It’s Not Just about the Teeth

Saul N. Miller, D.D.S., Editor

It all started as I walked by the front office, where I am not supposed to be anyway. As I visually took in everything on the desk in front of Rita, I noticed a certified letter from one of the insurance carriers for whom we have contracted to provide preferred care.

When I had a minute, I carefully found a way to sneak it away from Rita and excitedly went to the lunch room. Certified, I thought, maybe they want me to be an extra super special chosen preferred dentist, considering the quality of my work, lack of complaints, appropriateness of care, and the fact that my patients virtually never wait in the reception, don't call it waiting, room. In the remaining 30 seconds before I was scheduled to be with my 11:30 patient, I opened the envelope and read the first paragraph in which appreciation was expressed for my participation in the plan. A bit formal, I thought, but apparently they wanted to be sure I got the thank you note. Getting up in years, approaching the big 62, and wanting to savor every word of this thank you note, I put it down. It was time for me and Mrs. Jones, and I did not want her to wait. You can only imagine my anticipation, for both Mrs. J and completion of the letter.

Coincidentally, the lovely Mrs. Jones is covered by this insurance carrier. She is in excellent dental health; after many years and much encouragement, her oral hygiene was excellent; there was no bleeding on probing and pocket depths were in normal limits, as was her oral mucosa. Her restorations were intact. Although there was some wear, there was no need to repair anything or replace any satisfactory amalgams with one of those wonderful new white fillings. One more look around to be sure I hadn't missed anything, and I noted a defective margin and dark suspicious shadow around the occlusal amalgam restoration on #17. Now in her 80's, Mrs. Jones was not getting any younger during those many years of dental and oral hygiene encouragement. She has trouble opening her mouth, cannot have the chair brought back too far and needs extra support around her neck. Gagging is also a problem . . . for her, that is.

I could certainly live without doing this restoration, I thought – not to mention the fact that it costs me more to perform this service than the carrier reimburses this chosen provider. But, alas, Mrs. Jones comes to me for my care, integrity, kindness, dazzling sense of humor and brilliant repartee between me and Rita, and gentle touch. There would be no question that the restoration would be placed, if indicated. Since Mrs. Jones needs to assemble a small battalion to get to the office, it was decided that it needed to be performed during this visit. Finally, after contortions that would have warranted a gig with Cirque de Soleil, the amalgam was removed and significant recurrent decay was noted that, lo and behold, extended to the mesial surface. The tooth was carefully restored with an MO amalgam. We missed a good part of lunch and noontime exercise, but we did the right thing, although the compensation would be . . . well, you know the story. At the front desk, Mrs. Jones said that since she is on a fixed income, she would send in her co-pay when she got her check.

Ahhh, lunch time! While I was waiting for my Lean Cuisine Lasagna Florentine to cook to zapped perfection, I took the opportunity to enjoy the rest of my certified thank you note. Again, I basked in the appreciation of my participation, only to read that a computer noted that I have performed approximately 10% more one and two surface amalgams and composites than my colleagues. Whoops! (Isn't it ironic, don't ya think?) I read on to see if there was any mention of Mrs. Jones, or that my patients may have required fewer crowns, endodontic treatments and emergency visits than (fill in the blank). I wondered, are the amalgams to repair an older crown margin, followed by a visit to my chiropractor, included in this percentage?

Should I go back using my bifocals or loupes instead of using my binoculars? To paraphrase Yogi, you can see an awful lot if you look.

Should I not send in for payment? I hardly make anything on the service anyway, and I want the insurance carrier to like me . . . to really like me, as Sally Fields or George Costanza might say. I guess I better see how many one and two surface direct restorations I have placed recently.

Anyway, like many of us, I am glad that I am doing my part to provide necessary care for the subscribers of numerous insurance carriers, even though . . .

(Editor’s note: I understand that carriers also have obligations to their subscribers/customers, and that utilization guidelines are based on research and science.)