Dental care in the U.S. is fucked up.
I have full employer provided dental insurance (Delta Dental) and still pay hundreds of dollars per year, have restricted choices and receive mediocre care.
Its got nothing to do with the skill and knowledge of U.S. dentists. Low quality dental care is to due to the perverse incentives insurance provides U.S. dentists.
Under Delta Dental, there is a typically an annual deductible of $300, a 20% copay, plus a yearly maximum payout of $3000.
This all sounds reasonable but Los Angeles dentists have negotiated schedule of fees for insurance customers that sets above market prices. If you walk into a dentists office without insurance, the prices are below the Delta Dental negotiated fees. What this means is that if you need a crown, the negotiated price is $800 and you will owe $300 (deductible) + $160 (20% copay) =$460 out of pocket. This is about what you pay without insurance making the insurance essentially worthless.
In fact, the profit margin is high enough that most dentists will waive the copay if you bargain correctly or are willing to shop your business. The price they charge uninsured patients is about 20% less than the price negotiated with Delta Dental. For the crown, mentioned above I pay about the same out of pocket with insurance that I would pay out of pocket without insurance. Like I said, dental care in Los Angeles is fucked up.
In addition, the dentist constantly upsells you to more expensive and/or not covered by insurance procedures. If you need a crown, for instance, the insurance covers a basic crown and the dentist will upsell to a metal or more expensive model. You pay for the overage and with no effective way to bargain on price. The dentist sets the price – take or leave it and you have to make a decision after the work has started and you are prone in the dental chair. So if you want a higher quality longer lasting crown that will add on another $300 and the dentist may tell you a non-covered procedure is necessary which tacks on another couple of hundred dollars. The end result is that your insurance covered crown ends up costing you over a thousand out of pocket.
Typically, the upsell is not presented as an option. The dentist simply says installation of your crown requires an additional procedure that tacks a couple of hundred onto the bill, says the more expensive crown is “advisable” or presents you with a dental health “plan” that includes uncovered and marginally necessary procedures.
It is a rare patient who will haggle with the dentist because the dentist is a doctor that is supposed to be putting the health of the patient not his own pocketbook first. It’s not part of the paradigm to dicker and strike out options like you would when shopping for an automobile and dealing with a sleazy care salesman.
The whole routing is is standard operating practice for U.S. dentists and is the way they maximize revenue from their practice. Dentists actually go to seminars where these techniques are taught under the moniker “Practice Management”.
Like I said, the dentist’s skills and knowledge are fine in the U.S. but dental insurance and the perverse incentives it creates screws up the actual dental care.
Enter Thailand where a free market exists and you get a glimpse of what dental care would be like without government regulation.
If you need dental care in Thailand, I recommend the Bangkok International Dental Center. They have 2 huge facilities in Bangkok one near Siam Square and the other on Rachada just north of the Esplanade Mall with dozens of dentists on staff, equipped with the latest dental equipment, and offering the full array of the latest technology.
Most of the dentists are women and the ones I saw were extremely attractive and personable.
The Rachada office is in its own separate building and has 5 floors of dentists.
On your first visit, there is a free exam (a full x-ray is 1000 baht, $33 USD) and the dentist puts together a treatment plan where each procedure is listed along with its price and you can choose which procedures you want done and what quality of materials to use.
Typically, the procedure is performed the same day/visit and you are in and out in a couple of hours. Procedures that require multiple visits are listed on the price sheet.
I had an evaluation exam with full mouth x-ray and a filling done for 2000 THB ($66 USD) and was in and out in less than an hour.
Notice that the same basic crown at BIDC that costs about $1000 in the U.S. costs only $229 at BIDC.
A deep cleaning that costs $600 in the U.S. is 6000 THB or about $200 USD at BIDC.
The dentists and assistants I observed followed strict sterilization procedures– when I handed them my eyeglasses the assistant removed here surgical glove took my eyeglasses and then replaced the glove and the dentists I had had a much gentler touch the the 2 dentists I use in Los Angeles.