Bad teeth, bad credit

Pressured by some dentists, patients hit by inflated bills

Sacramento Bee photo illustration/Getty

Manuela Tobias is a journalist at The Fresno Bee. This article is part of The California Divide, a collaboration among newsrooms examining income inequity and economic survival in California, and is an abridged version of the full story, which is available at

Kenda Williams, 51, went to West Coast Dental in Torrance to treat the shooting pain in her molar. She spent the day in a drug-induced haze.

Williams later found out she had signed up for two credit cards that day to cover her dentist’s $9,055 bill. Unemployed and on Medi-Cal, the Los Angeles resident had no idea why her bill was so high, or why she had been approved for so much credit.

“I thought I was just getting a root canal,” Williams said. “They were giving me a bridge. I already had a denture that was brand new. They’re claiming I asked for a bridge and I did not. They knew I could not afford it because I was unemployed. All I went in for was a root canal.”

She does not recall signing up for the cards, and she said the signatures on the consent forms do not match her own. The dental office did not send in an authorization form to her insurance provider, a Medi-Cal managed care plan, documents show. The insurance company later reimbursed her for $1,070 worth of services, but she still owes about $6,000.

Across California, patients like Williams are wading into years of debt because of high-interest credit cards used to finance dental treatment. They have succumbed to requests by dentists to put their high-priced services on a controversial segment of the health-care industry: companies that offer loans for “out-of-pocket” medical care.

An investigation by The Fresno Bee for The California Divide, a statewide media project examining economic inequality, has found that some dentists appear to be inflating bills and pressuring patients to put their services on a credit card. These credit contracts, which can be easily arranged in the dentist’s office, often have deferred interest provisions, which means that if the patient does not pay in full within a certain time period, interest on the initial loan is charged, with rates ranging from 13% to 29%.

The Bee also found that some dentists charged for care in full before services were performed, leaving patients like Williams paying their bill without ever having their treatment completed. Legal aid organizations report that low-income Californians are particularly at risk of falling into debt traps with medical credit cards because of ongoing struggles with the state insurance system.

Medi-Cal doesn’t cover major dental care unless it is medically necessary, and a limited number of Medi-Cal and Medicare providers render the full range of covered services.

“We definitely see dentists refusing to run the [Medi-Cal authorization] request a lot,” said Eric Schattl, supervising attorney at the Neighborhood Legal Services of Los Angeles County. “So then they’re guiding people toward the card early on in the process, even if they know they are Medi-Cal recipients.”

West Coast Dental in Torrance declined to comment about Williams’ case. But advocates say the terms of medical credit cards are too complicated for most people to understand. They are particularly confusing in high-pressure situations, like the moments of excruciating pain leading up to important dental procedures.

“It’s a dentist pitching this product. Your relationship with the dentist is a very intimate relationship. You have to trust the dentist—they’re in your mouth,” Schattl said.

Millions of accounts

Nationwide, more than 6 million accounts are active with CareCredit, a product of Synchrony Bank. It is the most popular medical credit card on the market, according to the U.S. Government Accountability Office. The card can be used to finance anything from veterinary services to LASIK eye surgery. It is offered at 109,000 dental offices nationwide.

Of the thousands of consumers who filed complaints against Synchrony Bank nationwide in the last five years, 177 consumers, including 43 Californians, mentioned the word dentist or dental. There could be hundreds more, however, as most people opted not to publish their complaint narratives.

The Health Consumer Alliance, a statewide coalition of legal service offices, says it has reviewed and helped consumers on 28 dental credit card cases so far this year, and 55 cases in 2018. Central California Legal Services, based in Fresno, estimates they reviewed 24 cases since 2013.

Medical credit cards are not all that different from other credit cards on the market. But customers don’t need to go to a bank to take them out; health-care providers can fill out a client’s application and have it approved in seconds.

“The reason that they are popular is that they’re marketed in a way that oversimplifies in an almost misleading way what the person is obligated to,” said Gina Calabrese, a professor of legal clinical education at St. John’s University.

Beginning next July, a new state law will prohibit health-care providers from signing up patients for deferred interest credit products in their offices. The credit industry and dentists had worked to water down the bill; the original version would have prohibited providers from offering or promoting such products.

Lisa Lansperry, a spokeswoman for CareCredit, said an internal survey showed 94% of their customers were satisfied in 2018. She added that if a consumer has a complaint, the company takes it seriously.

The California Dental Association, which represents more than 27,000 dentists, endorses the cards because many people lack adequate insurance to cover the dental treatment they urgently need, according to spokeswoman Joie Harrison. CareCredit has 120 partnerships, more than 70 of which are paid, with industry groups, including the California Dental Association. Both CareCredit and the California Dental Association declined to disclose whether the dental association was paid for promoting credit cards to patients.

The appeal for dentists is clear. Minus merchant credit card fees, their immediate payment is guaranteed, and gone is the administrative burden.

“In a private office we don’t want to chase down payments,” said Mark Cave, the dental director of Fresno’s Clinica Sierra Vista, who also has a private practice in Visalia. “If we have to hound you for $25 we lose relationships over that with patients. You owe me $300 but you’re sending me $25, and I’ve got bills to pay, too, or we can go to CareCredit.”