Thursday, November 8, 2012

Who Pays?

Hey all,

I am back from NYC and the marathon that never happened. Yep, I paid for a plane ticket. I paid a ton of money to stay at a really nice hotel (really nice hotel in New York is still very small). I found out that the race was cancelled while I was in line to get my T-shirt and my race number.

That was tough to swallow. I am okay with them cancelling the marathon, but to do it on Friday afternoon was a killer. If they had announced the cancelation on Thursday or Friday morning, I would have stayed home. And, of course, the $280 entrance fee is non-refundable. Usually, I like to be kissed before this happens to me.

Anyway, I’m still thinking about the folks in New York and New Jersey and have been praying for you. I hope things get back to normal soon.

We did make the best of it in the greatest city in the world. We stayed about two blocks from Times Square. Wow! TV doesn't do Times Square any justice. There are buildings that have ads that are 30 stories tall.

The weather was cold; it was good for a Florida boy to experience 39 degrees in early November. Between Times Square and the weather, I now really appreciate having a back yard and great weather.

You know the saying, "In a New York minute?" Well, it is hard to not feel rushed in this city. There was no place to just sit and relax. I guess there is Central Park, but it almost seems manufactured. Everyone is working and totally in the rat race but when you do want to relax, even though you know you never will, there is this park in the middle of this city.

We did get to see a show. Spiderman was great. We went to Sparks for dinner (this place was made famous because John Gotti was killed on his way out of there) and got a very overpriced steak. But it was all good. We went down to Greenwich to shop. I got to experience New York. The best thing is that I think I got a pass for next year so I get to do it all again. I feel rushed already.

Oh, I got to fly first class on the way up there and it was SO SWEET. I can't help but think of that Seinfeld episode when Jerry is up in first class and Elaine is back in coach. How can you not feel that way? The seats recline flat. You can lie down! They bring you heated peanuts. They put a tablecloth on the tray when they bring your meal. It is unbelievable. We flew coach back and felt like second class citizens. They won’t even let you have entire can of Diet Coke.

I am reading the book “No Easy Day.” It is written by a Navy Seal about the mission that killed bin Laden. It is pretty good. It is a very easy read, and I need that right now.

Can you believe Christmas is only seven weeks away? If you haven't thought about your Christmas party yet, you are way behind. Get going on that. And don't forget, my Christmas blog will be my last. We have some good people coming in, so you won't be without good reading. It sucks that I can't do this for a living.

Today I want to talk about who pays. A woman who doesn’t smile came in. Her teeth were really bad. Number 7 was missing and all her others were badly decayed. Her husband, a nice-looking guy, wanted to fix it for her. They are not poor, but he wanted to know how much it was going to be so he could save the money. They made an appointment six months later.

We did a lot of caries control, taking the decay out of the adjacent teeth. We did a lot of build-ups. Then I made her a bridge from 6-8 and two other anterior crowns on 9 and 10. We made her a temp. They looked great. But the tissue on #6 was not quite right. See, I put the cord in tissue, for the impression, and it retracted. The problem is that it never came back. The bridge came back from the lab in a couple of weeks and it looked beautiful, except for the mesial margin of #6. The margin was a smidge over the tissue.

I told her I was thrilled with the way it looked (so was she), but I showed her my concern. She wasn't concerned. She obviously wanted them all put in permanently because she thought it was awesome. I told her I thought we should put it in temporarily and see what the tissue looked like in three weeks. She was fine with this.

Things looked pretty good three weeks later. She was thrilled. We took off the bridge and cemented it back on permanently. When I went to remove #9 and 10 to recement them permanently, they wouldn't come off. I told her that I was not going to break these crowns trying to get them off, but to call when they get loose or come off.

She came in when #9 broke off. But the build-up was in the crown and some of her tooth. The temporary cement never came loose, but the tooth broke. Luckily this tooth had a root canal and none of the margins were affected by the break. I did a reverse post and core. Where I do a post in the tooth, I put bond on the tooth and I put the core in the crown (self-cure build-up material such as CorePaste, don't forget to lube the inside of the crown) and then put the crown back on the tooth and it forms around the post. When I take the crown off, I have a post and core that the crown fits on. I did all of this and recemented the crown (permanently).

She went up front to show her husband; he was just as pleased as she was. While they were up front, I had a discussion with my staff in the back about how much I would charge. I put in a crown and it broke. I did the best I could and it still broke. Are we, as dentists, married to teeth we work on? How long are we married to them?

After the discussion with my staff, I decided to charge them for the post and core. I was going to charge them for it but give them a discount You know, something for my troubles. Just enough to pay the staff, for the supplies, and for the electric. I went out front and they were gone. It was the, "Thanks for your work. We are not expecting to pay for anything today." kind of gone.

That ended this discussion. I was NOT going to send them a bill because they would really be caught off-guard and probably get upset. What would you have done? If you do a crown and the whole thing breaks off, is there additional charge to do something else? I am assuming most of you are going to say that it is our responsibility. For how long?

I have to tell you that I don't agree with what I do. I don't think I should have to pay for some other problem they have just because I did a crown. Obviously, the tooth was not strong enough after the build-up. You might say that I should have done the post and core originally. Okay, I would buy that. But I am doing it later. Why should she get it for free if I do it later?

What if you have a patient who breaks an old crown off at the gumline? The tooth has an RCT, so you do a post and core and a new crown. A couple of months later, the crown and post break. Is it your problem? I know the answer; this is a rhetorical question. The person obviously has a bite issue.

We have talked about this before with other things. I hate this part of my job. I want to please everyone, so most of the time I don't charge. What other profession do people come in and get charged NOTHING? No other profession.

Have a great Thursday.



Anonymous said...

Recently, I had an elderly patient (85 yrs young ) where I prepped # 8 for a crown. The patient has significant wear , a deep bite, and envelope of function issues. After a year, she broke the crown off. I did a reverse core and put the crown back in. I had a conversation with her in the operatory about what I did for her and her problems. I did charge for the post and core. At her most recent recall, I observed swelling on the facial area of the gingiva. I believe she has fractured the root. The tooth was taken out of occlusion when previously recemented and the patient wears a night guard. Sometimes we are miracle workers,,,sometimes not !

Beth Simon said...

Hi John-- is it poor blog etiquette to comment on an old blog? Will you even know? Anyway, I will show this one to Ken because the answer to your question is CPAs! Ken has been angsting about the same issue-- He does a tax return and gets paid. The client gets a notice from the IRS, but not because Ken has made an error. So Ken has to research the issue and draft a response. Sometimes it even takes phone call(s) to the IRS (think gobs of hold time). Does he charge the client for all that work? Most clients think, "It's still about my tax return that Ken did, that I already paid for, so. . ."


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