Dental Insurance - Denplan

rosemarie58

Hi all
Could any of you helpful and sensible people give me some impartial advice please. I have been paying into Denplan for many years now £30 per month. I have recently felt that its not worth the money and also my dentist seems so stressed and disinterested lately that I dont like going to him with any problems as he's not very sympathetic even though I am paying. Recently I wanted a second opinion on a filing that keeps coming out and went to a private dentist as I thought it would be worth paying a one off amount to get it sorted. Whilst there they took some sophisticated xrays of my teeth which revealed two big issues they said needed urgent attention. They had really up to date equipment and experts in that particular field to do the job. They gave me a quote and I decided to take the bull by the horns. The issue now is that it could turn into a bigger job than thought as my current dentist really should have noticed these issues so they are quite difficult. I am worried its going to cost thousands even though I have been paying into this scheme for years. Is this my own fault for seeing a private dentist whilst under another? I feel Ive made a right pigs ear of things. I have accepted I will probably have to leave my old dentist and possibly denplan but does anyone think I have a case for asking the old dentist to contribute towards the cost of the private treatment? Evidently the premiums go straight to the dentist these days and not to denplan. How best to word letter as I dont want to end up in big squabble between dentists as that would be stressful. Can anyone help please as I could potentially pay out lots of money and maybe still lose a tooth. I feel the new private dentist is very professional and thorough and I am happy with them but I'm not rich enough not to worry about the costs. I feel my dentist should pay something as he's been taking my premiums and not keeping enough of a close eye on what's happening with my teeth which I am cross about. Thanks for reading and sorry for length of post, I'm very worried about this.
Thanks a lot
Ceri. x

Toothsmith

With any problem with any dentist - regardless of payment system - if you have some sort of problem, the first thing that should be done is to contact the dentist involved directly.

It needn't be a nasty letter, or in any way accusatory, just a simple statement of the facts, and ask for the dentist's opinion on what has happened.

The facts as I can see it are -

You had a filling that kept falling out, and dentist 1 did not seem to be able to fix it or offer any ideas as to why it kept coming out.

Obviously, the filling keeping on coming out concerned you, so you went to see dentist 2 to get a second opinion on it (which you're perfectly entitled to do)

Dentist 2, after a thorough examination noticed that x,y and z was also a problem in your mouth.

Ask dentist 1 if he has any comments on x,y and z and how these problems have come about when you attended regularly for your check ups?

Leave it at that.

This should trigger a response from the dentist and if he's got anything about him he should respond to it as a proper 'complaint'. He should reply to you within a few days to let you know he has received your letter, and he should send details of the practices formal complaint procedure.

This should let you know that you will receive a proper response to your complaint within about 10 working days.

It will also detail places that you can take your complaint if the dentist cannot resolve it to your satisfaction. These may include the General Dental Council's own private complaint handling system, Denplan's complaint handling system, or the CQC.

In your case, probably Denplan's own system would be best - If you get no satisfactory resolution from the dentist.

In all cases though, they will have expected you to have written to your dentist about it in the first instance.

If you get no response from the initial letter, then just a slight rewording to make it clear it is a complaint should definitely get a response. But the first letter really should do it.

One final thing to bear in mind though is that if you go and see three different dentists, you will always find a big range in treatments proposed. There is rarely one correct answer to the question "what do I need doing?" but more likely a range of options. That can be a hard thing for people to understand sometimes - but even with some small cavities in teeth.

One dentist might prefer to leave it alone and see if changes in diet & behaviour will halt it, another would want to get in and do a filling. For a tooth with a cracked filling in it, one dentist might want to replace it, another might be happy to leave it alone until it properly fails.

In an ideal world, every dentist should have time to tell you exactly what they have found, what treatment they recommend, what alternatives there are and ask you which one you would prefer. But time pressures often prevent that being as full a discussion as it should be.

My feelin with your complaint is that you should at least ask the question of your old dentist as to why the new dentist found so much to do.

Depending on his answer to that question, you can then decide what you want to do next.

rosemarie58

Toothsmith wrote: »

With any problem with any dentist - regardless of payment system - if you have some sort of problem, the first thing that should be done is to contact the dentist involved directly.

It needn't be a nasty letter, or in any way accusatory, just a simple statement of the facts, and ask for the dentist's opinion on what has happened.

The facts as I can see it are -

You had a filling that kept falling out, and dentist 1 did not seem to be able to fix it or offer any ideas as to why it kept coming out.

Obviously, the filling keeping on coming out concerned you, so you went to see dentist 2 to get a second opinion on it (which you're perfectly entitled to do)

Dentist 2, after a thorough examination noticed that x,y and z was also a problem in your mouth.

Ask dentist 1 if he has any comments on x,y and z and how these problems have come about when you attended regularly for your check ups?

Leave it at that.

This should trigger a response from the dentist and if he's got anything about him he should respond to it as a proper 'complaint'. He should reply to you within a few days to let you know he has received your letter, and he should send details of the practices formal complaint procedure.

This should let you know that you will receive a proper response to your complaint within about 10 working days.

