Unsure about NHS Dental charges with new dentist

bytesplicer

Hello!  

I just had a course of treatment with an NHS dentist.  I contacted them by phone telling them I had two broken teeth, I didn't have a dentist at the time, they said I would need to pay £25.80 to get an appointment.  I paid this for an appointment which was arranged for 9 days later on 22/06/23.  During this appointment the dentist told me I'd need crowns, but he won't do those on the NHS.  In the meantime, as I cannot afford the private charges, he would fit 3 glass ionomer fillings which he said were temporary measures and would be done under band 2 (£70.70).  I paid another £30 after this examination.  My next appointment was 27/06/23 where the fillings were done and I paid the remainder of the band 2 charge, £14.90.  At this point I considered the bill settled and as they specified the charge I assumed they did too.

I asked the admin staff if they could send me the treatment plan for an insurance claim, which they said they would do.  One month later this hasn't arrived, so I went into the dentist to ask for it, and they printed it out.  On the printout it showed an outstanding balance of £25.80, which I queried as I thought my exam and treatment were all a single charge in band 2 and I was all settled up after my appointment.  The admin told me this is the way the NHS do things, because my first appointment was 'assessment and advice' rather than an 'examination' it isn't covered under the NHS bands, because I knew I had issues with two teeth it isn't part of the treatment band and that I had been booked in for an emergency appointment.  This seemed odd to me but I didn't really have any choice but to pay the additional £25.80.

Here's what I paid total, my question (thanks for bearing with!) is is this legit?  I really thought there'd be one overall charge governed by the band, but they said this isn't the case.  Are they right?   Why didn't they ask for this after my treatment completed, instead of 1 month later when I returned to query the missing insurance information.  I also note that after my appointment they made a follow up appointment to make sure I don't need root canal under these fillings, but note that the appointment is exactly 8 weeks after my fillings, meaning if I do need root canal I will be charged again as 8 weeks is the NHS treatment cutoff.

So this is worrying me, the band 2 treatment has already knocked the wind out of me financially, and now an extra £25.80 on top of it.

Here's a list of the charges and dates if that helps.

13/06/23
Credited £25.80 prior to initial appointment

Balance £25.80

22/06/23
Debited £25.80 for Assessment and advice + small xray (no charge listed), told I will receive 3 fillings under band 2
Credited £30.00 for deposit on treatment

Balance £30

27/06/23
Debited £25.80 for Examination
Debited £44.90 for 3 Glass Ionomer Fillings
Credited £14.90 to pay off balance of treatment

Balance -£25.80 (I presumed it would be £0 here as they asked me to pay the remainder £14.90, so this was added after I paid).

07/07/23 (today)
Credited £25.80 to pay balance

Total cost £25.80 + £30 + £14.90 + 25.80 = £96.50

So more than the band 2 cost despite both of my appointments happening within 5 days of each other.  The extra £25.80 seems to have been added after I paid the final amount of £14.90.

Sorry for the long post, and thanks in advance for any advice or suggestions!

Kind regards
Matt

Undervalued

What reason did he give for not doing the crowns on the NHS?

That would have made the treatment Band 3 so around £300 but still far cheaper than private. If they were judged to be medically necessary they should have been offered on the NHS. 

bytesplicer

Undervalued said:

What reason did he give for not doing the crowns on the NHS?

That would have made the treatment Band 3 so around £300 but still far cheaper than private. If they were judged to be medically necessary they should have been offered on the NHS. 

Hi, thanks for the reply.  He said it costs too much for them to do crowns on the NHS; if he did both my crowns on the NHS he would end up having to pay for it from his own pocket.

silvercar

bytesplicer said:

Undervalued said:

What reason did he give for not doing the crowns on the NHS?

That would have made the treatment Band 3 so around £300 but still far cheaper than private. If they were judged to be medically necessary they should have been offered on the NHS. 

Hi, thanks for the reply.  He said it costs too much for them to do crowns on the NHS; if he did both my crowns on the NHS he would end up having to pay for it from his own pocket.

Undoubtedly true. The question is whether he is allowed to refuse to offer the crowns on the NHS, having decided that that is the correct course of treatment for you.

