Yours Toothfully by Dr Chan Joon Yee

It’s official. We’re in a technical recession. Consumers are expected to tighten their belts in the coming months and where dental treatment is concerned, patients are going to be price-sensitive and suspicious telephone “shoppers”.

“Hello, ABC Dental ….”

“How much you charge for scaling huh?”

“$20″

“Wa, so cheap ah. Can come down now?”

“Sorry, appointments full until next month.”

One month later … scaling done at ABC Dental.

“Alamak! How come $100?”

You don’t know meh? Itemised billing mah.

1. Consultation $20
2. Scaling $20
3. Polishing $20
4. Removal of stains $20
5. Infection control $10
5. Overcharge prevention fee $10 *

* just kidding

This is a case of “You want transparent, I give you transparent lor.”. Since April this year, MOH has made it mandatory for clinics to itemise their bills. In theory, it gives rise to greater transparency as patients would then know exactly what they are paying for and how much. The problem on the ground is, patients may not know exactly what steps and procedures are required in a course of treatment. Molecules can be split into atoms. Atoms can be split into neutrons, electrons and protons. When dental clinics apply creative “nanotechnology” to their bills, there is really no limit as to how finely one can slice up the bill.

For many honest and hardworking doctors, itemising is a headache. They used to charge $30 for a certain treatment which they do not regard as having multiple components. Now, they have to think up some consultation charge to add up to that $30. For dentists, there is plenty of room for “creative nanotechnology” as we can see from the bill at ABC Dental above.

Any normal patient would refer to the whole procedure of dental prophylaxis as “scaling”. Who would know that polishing, consultation, checkup, infection control etc can be separately charged? For a medical bill running into tens of thousands of dollars, it would certainly make sense to itemise. It makes it clearer to the patient how much he is paying the surgeon, the anaesthetist, his room etc. But when you’re dealing with relatively small amounts, then it may not make so much sense. If I tell a patient that extraction costs $80, I mean to tell him that it includes consultation, medication, gauze, infection control and the local anaesthetic. As long as there is this common trust and understanding between patient and dentist, it really doesn’t benefit anybody when the dentist is forced to creatively split the bill into a potentially unlimited number of parts.

In fact, this new policy does the opposite for consumers it is meant to protect. It makes things even more ambiguous and open to overcharging. This form of billing doesn’t make sense even for some larger bills that come in the form of a package. For example, a dentist may want to offer a $3000 package for a dental implant including the surgery, the crown and so on. And with a multiple stage treatment like dental implants, the ways to manipulate charges are virtually limitless. The crown sitting on top of an implant is not part of the implant. Same goes for the abutment. It doesn’t take an accountant to see that I can quote $500 for the implant and still end up charging more than $3000 for the whole treatment when there’s abutment cost, crown cost, second stage surgery cost …. not included yet.

How should the average patient who is not aware of how many ways a bill can be split, manage “creative nanotechnology” at the clinic? The answer is simple. Find a dentist you can trust and don’t ask him to itemise the bill as per MOH requirements. Ask for a total amount for the whole package. Confirm that you do not need to pay anything more than this. If you’ve been a nice patient, he might even throw in some scaling (and polishing) for free.