It will also detail places that you can take your complaint if the dentist cannot resolve it to your satisfaction. These may include the General Dental Council's own private complaint handling system, Denplan's complaint handling system, or the CQC.

In your case, probably Denplan's own system would be best - If you get no satisfactory resolution from the dentist.

In all cases though, they will have expected you to have written to your dentist about it in the first instance.

If you get no response from the initial letter, then just a slight rewording to make it clear it is a complaint should definitely get a response. But the first letter really should do it.

One final thing to bear in mind though is that if you go and see three different dentists, you will always find a big range in treatments proposed. There is rarely one correct answer to the question "what do I need doing?" but more likely a range of options. That can be a hard thing for people to understand sometimes - but even with some small cavities in teeth.

One dentist might prefer to leave it alone and see if changes in diet & behaviour will halt it, another would want to get in and do a filling. For a tooth with a cracked filling in it, one dentist might want to replace it, another might be happy to leave it alone until it properly fails.

In an ideal world, every dentist should have time to tell you exactly what they have found, what treatment they recommend, what alternatives there are and ask you which one you would prefer. But time pressures often prevent that being as full a discussion as it should be.

My feelin with your complaint is that you should at least ask the question of your old dentist as to why the new dentist found so much to do.

Depending on his answer to that question, you can then decide what you want to do next.

:A
Thank you so much, what a star you are, that's exactly it.
Ive been looking around at dental websites and most of the advice Ive seen is that any infections in teeth should be dealt with if anti-biotics dont work. Mine have been there for a while.

Your advice is really helpful, I will word an objective letter to my dentist. I find him a bit scary as he's always in a bad mood and stressed so I dont relish the idea but I have to stop stressing about it and just do it. Once again, thanks a million.:)

rosemarie58

Hello, could anyone give me some more advice please?, I am hopeless with things like this and particularly confrontation.

I have now received a letter from my old dentist which is really quite defensive. (I think I had expected this). Basically he says that I should have gone to him first and that Denplan wont pay anything towards any of the costs I have incurred or will incur as 'I went to another Dentist without Denplan's permission' Does anyone feel that this is correct? or do I take this forward to go to mediation?

The costs are now mounting as the root filling is trickier than the endontist expected, and I know he has done his best and I trust his judgement.

Please any advice would be so helpful. Thanks a million.

Toothsmith

But you did go to him first didn't you?

The filling came out a few times? And you went to him each time?

When did you last have a check up with him? If it wasn't that long before, then he has no excuse for missing things that the other dentist found.

Write back asking him for the practice's complaints procedure. (He really should have sent a copy of this with his reply) that will move it up to the next level, and might make him think a bit harder about coming up with a solution for you.

rosemarie58

Toothsmith wrote: »

But you did go to him first didn't you?

The filling came out a few times? And you went to him each time?

When did you last have a check up with him? If it wasn't that long before, then he has no excuse for missing things that the other dentist found.

Write back asking him for the practice's complaints procedure. (He really should have sent a copy of this with his reply) that will move it up to the next level, and might make him think a bit harder about coming up with a solution for you.

Hi, Thanks Toothsmith
The last check up I had with him was November 2012 and I went for the opinion on the fillings in Jan 2013. The opinion was really to find out if there was any different materials they could use that I could pay for as I was fed up with going back to my dentist every 2-3 months getting them replaced. (this isnt a worrying matter to me now as this issue is cosmetic and has paled in light of the two big issues they told me about. This was where they told me I needed a big root filling on lower tooth and also one on the top tooth, which I wasnt expecting to hear. The surgery was so high tech and I felt confident they were up to fixing it as they said they could work under the crown. I thought there would be no harm in paying them to do it to get it out the way and sorted. I thought they would have the time and energy to do it whereas my dentist doesnt seem to have much time. Unfortunately they cannot do it (I know the ondontist has tried really hard over 3 hour appointments) this is where the costs are now rising as I may have to consider other more costly options. At this point I felt it would be fair to ask Denplan to at least contribute part of the costs as I have been paying into denplan for a long time. This is when I wrote the letter telling him what had happened.
Shall I will contact him again and ask him for a second opinion on the two teeth in question and how we can move forward now?
Toothsmith you really are a star. :A

Toothsmith

rosemarie58 wrote: »

Hi, Thanks Toothsmith
The last check up I had with him was November 2012 and I went for the opinion on the fillings in Jan 2013. The opinion was really to find out if there was any different materials they could use that I could pay for as I was fed up with going back to my dentist every 2-3 months getting them replaced. (this isnt a worrying matter to me now as this issue is cosmetic and has paled in light of the two big issues they told me about. This was where they told me I needed a big root filling on lower tooth and also one on the top tooth, which I wasnt expecting to hear. The surgery was so high tech and I felt confident they were up to fixing it as they said they could work under the crown. I thought there would be no harm in paying them to do it to get it out the way and sorted. I thought they would have the time and energy to do it whereas my dentist doesnt seem to have much time. Unfortunately they cannot do it (I know the ondontist has tried really hard over 3 hour appointments) this is where the costs are now rising as I may have to consider other more costly options. At this point I felt it would be fair to ask Denplan to at least contribute part of the costs as I have been paying into denplan for a long time. This is when I wrote the letter telling him what had happened.
Shall I will contact him again and ask him for a second opinion on the two teeth in question and how we can move forward now?
Toothsmith you really are a star. :A

Ok - a few points come to light now.

