AboutMark Bornfeld DDS Expertise I can respond to all questions dealing with the practice of dentistry, from both the dentist`s and patient`s perspective. I am knowledgeable about all dental disciplines, from cosmetic dentistry to surgery, from restorative dentistry to root canal treatment. I have strong opinions about controversial issues in dental practice, including those topics which directly impact on the reputation of the profession in the eyes of both the lay public and our health profession colleagues.
Experience
Past/Present clients Editor, Queens County Academy of General Dentistry newsletter; contributor to Dentistry.com 29 years practicing general dentistry partnered with brother Steve as one-half of the DentalTwins®
Expert: Mark Bornfeld DDS Date: 7/17/2008 Subject: Full mouth debridement
Question I've just been referred to to a new dental office, because my previous dental office no longer accepts my DMO. I've only had one visit, but feel this new office is really out to make as much as they can off me. They say I need a full mouth debridement,which I've never needed before, and isn't covered by my insurance. How can I know if I really need that or just a good cleaning? The hygienist had a chart showing several stages of gum disease, and said my gums were in the first stage after healthy gums. They're also really pushing a new oral cancer check of which only a small part is covered by my insurance,and they charge a $5.00 OSHA sterilization fee - something I've never encountered before. How can I tell if this dental office has my dental health, or filling their pockets as a primary objective?
Answer Dear Irene,
You are right to be suspicious. While I can understand from the doctors' perspective the frustration of low insurance reimbursement rates, any doctor-participant willingly signs their contract agreement with the insurance carriers, and they should abide by the provisions of that contract. Unfortunately, some unscrupulous doctors want to have it both ways-- get patients referred to their offices, and then collect private fees. The way this is done is not always ethical.
Although the procedure "full mouth debridement" is a legitimate service, it is intended to provide a means of addressing severe gum inflammation, implemented when there is some time-critical urgency-- to quickly get a severely affected patient back to the point where normal therapeutic measures can be started. It is not a routine part of a periodic maintenance. So, although this is a legitimate procedure, it is too easily misused in inappropriate situations.
More troubling still is the practice of "unbundling": the division of a legitimate service into its component parts and then invoking a fee for each part. For example, all dental services are presumptively performed using sterilized instruments, and it is highly irregular to charge a separate fee for sterilization, regardless of whether it is done with the intent of coming into compliance with OSHA regulations. Likewise, an "oral cancer check" is an integral part of the oral exam, and it is not ethical to charge separately for that, any more than it is ethical to charge separately for a tooth decay exam, or for a periodontal disease exam-- they are all included under the codes that apply for an oral exam.
Assuming your narrative is faithful to the events as they happened, your dentist is acting unethically. He should either accept his insurance contract provisions with equanimity, or sever his contractual arrangement with the insurance company. There is no reason why you should be victimized by his greed.
Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY
