NHS dental repair charges?

Ferris

hi,
just over 3 years ago (as a free NHS patient) i had a gold inlay put into one of my molars. it was perfectly functional for three years, until a month ago, when it came loose and fell out.

as the remaining tooth did not appear to be damaged, when i went for a checkup my dentist happily re-bonded the inlay as part of my £15.50 fee. he seemed to pay little attention to what he was doing as he worked (it was nearly lunchtime), but i assumed the rebonding was so straightforward it didn't require great attention.

now, a month later, the inlay has come loose and fallen out again. this makes me a little angry, not least because it fell out and nearly disappeared down a plug hole, and it's not as if i was chewing anything particularly sticky at the time (soft bread). i would expect something that was refitted to last at least half as long as the original fitting, not just a month...

anyway, when i return to the dentist (tomorrow) to express my annoyance and try to get it fixed again, should i expect to be charged another £15.50 just to have it re-bonded for the second time in just over a month? this would seem to be a great moneymaking scam for dentists: do a substandard job, and you can get paid twice...

any ideas?

Toothsmith

A month doesn't seem very long to me, but then neither does 3 years for a gold inlay in the first place.

An amalgam filling may well have lasted longer if done well.

There could have been things wrong with the fit that weren't immediately obvious to the dentist. He may have had his doubts, but decided to stick it back on and see what happened.

You would have been charged the £15.50 anyway for the check up, so in effect he did this for free. He would have got no more points for doing it.

His alternative would have been to remake it - which would have cost you the £189 fee, or replace it with an amalgam filling for £42.40.

So, it's fallen out again. It may be that he can adjust it in some way and cement it on again, which, yes, would cost you another £15.50, but this would be for just the recementing, not a check up as well this time, or he may well recommend one of the other alternatives.

As for a moneymaking scam - yes it probably is.

Unfortunately, not for the dentist though.

The fees collected by the dentist go straight to the treasury (Patient fees collected are deducted from a dentists monthly payments for doing NHS work).

The dentist has very little leaway for deciding who to charge and who not to - a bit like the NHS prescription charge. If your bottom sits in the chair then one of the 3 fee bands must be charged!!!

Ferris

that's interesting... he made it quite clear first time round that an amalgam filling would be no use and that this would be my only possibility. is it possible to get an amalgam filling that large?

i'm fairly sure he didn't do it for free, anymore than he did the scale and polish for free... he looked up the charge for doing the repair, and it came up on the NHS list computer terminal thingy as £15.50, which is why he went ahead with it in the same sitting as the 45-second examination he carried out. he looked a little disappointed that he couldn't charge me more. it certainly shows up on my receipt, anyway.

the main reason i was asking was because i seem to recall something about the charge being waived for extra treatment required within 2 months of the original course of treatment. plus, it would seem to make sense intuitively to have some sort of quality of workmanship for a relatively simple repair - the inlay seems fine, the tooth was ok (according to the dentist), so its all a matter of cement, after all...

i can't help thinking if i'd just gone to boots and bought a temporary filling repair set, i'd be in much the same position as i am after going to the dentist... the small ball of sticky stuff he used seemed to be exactly the same stuff, anyway, and it lasted about as long...

thanks for the advice though... i'm just an old cynic when it comes to this sort of thing...

Toothsmith

Ferris wrote:

i'm fairly sure he didn't do it for free, anymore than he did the scale and polish for free... he looked up the charge for doing the repair, and it came up on the NHS list computer terminal thingy as £15.50, which is why he went ahead with it in the same sitting as the 45-second examination he carried out. he looked a little disappointed that he couldn't charge me more. it certainly shows up on my receipt, anyway.

He did it for 1 UDA (Unit of Dental Activity)

Since April 1st, NHS dentists just get a fixed sum of money each month. (With patient charges collected that month knocked off)

For that monthly payment, he is contracted to provide X many UDAs.

Each COURSE of treatment he does is worth 1,3, or 12 UDAs, depending on what the course comprises.

Check-ups, cleans, temporary repairs, recementings, xrays are all in the 1 UDA band.

That means just a check up earns 1 UDA

A check up, 2 Xrays and a clean earn .......1UDA

Your last treatment .......1 UDA

The dentist probably was disappointed, as he may have thought a recement fell into the 3 UDA band. It doesn't.

A check up and a tiny filling would fall into the 3 UDA band. Or a couple of fillings and an extraction.

A mouthfull of fillings, a couple of extractions and a root filling would also earn a dentist 3 UDAs.

All would cost the patient a £42.40 tax.

For 12 UDAs, the treatment must include a lab-made element such as a crown or a denture.

Again though, a single tooth denture gets 12 UDA, a mouthful of new crowns also gets 12 UDA. Both cost the patient £189

There is a rule that any treatment required within 2 months of seeing the dentist is still covered. I'm not 100% sure how that works.

Basically, if you have a treatment requiring fillings, and find within a couple of months you need another filling, then it is counted as the same treatment.

If you have a check-up and a filling falls out within a couple of months, you will just be charged the difference between the £15.50 fee and the £42.40 fee.

Not sure how it would apply to an inlay falling out.

Either way, the dentist will not get paid any more. The best he can hope for is an extra UDA.

Ferris

thanks, toothsmith, that makes a lot of sense... it certainly helps explain why there are so few NHS dentists around, anyway.

it also explains why the two dentists i saw both tried to push some extra treatment on me - and different, unrelated kinds of extra treatment (in the higher band) in each case... and why when i asked if i could delay that treatment (for valid personal reasons) they automatically - i.e. without asking me how long i wanted to delay for - booked me an appointment for 3 months, so that i would have to start paying all over again...

i suppose if i felt the system was screwing me, i'd try to screw it back, so i can't really complain when they do the same... :P