Dentist charges help

[sopplayer]

Hi I wondered if anyone could give me some advise on the following.

I have been going to the dentist regulary since I was a child and the surgery I have used has seen various dentist come and go thoughout the years.

At my last appointment the surgery has changed again, this now incorporates a few dentists (there has only been 1 previous to this) plus hygenists and therapists.

At my visit I was told that I had a fair bit of scale build up mostly on my back teeth and was told that a few visits would be needed (another 2 x half hr visits). So she descaled my bottom back teeth and it was horrific it hurt like hell,bled and my gums swelled up in the following couple of days.

I told her at the time of my discomfort and she said that next time she would numb the area.

Well after getting myself all wound up for my visit again this morning off I went (shaking like a leaf).

Now she numbed my top gums and started work (had to appply more numbing stuff cos I still felt pain). She was very nice and understanding and I got through it.

When I got to the receptionist she told me I needed to pay another £27 odd for the treatment, I was under the understanding (after reading an NHS leaflet on dental charges) that you paid for band 1 course of treatment (£15.90) which included examination,diagnosis,advise and scale and polish if needed.

I asked the receptionist if she could explain and she produced the same NHS leaflet and said "oh it doesnt say in here but its because you have to have more visits".

Can anyone offer any advise on whether I should be paying more than a band 1 course of treatment.

Thanks in advance

[Toothsmith]

This seems right - and very good practice.

One 'clean and polish' is included in the Band 1 charge, but multiple visit 'treatment of gum problems' is a Band 2 £43 odd. If you'd already paid the £15.60 Band 1, they are right to charge you the extra.

There are many places out there who would have told you that this could only be done privately, or even charged you the £43 on top of the 15.60.

This sounds like a good thorough practice.

[sopplayer]

This seems right - and very good practice.

One 'clean and polish' is included in the Band 1 charge, but multiple visit 'treatment of gum problems' is a Band 2 £43 odd. If you'd already paid the £15.60 Band 1, they are right to charge you the extra.

There are many places out there who would have told you that this could only be done privately, or even charged you the £43 on top of the 15.60.

This sounds like a good thorough practice.

Thanks for the reply.

Is a 'clean' the same as a 'scale', and does 'treatment of gum problems' mean descaling?

I'm just trying to understand the charges as I cant seem to find a definition of charges anywhere.

[Toothsmith]

A clean & polish is the same as a scale and polish.

The defenition is a bit woolly between a simple clean, and more advanced gum treatment, but then ptients don't always follow hard and fast rules either.

You could get a fair bit done on one patient in a simple single visit. Another patient may take several visits just to clean off a relatively small amount of gunge.

It's really up to the dentist to decide which category the patient falls into, but as a rule of thumb, multiple visits will fall into the higher category.

[sopplayer]

A clean & polish is the same as a scale and polish.

The defenition is a bit woolly between a simple clean, and more advanced gum treatment, but then ptients don't always follow hard and fast rules either.

You could get a fair bit done on one patient in a simple single visit. Another patient may take several visits just to clean off a relatively small amount of gunge.

It's really up to the dentist to decide which category the patient falls into, but as a rule of thumb, multiple visits will fall into the higher category.

Thanks for clearing that up for me, its just that in the leaflet they gave me is says 'All charges apply to an overall course of treatment,and not the individual items within the course of the treatment. You will only have to pay one charge for each course of treatment-even if you need to visit your dentist more than once to finish it'

And just wondered why this wasn't treated under band 1 scaling.

Also it says on the NHS website that I should have been given a form if I was gonna be charged for band 2 and informed as such, which i wasn't.

[Toothsmith]

I'm not 100% sure of all the NHS regulations and paperwork as I don't do any NHS stuff now.

On the old NHS contract though, it was in the regulations that dentists should give out full treatment plan forms to any patient requiring more than an examination and a clean. Whether they had to pay NHS charges or not.

Frankly, there is not enough time in the day to run an NHS practice, see all the patients you have to see, and fill in every single form that the regulations say you should.

I would content yourself with the fact you have a good NHS practice, operating within the regulations, AND looking out for all the work you need rather than glossing over the less obvious bits.

[sopplayer]

Thanks,

Don't get me wrong I am happy with the treatment I am receiving even now as the numbness has gone and its very sore, and I am more than happy to pay what I owe, it just seems to contradict what the NHS says I should be charged.

just found a link to the leaflet.......

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073216

[Toothsmith]

I am the first one to leap up and down if someone comes on and a dentist has acted incorrectly - particularly with the new NHS contract, which I think is horrible and completely unworkable.

But - in this case your dentist is right - although the actual letter of what he's saying isn't in the leaflet. That's more the error of the leaflet than the dentist.

If you ring your local PCT, and ask to speak to someone in the dental department, I'm sure they'll confirm this for you.

[LondonDiva]

2nd what toothsmith says.

It looks like you were charged band 2 fee, which implies that your theeth had more than simple work carried out.

You shouldn't have been given a form for band 2 work, but you should have been given a treatment plan for any work carried out. However, in routine cleaning etc, that is very rarely given and it's complex things like root canals etc that the plan is provided.

if you want a treatment plan, ask for one before hand or even just call and ask tomorrow.

Diva

[sopplayer]

Thanks, I was told today that the work needed doing but it could wait 12 months or so,and didnt need doing all at once, I just feel that this could have been pointed out prior to them organising me more appointments as I suspect it could have been done gradually under my 6 month visits.

[Toothsmith]

If you have a gum problem, it needs sorting out just like a cavity does.

You can't give the teeth a good thorough clean a little bit at a time.

The idea is to reduce the amount of bugs living in and around your gums, so that inflammation and irritation decreases, and your gums become less swollen, bleed less, and generally improve the health of your mouth.

If you only clean the teeth a little bit each time, you don't make any significant effect on the amount of bacteria in your mouth, and everything just carries on slowly getting worse.

The work could wait a while if things aren't too bad, but I don't understand the bit about doing it gradually - this seems more like what previous dentists have been doing for you - just a mild clean up each time you go. If there is a problem brewing, this sort of approach doesn't get to grips with it.

Who was it who told you? The dentist, or someone else?

[sopplayer]

It was the Hygenist who told me that. The thing is I haven't got any gum problems (or didnt have before the cleaning was done).....no swelling....no bleeding.......in fact I haven't had any problems with my teeth for years....the last time I had a problem was about 15 years ago when I had a absess in my gum which burst (ouch!!). I have always tried to look after my teeth and have only ever had 2 fillings.....I told the hygenist my concerns that if they got infected because of the cleaning that I might be better off leaving them and she said if I don't have it done I will have problems in later life, but it was my mouth, my descision.

[Toothsmith]

It was the Hygenist who told me that. The thing is I haven't got any gum problems (or didnt have before the cleaning was done).....no swelling....no bleeding.......in fact I haven't had any problems with my teeth for years....the last time I had a problem was about 15 years ago when I had a absess in my gum which burst (ouch!!). I have always tried to look after my teeth and have only ever had 2 fillings.....I told the hygenist my concerns that if they got infected because of the cleaning that I might be better off leaving them and she said if I don't have it done I will have problems in later life, but it was my mouth, my descision.


I'm not sure what the hygienist was meaning.

The thing about gum problems is that they can often be hidden, painless and easy to ignore.

When you start treating them, you often get flare-ups like you describe, which is what makes me think that there was something going on with your gums.

The other thing is that there is no benefit to the practice to be treating you for this if it weren't necessary.

The dentist will get a fixed monthly sum for doing NHS work now. The charges you pay do not go to the dentist, but come off the cheque he will receive every month for doing NHS work.

