Too big a bill for teeth cleaning

Jack Dunwoody, Tokai

After experiencing toothache, I went to Medicross Tokai, just five minutes away from my new retirement village.

I got an appointment with Dr Al-Jo Mackenzie for Tuesday at 10.15am. By then, my toothache had more or less passed – I’d taken some Panadol – but I wanted to still have the appointment, just in case. I had been allocated 45 minutes because I was a new client, but, in the end, the doctor was running 10 minutes late and finished five minutes early, so I was attended to for 30 minutes.

The doctor took an X-ray where my teeth had been sore which he showed to me on the screen. He explained my problem was more one of receding gums rather than a particular tooth, but he was going to scrape two of my teeth for now, which he did. When I left 30 minutes later I was presented at reception with a bill for R1 862.37.

I couldn’t understand such an exorbitant charge and queried it with the receptionist, who confirmed he had just priced what the doctor had indicated he’d done. So I paid the
bill, thinking as a pensioner that’s rather expensive for a toothache!

My wife and I looked at the detail on the bill later and could not make much sense of it, so she went back the next morning to
dental reception where she was referred to the financial manager Imran Ebrahims who was able to enlighten her.

We had had no problem with the charges for the oral examination, infection control, sterilisation, and local anaesthetic.

What we didn’t understand was a charge for prophylaxis (scaling and polishing) – complete of R425.54, when the doctor only scraped two individual teeth and certainly didn’t polish them. But what came next was even more bewildering as I was charged with something I’d never seen before on a dentist’s bill, a “modifier” 100% charge for another R425.54.

Then the same thing happened with theX-ray. It was charged at R164.44 and then it also had a “modifier” of 100% added for another R164.44

The financial manager explained to my wife that the doctor may put any percentage he likes up to 100% on these modifiers and he had chosen the full 100%. I later talked to the manager by phone and explained that I didn’t have “prophylaxis – complete” and that Dr Mackenzie has only scaled two teeth, so how could I be charged with a completepProphylaxis?

He said he would speak with the doctor and get back to me, which he duly did. However Dr Mackenzie was adamant, once he had scaled one tooth, he had to charge the full prophylaxis-complete charge of R425.54, which he then doubled with his discretionary modifier. So there would be no reduction to my bill.

I find this practice totally discriminatory and ethically questionable and am seriously disappointed that Medicross of all people should allow an individual dentist to manipulate their charges, effectively giving him a licence to print money.

I would be interested to know if any other readers have come across the concept of dentists applying modifiers to set charges.

Dr Oelie van Schalkwyk, dental director of Netcare primary care division (Medicross is a fully-owned subsidiary of Netcare), responds:

On behalf of the management of Medicross Tokai, we wish to convey our most sincere apologies to Mr Dunwoody for his experience.

Medicross views the concerns regarding possible inappropriate and unethical billing, as raised in Mr Dunwoody’s letter, in an extremely serious light. We would like to assure our patients that the management of Medicross regards ethical and appropriate billing at all times as of the utmost importance. I wish to specifically highlight that Medicross has zero tolerance towards any transgression of this kind and that we are committed to providing superior client service, exceptional patient care and ethical behaviour at all times. I have therefore personally been in contact with Mr Dunwoody to advise him that we will be conducting an analysis and review of the invoices referred to.

We have, furthermore, requested Mr Dunwoody’s permission to review the clinical notes of the dental procedures performed and have undertaken to revert to him regarding the outcome of our review.