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Comment by Analemma_ | Hacker News Reader

This is great news. Every six months I go to the dentist for a checkup and teeth cleaning, and it's always the same: they look at my teeth for a few minutes with the mirror thing, scrape off some plaque with the pointy thing, polish my teeth with the spinning thing, then I do the flouride rinse and leave. It usually takes less than half an hour, and then they bill my insurance $275 for it. It's ridiculous, and there's no way this requires a graduate medical degree, it could be done by someone who took a three-week mail-in training course. Keep dentists' offices with DDS's around for major surgeries or unusual situations, but for routine checkups this is fine.

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> it could be done by someone who took a three-week mail-in training course.

Sounds like you have healthy teeth, but your comment is fairly ignorant of the fact that nearly everything you described isn't done by someone with a graduate medical degree, but generally is done by a dental assistant/hygienist . I wouldn't want someone to touch my teeth if they haven't practiced using the instruments in a classroom. This isn't a programming course..

> Dental assistants receive their formal education through academic programs at community colleges, vocational schools, technical institutes, universities or dental schools. Graduates of these programs usually receive certificates. Although the majority of academic dental assisting programs take nine to eleven months to complete, some schools offer accelerated training, part-time education programs or training via distance education. [0]

[0] https://www.ada.org/en/education-careers/careers-in-dentistr...

Took my step daughter to the dentist this morning. An x-ray and impressions. Whole process took 14 minutes. And that includes having her pose for front face and side face photos. Not a dentist in sight, just an assistant.

$600.

They billed my insurance $750 for a cleaning, I had to pay $0. Healthcare really is Monopoly money.

And the fraud there is that they claim it's the dentist whom does it.

Why don't insurance companies crack down on fraud like that?

I'm pretty sure that my insurance company has a standard rate that they will pay out for procedures. And I'm also pretty sure they wouldn't pay for a $750 cleaning.

There needs to be a report, a lot of times.

I used to work for a company that did claims benefits management.

For all their (many) faults, insurance companies are often very interested in hearing about provider fraud.

Oftentimes, there may be no direct action from _your_ report, but it might help establish a pattern, versus "oops, we mis-coded the procedure/who provided it".

That sounds bizarre. Lots of people with medical insurance don't have dental insurance. I do and it covers cleanings but, as I recall, a cleaning is around $100 or so. (I get 3 cleanings a year and at different times the insurance I've had sometimes covered the third and sometimes didn't.)

Crowns are around $1200 which I end up covering half of.

In my experience, dental is actually relatively free market. Some providers (like mine) charge a bit more than insurance covers for things like fillings and I just pay it. But, even if you don't have insurance, rates are pretty reasonable for 30-60 minutes of a professional's time. My accountant certainly isn't any cheaper.

Dental insurance, especially, is a scam. The amount of "benefit" you get really is pretty low if $bad_things happen - a few thousand at most.

It's more like a pre-payment plan that lots of people don't pick up the item the care they pre-paid for.

I was going to go without because I saw what my insurance had been paying out. I figured I'd save a bit and I could "self-insure" in case of bigger problems. Joke was on me - I got billed about 6x as much as the insurance company. So now I pay for dental insurance because it gets me access to the "real" prices, not because I really want "insurance".

You can call dental clinics and ask for their prices. The prices quoted ITT are blowing my mind. For reference, see Fair Health [0].

[0] https://www.fairhealthconsumer.org/

I pay $119 a year for dental insurance through Costco. That's less than I used to pay for two cleanings per year without insurance.

Call your insurance and see what they'll pay when you need a $10,000 implant or $3,000 root canal.

You have a overpriced dentist. I pay mine $300 for 2 cleanings + xray a year in cash. And this is in a high COL area.

The dentist was overpriced, but cleanings were free to new but delta was paying $750 hence Monopoly money. Then they charged me $350 for fixing a cavity but refunded me $140 after their accountant told them to. So yes Monopoly money. I’d hate to get cancer even though my insurance is relatively good with at $1050 out of pocket max.

needed a root canal a few years back. went to the first local place. got an estimate of $2500. way too much for my blood. called around, got someone else to do it for around $1300. Found out there's actually a guy closer who does most for around $900+. But... I went with the $1300 lady. She was fine, and have been going back since. It's a bit of a drive, but the initial price was enough of a 'trust' factor for me, and I trust now that if/when I need something done, I need it done, and that her price will be reasonable. It might be a bad assumption on my part, but I did have that initial savings years ago. She'd be having to jack up everything else quite a lot to be trying to gouge me, and I don't think it's happening. She's just in a less expensive part of town, generally sees less affluent patients, and everything is priced for that market. That it's a 20 mile drive to get there doesn't bother me.

I can tell you from experience that an improperly done root canal can come back to bite you years later. Had one done by IHS[1] when I was in 6th grade. During my 1st year in college I woke up with mouth pain that was really, really bad. Had to get a parent to come get me and drive me to a dentist. He took x-rays and found out I had an infection growing since the initial root canal[2]. He prescribed antibiotics and a massive pain reliever (Percodan[3]). It took four weeks for the infection to go down enough for surgery. The doctor said it might come back because they might not get it all. It took two more operations (5 and 10 years later) to fix it all.

1) given what's happened to so many other people, I feel I got off cheap.

2) no, the IHS dentists did not see this growing and it was probably slowed by the multiple antibiotic prescriptions for step throat in high school.

3) Took it for two weeks, I'm still amazed I was functional enough to take tests and program. That stuff is a whole lot of don't care in one bottle.

understood. the procedure referenced above was from... gosh now, 9 years ago. no issues with it (I've had other teeth issues but not her fault). Wife had a bad root canal done by a 'fancier' place which went bad a few years later.

Sort of feels like a total gamble, really.

In theory the dentist is supposed to glance over your mouth and screen for gum cancer or other issues. So a three-week mail course is certainly an exaggeration.

The dentist office has to roll up all their costs under the services they provide. So the $275 contributes to all the staff wages and benefits, office space, etc. That is why for example the HVAC repairman charges $300 for changing a $5 capacitor in your AC. Places like Costco/Walmart can reduce the costs by keeping a steady stream of customers and sharing building space, etc.

> That is why for example the HVAC repairman charges $300 for changing a $5 capacitor in your AC

In my experience, the primary reason they do this, is because they can. Not because their existence requires it to survive.

Isn't it normally hygienists who do the routine work? With a DDS overseeing the process and doing the final exam?

From what I've gathered, dentistry is still very lucrative. I knew a DDS who work 3 days a week and clears over $500K per year.

It will be interesting to see how long that lasts.

That's why some dental offices hire dental hygienist to clean teeth while the DDS focus on more major procedures.

I thought they all do that. I never had a dentist do my teeth cleaning. The dentist shows maybe for two minutes at the ned and takes a quick look.

It probably depends on the dentist. I've never even see a dental hygienist at my dentist's office. It's always the dentist that does everything.

That's not the norm in the US. Maybe some old-timey solo practices but having dental hygienists do cleaning is all I've ever seen.

That's extremely unusual, I've been a patient at probably 20 different dental practices and I've never had a dentist do the cleaning, only the dental hygienist.

>there's no way this requires a graduate medical degree

The actual cleaning itself is done by a dental hygienist, which requires an associate's degree. The dentist only shows up and the end to see if he/she sees any problems.

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