Anne Aurand / The Bulletin

Jerry Brown, a 73-year-old retiree in Bend, has gone to the same dentist for almost 20 years. Since he's uninsured and pays for his dental care out of pocket, he asked the dentist how much a crown on a molar would cost. He was told about $1,000.

But then, Brown noticed an ad by a Redmond dentist who offered the same procedure for $595 — about $400 less.

Brown asked his dentist to explain the significant discrepancy and was told the higher price represented an increased level of expertise and better quality of work. Despite that possibility, Brown is considering the cheaper dentist.

“I still haven't done anything about it,” Brown said last week. “I'm going to hold off for a while and look around.”

Brown is among almost half of all Americans who lack dental insurance. A report from the Centers for Disease Control and Prevention said 42 percent of adults couldn't afford dental treatments or didn't have dental insurance.

Other surveys have said the number of uninsured is even higher.

When it comes to dental care, few patients put much effort into bargain hunting. Many patients probably have no idea whether they're paying a fair price.

They might not realize that prices for the same procedures can vary from office to office, and even from patient to patient within one office. The only real way to find out is to do a bit of homework.

Price transparency

Price transparency — understanding the cost and quality of a product before you buy it — is one of the tenets of a free-market system. It's how we buy clothes, cars and food. But not medical care. Or dental care, said Regina Novickis, director of public relations for Brighter.com, a website that aims to make dental services a comparison-shopping commodity.

“The U.S. dental care market is characterized by highly variable pricing and low price transparency. Together, these factors make it difficult for patients to make informed decisions about care and create an opaque market where they do not necessarily receive better care by paying more,” Novickis said. “Stark pricing disparities are effectively hidden from consumers, most of whom are not given, and do not ask for, price information in advance of treatment.”

An Oregon Dental Association spokeswoman couldn't offer examples of various dental prices in this region, citing anti-trust laws that don't allow the organization to collect information about various dentists' fees.

And, dentists don't typically advertise their specific prices either. “That's just the way it's always been,” said Mehdi Salari, a Bend dentist, who couldn't pinpoint one dominant reason why.

Many dentists won't offer price quotes for a procedure until they've done an exam and discovered what other related dental work needs to be done that would potentially change the price.

“We wouldn't give a cost estimate over the phone,” said Salari. “(There are) so many variations of things that can happen. If it's a cavity, is it just a filling? Does it need a root canal? Is the nerve dead? What's the bite look like?”

Salari said his office might tell a caller what the average fee is for a service in their office — about $1,000 for a crown, for example, he said. But the cost might change once a dentist looks inside the patient's mouth. And when patients end up paying more than they expected to, they get angry, Salari said.

Richard Fixott, a Redmond dentist, agreed and added that a prospective client could get a more accurate estimate if he or she is able to provide a lot of details when calling ahead. If calling about a broken filling, be prepared to quantify how big the hole is, how long its been broken, when it started to hurt and how bad the pain is, for example.

Cost discrepancies

Every office sets its own prices.

“Some of the pricing discrepancies can be attributed to operating costs that the dental office might incur. For example, rent may be higher at one office versus another. One dentist may have invested in upgraded technology, etc.,” Novickis said.

Fees account for the dentist's time, materials and in some cases, lab costs. “A composite (white) filling costs more because it takes longer to do well than a silver filling and the material costs more,” said Fixott.

Credentials and experience of a particular dentist can result in higher prices.

Fixott said patients get what they pay for, “up to a point. It depends on the procedure. If you have a tooth that you need a root canal on, and the roots are curvy, you'll get what you pay for if you go to an endodontist (a root canal specialist) rather than a general dentist. If you have a wisdom tooth with difficult extraction ... you might be better off healing and procedurally with an oral surgeon.”

Insurance policies play a role. Different patients who share the same dentist might be charged different prices for the same procedure, depending on each's insurance plan. One insurance company might cover $900 for a crown, while another covers $700. That variation is typically a consequence of the size of the company's patient pool. It results in different charges for different patients.

In some dental practices, an uninsured patient will pay more than the insured one for same procedure, because an insurance plan came with a contracted price for a procedure. On the other hand, some offices will give a cash discount to the uninsured. The only way to know is to ask.

To keep things simple in his office, Salari said he is a preferred provider for only one insurance company, Oregon Dental Service, the largest in Oregon for dental insurance. When Salari submits fees to ODS, the company tells Salari whether his fees are too high, too low or just right, and based on that he has established fees that are never higher than ODS reimbursement, he said. He said he also charges the same price to insured patients and uninsured patients.

Both Central Oregon dentists said there are more factors involved that can effect cost in a seemingly intangible way. Knowing and trusting your dentist is worth something, the dentists said.

“Health care is different than a commodity,” said Salari. “It's a service. Service is something to consider, it has a value.”

Some dental offices offer a high-end customer experience, more comprehensive treatment plans, more emphasis on prevention, said Fixott. That translates into “more expensive,” he said.

If your dentist offers a spa atmosphere — they give manicures or serve lattes — they probably charge higher prices, said Fixott.

Salari believes price alone should not drive a person's choices.

“They need the best care, the most compassionate care they can find,” Salari said. “Competence is more important than cheapest. But cost is a factor. If they say, 'Wow, this really costs this much?' They have a right to get a second opinion or estimate.”

Cost comparisons for some common dental procedures in Central Oregon

Brighter.com said on its website that general dentists in Bend might charge anywhere from $868 to $1,210 for a crown; from $128 to $195 for a rear filling; and from $798 to $1,089 for a root canal on a molar.

Mehdi Salari, a Bend dentist said “the average fee” in his office is about $1,000 for a crown; $180 to $327 for a rear filling, depending on the number of surfaces that need work; and about $1,000 for a root canal on a molar, but Salari usually sends root canal jobs to a specialist.

Richard Fixott, a Redmond dentist, said a “ball park figure” from his office is $900 for a crown; $100 to $450 for a filling; and $800 to $900 for a root canal.

Tips for saving money

• Some offices charge a one-time fee for a procedure and its related follow-up appointments, in which case the initial fee might appear high. But, adding on subsequent costs for follow-up appointments could result in higher overall costs. A consumer should ask how many follow ups are expected with a procedure and whether the initial cost includes those. For example: If a root canal needs to be reopened, do I pay each time? With dentures, does my fee cover adjustments? How many?

• Many dentists will allow monthly payments. This could save on interest rates accrued if paying with a credit card.

• Sometimes dental rates are fixed, but it doesn't hurt to ask if there's room for negotiation. Paying cash can provide extra bargaining power. Ask insurance companies what they reimburse for a given service in the region and ask the provider if they will accept that amount, or less, as a cash payment.

• Prioritize and stagger treatments over time.

• Investigate nontraditional dental payments intended for patients without insurance.

In a membership model, patients without insurance can pay a fee and receive certain preventive care services for no cost and other procedures at discounted rates.

PureCare Dental, in Bend, is the first and largest membership program in the region: www.purecaredentalofbend.com, 541-647-5555.

Coombe & Jones, in Redmond, has a preventive dental club: www.coombe-jones.com, 541-923-7633.

Gilmore Dental, in Redmond, offers a healthy mouth membership: www.gilmoredental.com, 541-504-5707.

Brighter.com is a national dental membership program, but it only has one participating dentist in Central Oregon: www.brighter.com.

Or, check out CareCredit, which works like a credit card but just for health care, including dental. www.carecredit.com

Sources: Mehdi Salari, Richard Fixott, Regina Novickis

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