Charging for questionable cases? (Friday Questions)
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- čas přidán 13. 09. 2019
- During the European Society of Endodontists (ESE) Meeting in Vienna Austria, Dr. Nasseh takes a minute to answer one of the participants' question regarding handling of cases where prognosis is questionable before entering the tooth.
- Krátké a kreslené filmy
Let me know what you guys do when you start a tooth with questionable prognosis? How do you handle the patient and the fee? Cheers! :)
Hi there, first of all huge fan of your clear headed knowledge and approach. coming to the question as hand, my understanding is that if we talk about all the procedures that we offer in our practice, in terms of finances, not all shall provide the same profitability. Some procedures which we do in bulk shall offer low profits, but are essential as firstly they cater for the bulk of monthly profit generation, and secondly, they help generate the procedures that offer more profit margins. for example, I am a maxillofacial surgeon, but having skills of a general dentist for rest of the specialties, I do scaling and endo for medium profits. This helps me keep a flowing patient cycle out of which some might turn up for procedures that are my forte. I charge high for wisdoms and implants etc. And that is where I get the opportunity to charge according to my expertise. Win some, loose some, in the end it all balances out. I have come across this exact situation and I always charged for the final procedure. That enabled me to remain honest to my patient as well as retain him at my practice. That is my perspective, I understand this might not be applicable at every practice.
@@morphistoify I agree Uzair. As an OMFS and a restorative dentist doing the endo you have the luxury of removing the tooth immediately after you realize it has a poor success rate. But as you mentioned, your situation is unique and for an endodontist this is not possible. We often have to send the patient back to the restorative dentist to tx. plan for a replacement first before removal. That's why in an endo office this often leads to an incomplete procedure. But thank you for sharing your feedback. :)
Cheers!
Great advice Dr Nasseh, patient communication is key then there are no surprises.... we have a set fee for teeth that are not saveable for any reason and every patient is informed of this before we start treatment....its a sad day for us too when a tooth cannot be saved!..😢
I think it also depends on where your practice is located. I observed that in big cities, the factors of the fast and demanding rhythms and the more impersonal relationship between the doctor and patient, dentists tend to be more typical with the price. While in towns with smaller population where you know everyone and there is another kind of bond created with patients and your reputation of being really fair and considerate for your patients might actually be more beneficial bringing more patients into your practice.
Amazing videos Dr Nasseh! Extremely informative! I usually watch your channel from Brasil and it helps me hugely, thanks!👏🏻👏🏻👏🏻
On cracked teeth (when I have already diagnosed the crack before starting of course) I go into detail about how unpredictable the prognosis can be. As for what to charge on a case that ends up being hopeless, I will charge for the xray, pulp testing, protective restoration (unless I extract that tooth the same day in which case I will not temporize it before I extract). Of course if I extract the tooth and place an implant that same day I just charge for those procedures and generally don't charge anything for the exploratory part.
@@retrogamerdave362 it’s good that you are able to give the replacement option right away and avoid this conundrum. You can also apply the cost towards the implant with an implant discount to absorb the fee. Good solutions! 👍
I charge dental filling fee for Exploratory diagnosis but symptomatic tooth is either extracted or replaced same day with costs involved.
That's great since you're able to do that. As a specialist, we often have to send the patient back to the referring dentist to treatment plan for either an implant or a bridge. For many patients, making that big of a commitment on the spot with the rubber dam in place is very difficult. But it's great to be the person doing the restoration too so you can give the patient a heads up from that perspective even before you get into the tooth. Cheers!
Great information. Could you do a video showing cases involving cracks... when to treat or extract? Thanks
I agree with you I do the same. Communication is the best thing I can do with the patient before start any lind of tratment.Well done Al
i appreciate your uploads
It's really relevant doc, thanks for the video
Hi,
Could you Do more Videos As live Demos on apicoectomies? Molar in den upper and lower jaws.
Instruments for packing etc
Would be Very valueable
I dont charge anything for exploring ! If at the end i manage to keep it i charge for the root canal treatment if not i dont charge the patient ! I know its a waste of my time and tools and products but patients are not understanding
Wow. Good for you! I assume you only book a short time just to explore. Then you book another appointment to do the procedure then. Otherwise, you can't book a full hour or hour and a half for a procedure only to find out you can't do it and not charge at all for that time! You still have to pay your assistant and everybody else at the office even if you don't charge for your own time! That essentially means that you're paying the patient for this exploration of his/her tooth's salvageability! But if that business model works for your practice then more power to you! :)
Cheers!
How are you removing a broken instrument from the root canal ? Which instruments are you using for it ?
How do you charge if complication occurs during tx such as perforation/ file seperation but u repair/obturate at the end but there is a guarded prognosis?
That's a good question. For me, if the problem is an obstruction I know I can deal with it surgically (apicoectomy) for which I would not charge. On the perforation, I think I would refund the fee if it fails soon thereafter. The goal is to keep your patients happy so they don't feel they're being nickel and dimed at every turn. Cheers!
Hello Dr. Nasseh, how much time should we normally wait for the crown after completing the obturation. ?
Also, tell if there is any basis for that.
Thanks and regards
That's a great question. After the endodontic treatment, I have a good idea whether I achieved my objectives adequately or not. If not, I always want to see the patient in 4 weeks prior to placement of a crown (most surgical healing in the human body occurs within four weeks, occasionally 6-8 weeks (lots of literature on that in the medical field). Since the inflammation at the apex is form of injury repair, the literature applies. But if I'm confidant that the procedure went well and that if anything happens I'm able to deal with it surgically I will generally tell the patient that they can proceed to place the crown right away. I also tell them the tooth may be sore for up to a month; but if it's sore beyond a month it's not normal and they should see me. This is a very good question Syed and I should probably make video about it. Thank you! :)
@@AANasseh thanks for the comprehensive reply Dr. Nasseh and thanks for selecting this question. Looking forward to watching the video. Living in a country like mine (India) where doing good endo is a challenge, your videos are a lifeline for me and many others like me. Keep up the good work Sir.
Hi, I need your opinion regarding this. Is it okay to obturate a canal 4 mm short of working length when the patient is pain free for days before obturation?
I always charge full, treatment in questionable or poor prognosis teeth, I charge for the procedure, not for the success. In every treatment, we promise we do the procedure, not the success, BUT our job is to give thorough information, make sure that patient has complete understanding for the patient to decided what to do with their teeth, the decision to take risks always come from the patient, not a doctor. the patient must understand completely what to expect, there is a chance that treatment will not successfully, and waste money and time, but there is also a chance that teeth can be saved, function and served you well.
Sir I’m an Endodontist in India I want to ask two question first one is,,,,in some cases might b a premolar or molar it’s difficult to achieve the canal patency even with a small size file how to proceed with that???? since apical third plays a vital role in the treatment outcome next question is ENDO sequence bc sealer and go points as well as ENDO sequence files are available here???
Did You dismissed your barber???
no but I should!
Hello sir, I didn’t find your mail address to mail you, first of all sorry for the que’ out of caste, can you please describe about V-Flex endo file system (about it’s pattern of use and comparison with proTapers).
Thanks in advance 🙂
Keep shining..
Sorry. Not familiar with that system.
I think it is not fair to make the pt pay for nothing
The patient is paying for your time and expertise. Have you ever had a consultation with a Lawyer? If you expect the lawyer to get paid only if you win they will not take up your case if they don't think they will definitely win! Not charging the patient only results into more teeth being lost unnecessarily because any logical dentist would not want to waste his time on a tooth that's possibly questionable.
Charge “incomplete endo fee” about 30% of normal root canal. Clean and medicate all canals but no obturation. Still doing a lot of work.
why do I watch this?
That’s the logical way to bill. It’s not rocket science. And on another topic, dentists should reduce their fees. They are unfair in the US.