With the new contract (And to a certain extent with NHS work prior to the new contract when funding didn't reflect the time required for certain proceedures) the temptation is more to gloss over things that don't actually hurt the patient. I have seen mouths in a terrible state from people who regularly attended various dentists and thought everything was fine.

[sopplayer]

Wel I have just returned from my dentist to have my top left 4 teeth scaled in a half hour appointment feeling very numb (even my left eye is numb).

I have to return in 3 months time to have my top and bottom front teeth scaling and it will cost me another £15.90 for the pleasure:eek:

So up to press to have my teeth de-scaled (aint even had a polish yet) its cost me £43.60+ £15.90 in 3 months time.

All seems alot of money for a de-scale, what do you think Toothsmith is this good practise?

[Toothsmith]

Yes - I do think it's a good place.

They are applying the regulations correctly, yet still identifying and treating the problems they come across.

Stick with them - even if they decide to go private in the near future!

[sopplayer]

Thanks,

Can I ask if I went back within 2 months would it cost me the same?

Its just that I can't seem to get my head round that band 1 says that it includes and scale and polish, and for my scale and polish its gonna cost me £59.50. It also says that you will only pay one charge for each course of treatment no matter how long it takes to complete it.:confused:

[Toothsmith]

One hygienist visit at my practice would cost £59.50 - just to give you some idea.

I think for something to count as the 'same treatment' it has to be done within 8 weeks, but I'm not 100% sure of that.

3 months is a perfectly proper and correct recall interval though - 7 weeks would not be.

You have to realise that this practice has to make a living as well. It's hard enough to keep a practice running under NHS regulations without patients wanting everlasting treatments.

I would suggest that you are getting very good value for money here, and so not to try and kill the goose that lays your golden egg.

[sopplayer]

Hi,

Just a bit of an update.

I contacted PALS for advise and have received the following:

Thank you for your initial enquiry regarding dental charges.

The Primary Care Development Manager XXXXX who has advised on your question. His reply is that you should not be being charged for further treatment; as you pointed out Band 1 covers that course of treatment and you should not be expected to pay a second charge for what is the original course of treatment.


It asks me to speak to my dental surgery and ask them to reconsider their charges and if they won't to make this an official complaint at PCT headquarters.

[Toothsmith]

If this went to a complaint, I think you'd find the manager was wrong (I'm 99.9% certain he is). It's not unknown for PCTs to have no idea as well.

Up to you where you take it from here though. I've just given you my opinion on the regulations.

As far as I can see it - you stand to loose far more than you stand to gain here.

Win or loose any complaint, and you'll almost certainly be looking for a new dentist (He can legitimately claim the patient/dentist relationship has broken down). As I said, I think this is a good dentist applying the NHS regulations correctly - you'll be struggling to find another like this close by and still offering NHS treatment.

And yet all you have to gain is about £27.

Is it REALLY worth it?

[sopplayer]

Thanks toothsmith,

It did cross my mind that I could find myself looking for a new dentist, but when you say he could claim that the patient/dentist relationship has broken down.....I have no problems with the dentist....they have been very good with me, but as any other moneysaver I wouldn't be impressed in paying more than I should have to....at the end of the day I dont write the rules....and if it says i should pay x amount for a course of treatment then that is all I should pay.....if given a good reason why I should pay more then I would certainly pay what is owed.....I am certainly not trying to rip anyone off out of money they are owed, and if I was struck off for asking if they would reconsider their charges according to PCT advise I would really kick off...

[Toothsmith]

Fair enough, and basically I agree with you which is why I often post to tell people that they shouldn't be paying private fees to see the hygienist if they have been accepted as NHS patients.

Or to be paying private fees at all for any 'necessary' work if they are NHS patients.

To my understanding of the rules though, (Which I think is better than the PCT manager who replied to you), I am sure you have been treated correctly.

Just promise me that if you do mention it to the dentist, and he says " No - we have charged you correctly" You will let it lie.