What you now have is glass ionomer fillings, rather than the crowns. So you have paid for what you have got. The question in my mind is why he said you needed crowns and why he hasn't given them to you. I suspect it is because the crowns would be too expensive for him to do on the NHS and for you to pay for privately, leaving little option but this solution. So this is the not ideal but a fix-it solution. Some people would be very happy to have had this option, when it wouldn't have been an option if they were a totally private patient, never mind that the NHS dentist didn't offer it, when perhaps he should have done.

bytesplicer

silvercar said:

bytesplicer said:

Undervalued said:

What reason did he give for not doing the crowns on the NHS?

That would have made the treatment Band 3 so around £300 but still far cheaper than private. If they were judged to be medically necessary they should have been offered on the NHS. 

Hi, thanks for the reply.  He said it costs too much for them to do crowns on the NHS; if he did both my crowns on the NHS he would end up having to pay for it from his own pocket.

Undoubtedly true. The question is whether he is allowed to refuse to offer the crowns on the NHS, having decided that that is the correct course of treatment for you.

What you now have is glass ionomer fillings, rather than the crowns. So you have paid for what you have got. The question in my mind is why he said you needed crowns and why he hasn't given them to you. I suspect it is because the crowns would be too expensive for him to do on the NHS and for you to pay for privately, leaving little option but this solution. So this is the not ideal but a fix-it solution. Some people would be very happy to have had this option, when it wouldn't have been an option if they were a totally private patient, never mind that the NHS dentist didn't offer it, when perhaps he should have done.

Yes, that's almost exactly what happened.  After the examination he said I need two crowns but he won't do them on the NHS as he'll have to pay out of his own pocket.  I told him I couldn't afford private treatment, at which point he said he would do glass fillings now as a temporary measure but I will need to pay private costs to get crowns in the next few months.  I told him I wouldn't be able to afford private at any point in the foreseeable future.  I'm concerned that because of this he added an extra charge for an examination (this charge was made after I'd settled what they said was my total bill for the treatment) to make a bit of extra money from me in case I don't return for the private treatment.

Undervalued

bytesplicer said:

silvercar said:

bytesplicer said:

Undervalued said:

What reason did he give for not doing the crowns on the NHS?

That would have made the treatment Band 3 so around £300 but still far cheaper than private. If they were judged to be medically necessary they should have been offered on the NHS. 

Hi, thanks for the reply.  He said it costs too much for them to do crowns on the NHS; if he did both my crowns on the NHS he would end up having to pay for it from his own pocket.

Undoubtedly true. The question is whether he is allowed to refuse to offer the crowns on the NHS, having decided that that is the correct course of treatment for you.

What you now have is glass ionomer fillings, rather than the crowns. So you have paid for what you have got. The question in my mind is why he said you needed crowns and why he hasn't given them to you. I suspect it is because the crowns would be too expensive for him to do on the NHS and for you to pay for privately, leaving little option but this solution. So this is the not ideal but a fix-it solution. Some people would be very happy to have had this option, when it wouldn't have been an option if they were a totally private patient, never mind that the NHS dentist didn't offer it, when perhaps he should have done.

Yes, that's almost exactly what happened.  After the examination he said I need two crowns but he won't do them on the NHS as he'll have to pay out of his own pocket.  I told him I couldn't afford private treatment, at which point he said he would do glass fillings now as a temporary measure but I will need to pay private costs to get crowns in the next few months.  I told him I wouldn't be able to afford private at any point in the foreseeable future.  I'm concerned that because of this he added an extra charge for an examination (this charge was made after I'd settled what they said was my total bill for the treatment) to make a bit of extra money from me in case I don't return for the private treatment.

As far as I am aware that is not allowed. Crowns, if medically necessary are included in NHS Band 3.

From time to time there are reports of NHS dentists refusing to do even relatively straightforward root canal treatment (which is included in Band 2). They are allowed to decline treatments that are more specialised than could be expected from a general (non specialist) dentist. However, it seems that some will either falsely claim that to be the case or sometimes just outright refuse which is a clear breach of the rules and should be reported to the GDC.

Undervalued

bytesplicer said:

Undervalued said:

What reason did he give for not doing the crowns on the NHS?

That would have made the treatment Band 3 so around £300 but still far cheaper than private. If they were judged to be medically necessary they should have been offered on the NHS. 

Hi, thanks for the reply.  He said it costs too much for them to do crowns on the NHS; if he did both my crowns on the NHS he would end up having to pay for it from his own pocket.

That is the fault of the system and is not your problem. He is free to stop doing NHS work and become a private only practice but what he cannot do is be part of the NHS system then bend the rules.

bytesplicer

Thanks for the replies, looks like the issue is worse than just an extra charge, will have to look and see what I can do about it.