After nearly two months at home because of the COVID-19 pandemic, Erica Schoenradt was making plans in May to see her dentist for a checkup.
Then she got a notice from Swish Dental that the cost of her next visit would include a new $20 "infection control fee" that likely would not be covered by her insurer.
"I was surprised and then annoyed," said Schoenradt, 28, of Austin, Texas. She thought it made no sense for her dentist to charge her for keeping the office clean because the practice should be doing that anyway. She canceled the appointment for now.
Swish Dental is one of a growing number of dental practices nationwide that in the past month have begun charging patients infection control fees of $10 to $20.
Swish and others say they need the extra money to cover the cost of masks, face shields, gowns and air purifiers to help keep their offices free of the coronavirus. The price of equipment has risen dramatically because of unprecedented demand from health care workers.
Dentists say they struggle to pay the extra costs, particularly after most states shut down dental offices in March and April for all but emergency care to reserve protective equipment for hospital use. They are also seeing fewer patients than before the pandemic because some fear going back to the dentist and, at the same time, dentists need to space out appointments to keep their waiting rooms uncrowded.
Nearly two-thirds of dental offices across the country have reopened for routine care, according to the American Dental Association.
The association, which sets industry standards, says dentists who opt to charge the extra infection control fee should disclose it to patients ahead of each visit, a spokesperson said.
"The infection control fee is helping us mitigate the costs of the extra expenses," said dentist Michael Scialabba, vice president of 42 North Dental, whose 75 dental offices in New England are charging an extra $10.
Why don't dentists just raise prices, instead? Dentists said they have little or no leverage to force large insurance companies to raise their reimbursement rates. The American Dental Association asked insurers to take into account the additional COVID-19 costs dentists face, and many insurers responded by agreeing to pay extra fees.
For example, United Concordia Dental of Harrisburg, Pennsylvania, agreed to pay dentists $10 per patient per visit in May and June to offset their protective equipment expenses for all fully insured clients. The company has more than 9 million members nationwide.
The new fee upsets some patients, although most understand that the cost of dentistry has increased, said Rishi Desai, director of operations and finance at Swish Dental, which has eight locations in the Austin area. "We are just as frustrated with all of these, too, but as a small business we had to reassess things."
Desai, whose wife, Viraj, a dentist, founded the dental chain, said the extra money will help the practice survive. "We are not making money off this," he said. "This is just to sustain us so we are not bleeding out cash."
He said that last year Swish was paying about $6 for a box of 20 masks. Today, $6 buys a single mask. The dental office has installed sneeze guards, staffers are wearing face shields over their masks, and the offices have added air filtration systems and hired additional sanitation staff members to clean the offices every day.
He estimates that the offices are working at only half capacity since they reopened in mid-May. In weighing how to handle the extra costs, Swish was reluctant to cut employees' wages, he said. "Everyone is trying to figure this out," he added.
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Kim Hartlage, office manager of Klein Dental Group in Louisville, Kentucky, said insurers recommended that the office add an infection control fee. The insurers balked at raising their reimbursement rates.
She said the small office has had to buy many more disposable masks and gloves. "We've had to step up our game," she said. So far, she hasn't heard any feedback on the $10 fee. "We have very understanding clients," she said.
Tamar Lasky, an epidemiologist, said she likes her dentist in Owings Mills, Maryland, and was glad that the office was communicating the many precautions it was taking to prevent the spread of COVID-19. But she said she was stunned when she was informed by email that a $15 "infection control charge" would be added to her bill.
"I can readily imagine there are a range of additional expenses, as well as a loss of revenue, associated with the pandemic, but infection control is not an extra service. It is part of the practice of dentistry," Lasky said.
"I'm not sure what is the best solution to the increased costs of tighter infection control, but this new charge may not be covered by insurance, and that passes all the burden to the patient."
CORRECTION (June 3, 2020, 9:33 a.m. ET): A previous version of this story mischaracterized the ADA’s involvement with the fees. The ADA did not give dentists the greenlight to charge fees, but left the decision up to individual practices.
Kaiser Health News (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.