Number one, Denplan are not an organisation that provide dental care. They are an organisation that administer payments for dentists. Your money has been paid to your dentist, and there is no 'pot' that has built up with your name on it. It is up to your dentist to provide the treatment you need to maintain your dental health. Any financial dispute is between you and the dentist. Denplan do have a complaints handling service, which can help mediate between you and your dentist - but Denplan will not 'pay' for any treatment you may need as a result of any omission by your own dentist.

Secondly - the problems that have been found by the new place. They were problems underneath teeth that weren't giving you any problems? If so, then over his time with you, your old dentist probably didn't have any cause to x-ray them to have a look for any problems. Nowadays, we're encouraged to keep radiation doses as low as possible for people, so just going on a 'fishing trip' with x-rays around the mouth is not something you would do on a regular basis for an established patient with no problems. Every two or three years you might take x-rays that look between the teeth for developing cavities, but with no symptoms, you wouldn't go looking along the ends of all the teeth to see if there were infections.

When you have a new patient assessment though, often that is a reason to have a look underneath some of the bigger fillings - although again, with no symptoms it would have to be justified in some other way.

If your own dentist HAD found these problems, then what would have happened under Denplan? He would have root filled the tooth, which would have been covered by your payments under your agreement. Had he had difficulties and needed to refer you to a specialist endodontist, then you would have had to pay for that, as your Denplan payments do not cover specialist referrals. If that then failed as well, then removing the tooth would have been covered by your payments (with the original dentist) and then replacement could be discussed.

If it was decided to replace it with a bridge, then under Denplan, you would have had to pay the lab fee. The fee the technician who makes the bridge would charge the dentist to make it. It would be the same if a denture was deemed to be the correct replacement.

If an IMPLANT was what you decided on as a replacement, then you would have had to pay the full charge, as Denplan does not cover implants in these circumstances. So - you would be no better off than you are now.


So - to round up.

If you have a claim against your dentist, it would be that he did not notice that this was going on. It would be reasonable to claim that the cost of the root filllings should be met by him.

The fact that the root fillings were difficult and it may well lead to the loss of the teeth would probably have been discovered had he found and tried to treat them - so you would have been in exactly the same position (although a few options might have been a bit cheaper for you if you were covered by your Denplan agreement - but implants wouldn't have been).

It could be argued by your previous dentist that as the problem was symptomless - it could have been that without treatment, the teeth would have lasted longer! Admittedly, this is probably quite a weak defense, but if they hadn't been found, would you have known about them? Would you still have the tooth/teeth?

It would be reasonable to ask him (Not Denplan) for some sort of contribution to treatment he might have missed (Although when you get three different dentists, you will always get 3 different treatment plans - and showing which one is 'right' is always difficult, as all of them would have pros and cons, and each may be valid. But if there are missing fillings, or big decayed holes, or obvious gum disease, then that is not defesible.

Finally - what I have written above is what I, as a dentist, would consider a reasonable way to solve this. What you actually might be able to get if you engaged a medical negligence lawyer who was experienced in dental claims could well be completely different (and much more) Assuming there is a case to answer.. But the claim would be against your former dentist - not Denplan.

rosemarie58

That's so, so helpful and really clarified things for me.

Without banging on too much with another lengthy post, I never really wanted to get into a complaints situation with my current denplan dentist and still hopefully dont. i would have been happy to pay for the root filling out of my own pocket but it became really problematic and the costs started mounting which was when I thought that he might consider contributing something out of my Denplan dues as I'd saved him a long job. Obviously this is now not the case. The cost of 3 x hour appts to root fill was £500 and they seemed confident that they could do it. The Entondist said he couldnt do it as one part of the root had calcified (??) so he couldnt get to it. This crown wasnt symptomless as I had an abscess under it in August last year which was x-rayed in August 2012 and he gave me anti-biotics for but the infection still remained.

I didnt intend to make a big issue over the abscess under the top crown as it hasnt flared up so as you say was almost symptomless so my Denplan dentist didnt xray it (although I have always been able to feel the lump and it is sore when touched) According to the CT scan from the new dentist it is quite big and has been there a long while. The reason I felt that I now had a lack of trust in my old dentist is that I distinctly remember saying to him a long time ago that I could feel something at the top of the tooth that was really sore and he dismissed it with a brief 'well you will do, its just been crowned' so I basically shut up about it. I can see it was sort of my responsibility to bring it up again but I didnt. It upset me when the new dentist said that he probably wouldnt be able to save that tooth. As I say I'm sure my denplan dentist will have no memory of that conversation so I have no plans to hold him to it.

Toothsmith you really are such a fantastic professional and its such a pleasure to know that there are people like you in this world.
It gives us all hope