutment and Crown: He removes the healing posts, screws in a temporary alignment post or posts, makes the impressions to send off to the lab and then replaces the temporary alignment posts with your healing posts.   In two weeks time your Dentist receives your custom made abutment and crown.  He simply removes your healing post, screws in the Abutment and glues the Crown on top.  Everything has been custom designed to fit together in your mouth. 

            This combination of a matched abutment and crown delivered as a "single" package  is what you get when you go to an honest Dentist whom orders an implant Crown using the proper insurance codes.  (Delta Dental PPO Crown  Code # 6059)  In my case a "single" implant crown with abutment (Times two) billed at $1500 each with a Delta Dental approved amount of $826 each (times two) covered at 70%.  This cost was "one charge"  ($826 for an implant Crown) that comes standard with the: Custom made Abutment to fit my mouth and the Crown.  Compared to my local dentist in Aurora that wanted to charge $750 each for two custom abutments ($1500 for two Abutments with no reduction for insurance 100%  out-of-pocket to the Dentist) and  $1200 each for the crowns that the insurance company allowed $800 to be charged for a total of, $1550 allowed per tooth as opposed to $826 per tooth allowed to my Dentist in Indiana using the same Delta Dental PPO insurance policy. 

            Now we see why the Dentists in Illinois so loved this bill that was passed!  If they order something that is (Conveniently) not covered by your insurance: They can now bill however much the law allows and not have to worry about any limits being placed on them by the insurance companies that they have made billing agreements with.  In my case: Rather then order the standard Implant Crown and Abutment "Combination" that is fully covered under my insurance at 70%, they choose to order "each item separately" in a manner that gives me virtually the same product at a vastly inflated cost and profit to themselves.  I am told that the Dentists have a right to order in any manner or materials as they see fit. They are after all the "Doctor" and it is their choice to make.  I suspect that their reasons have a lot more to do with money then product! 

A few additional notes on my experience.

            I actually visited another Dentist in Indiana (Indiana does not have a law like that passed in Illinois) that basically did the same sort of billings as my Aurora Il. Dentist did. The reason I decided not to use him was because after visiting him and getting a predetermination from Delta Dental, I called and asked him if it would be OK for me to keep my healing posts once they were removed to screw in the abutments for the crowns.  He refused.  He told me they (the healing posts) were medical waste and he was required to dispose of them properly.  I wasn't buying that line and went on to find the Dentist that I used (Dr. Michael R. Mitsos D.D.S.  in Munster, IN 46321  (219) 836-8200).  He agreed to remove, sterilize the healing posts, and give them to me in a sealed bag when we put the crowns on.  I wanted the healing post in the event that I should ever have to replace a crown; I would have my healing posts to use during the replacement period. 

            The Oral Surgeon I used in Naperville Illinois was Dr. Harold Patino DDS (630) 536-1900.  I was referred to him by my local General Dentist in Aurora, IL. and he was listed under my insurance plan as a participating provider under my Delta Dental PPO Plan.  My insurance does not cover implants so Dr. Patino was fully a fully out-of-pocket expense.  He wanted $1500.00 per implant (I was having two implants done on separate dates) plus an additional $300 each time to use a general anesthesia rather then using a Local anesthesia to numb the area of the surgery.  I told him I would just go with the Local anesthesia that was included in the price per tooth and he later offered to do the surgery giving me the general anesthesia for free.  He had indicated to me that it was generally easier for him as the Surgeon to do the procedure while the patient was asleep.  I sort of viewed that as just another form of an overly greedy billing practice and had he been more reasonable with offering General anesthesia for say $100 instead of $300, I probably would have just agreed to it at the start.   That being said, I was completely Satisfied with the quality of the service I received from Dr. Patino.  It should also be noted that Dr. Patino uses an implant design by a company named "Nobel Biocare."   I came to find out later that there are different companies that are supplying implant materials to Dentists and you need to make sure your General Dentist and Labs provides services for whichever supplier is used.  I found this to be an issue when I went out of State looking for a Dentist.  I also found out that Nobel is a recognized name in implants and considered to be "upper end," at least from the Dentists I talked to.  It seems likely to me that this "Upper End" also translates into more (or even, much more) expensive.  You may want to do a little research on what name brand products your Surgeon uses before having them put in.

            Finally:  Always Ask all of the people you plan to use:  "Are there Cheaper alternatives that can be used for this procedure?"  "What are they?"  If you do not ask, they will not tell you and if they tell you "NO" and you find out later what I found out, maybe you can do something about it.  Check to see how your State Representatives voted on this bill and let them know you are not happy with them!  Look out (!) if they ever pass this type of Golden Bill for our regular Medical Doctors!!!