• We’re currently investigating an issue related to the forum theme and styling that is impacting page layout and visual formatting. The problem has been identified, and we are actively working on a resolution. There is no impact to user data or functionality, this is strictly a front-end display issue. We’ll post an update once the fix has been deployed. Thanks for your patience while we get this sorted.

Dentist/Insurance is trying to screw me...

H

homestarmy

Diamond Member
To make a long story short, I had a deep cavity that was not yet touching the root, and I was told by the dentist (not my normal dentist - she was out on maternity leave) that I needed a crown, as just filling it would leave it too fragile. So the crown was done, etc, and the insurance company did not pay - they only paid for the price of a filling.

So I have been through it on both ends. Insurance advised me to have the dentist send more info as to why they needed to do this. Two or more times they supposedly did it and the insurance company recieved nothing. Not until I got a third party involved (Health Advocate) did they actually successfully submit the information to the insurance company. By this point, a whole year has gone by. In that time, I had recieved what amounted to basically threats on my credit report if I did not pay at least part of it from the dentist's office. I made what their minimum payment was (the dental company) as to not ruin my credit.

Now the insurance has reviewed the record, and they say that really there was no reason why it was necessary for me to have the crown. So I'm back where I started, both parties are screwing me.

What is there to do at this point? I am likely going to go to the dentist, explain that I was given a service that was not needed, and that I will not pay for. I am over due for my checkup etc (because I have been wanting to get all of this resolved), and I will tell them they can take care of it and schedule me, or they can lose a customer (long time customer, homeowner within a mile of the place). I am also debating whether to take legal counsel. To my knowledge, performing unnecessary medical procedures is frowned upon (at least in what I have heard from doctors performing unnecessary surgeries to line their own pockets).

Thoughts? Help? Stories?

Thanks so much to anyone that can help. Pleast post!
 
Originally posted by: homestarmy
To make a long story short, I had a deep cavity that was not yet touching the root, and I was told by the dentist (not my normal dentist - she was out on maternity leave) that I needed a crown, as just filling it would leave it too fragile. So the crown was done, etc, and the insurance company did not pay - they only paid for the price of a filling.

So I have been through it on both ends. Insurance advised me to have the dentist send more info as to why they needed to do this. Two or more times they supposedly did it and the insurance company recieved nothing. Not until I got a third party involved (Health Advocate) did they actually successfully do that. By this point, a whole year has gone by, and I had recieved what amounted to basically threats on my credit report if I did not pay at least part of it. I made what their minimum payment was (the dental company).

Now the insurance has reviewed the record, and they say that really there was no reason why it was necessary for me to have the crown. So I'm back where I started, both parties are screwing me.

What is there to do at this point? I am likely going to go to the dentist, explain that I was given a service that was not needed, and that I will not pay for. I am over due for my checkup etc (because I have been wanting to get all of this resolved), and I will tell them they can take care of it and schedule me, or they can lose a customer (long time customer, homeowner within a mile of the place). I am also debating whether to take legal counsel. To my knowledge, performing unnecessary medical procedures is frowned upon (at least in what I have heard from doctors performing unnecessary surgeries to line their own pockets).

Thoughts? Help? Stories?

Thanks so much to anyone that can help. Pleast post!
Click to expand...
did you have a pre-authorization done? dental insurance companies require that you get prior approval before a costly procedure such as a crown.

 
Originally posted by: moshquerade

did you have a pre-authorization done? dental insurance companies require that you get prior approval before a costly procedure such as a crown.
Click to expand...

I assume that none was done. Should I go to my local dentist office and ask if a pre-authorization was done, and if not, why was it not done?. Is this considered protocol or something that they write off as a "courtesy" to their patients?
 
Originally posted by: mugs
Ask another dentist.
Click to expand...

That might be a good idea... so take my info to a prospective dentist letting them know that if they help me out that I will become their new customer?
 
Originally posted by: homestarmy
Originally posted by: mugs
Ask another dentist.
Click to expand...

That might be a good idea... so take my info to a prospective dentist letting them know that if they help me out that I will become their new customer?
Click to expand...

Just say you need a second opinion.

Unfortunately, you're liable for the cost of the procedure, necessary or not. If it goes to court the judge will ask why you didn't get a second opinion to begin with.
 
It all depends on your insurance. I had bits of teeth on a deep cavity break off the same tooth. The first time he repaired it, the second time he put a crown on it. Pre-authorization is just double checking that insurance will pay for a procedure before it is done. You agreed to pay for it if it wasn't covered. There was a reason for the crown, to prevent your weakened tooth from breaking.
 
Originally posted by: homestarmy
Originally posted by: mugs
Ask another dentist.
Click to expand...

That might be a good idea... so take my info to a prospective dentist letting them know that if they help me out that I will become their new customer?
Click to expand...

Sure, something like that. A second opinion could help you figure out who is trying to screw you, the dentist or the insurance company. Insurance companies hate paying for stuff, so if they can justify denying it they will.

FWIW I recently had two cavities in adjacent teeth. One was down to the root and I had to have a root canal and a crown. The other was nearly as deep (sounds like a similar situation to yours) but my dentist just put a filling in. If there was a chance of the tooth breaking I'm confident he would have let me know and given me the option of doing a crown (insurance wouldn't have been an issue in my case, I ran out of my $1500 of coverage already). That's not to say that your dentist was necessarily ripping you off, it could depend on which tooth it was and where the cavity was.
 
Originally posted by: xrax
It all depends on your insurance. I had bits of teeth on a deep cavity break off the same tooth. The first time he repaired it, the second time he put a crown on it. Pre-authorization is just double checking that insurance will pay for a procedure before it is done. You agreed to pay for it if it wasn't covered. There was a reason for the crown, to prevent your weakened tooth from breaking.
Click to expand...

That is likely what would have happened to me. The tooth was basically a hollow shell to my understanding - it was so long ago, I don't specifically remember it all.
 
Originally posted by: mugs
Originally posted by: homestarmy
Originally posted by: mugs
Ask another dentist.
Click to expand...

That might be a good idea... so take my info to a prospective dentist letting them know that if they help me out that I will become their new customer?
Click to expand...

Sure, something like that. A second opinion could help you figure out who is trying to screw you, the dentist or the insurance company. Insurance companies hate paying for stuff, so if they can justify denying it they will.

FWIW I recently had two cavities in adjacent teeth. One was down to the root and I had to have a root canal and a crown. The other was nearly as deep (sounds like a similar situation to yours) but my dentist just put a filling in. If there was a chance of the tooth breaking I'm confident he would have let me know and given me the option of doing a crown (insurance wouldn't have been an issue in my case, I ran out of my $1500 of coverage already). That's not to say that your dentist was necessarily ripping you off, it could depend on which tooth it was and where the cavity was.
Click to expand...

Should I and can I go to my current dentist and demand the x-rays to show to the other dentist?
 
Originally posted by: Citrix
just go to another dentist.

how much is your outstanding bill, $1,000?
Click to expand...

It's not $1000, its a few hundred or so, but that is kinda big money in my graduate student situation. Not to mention, this is complete bullshit and I'm not going to pay for something that I should not be responsible for!
 
you can have your new dentist request copies of your xrays from your old dentist. There is usually a fee involved. My dentist probably followed the correct protocol. He gave it a chance to break, Fixed it and the other side of the tooth broke, then put on the crown. In the end the dentist made more money by fixing the tooth the first time. I would continue to argue with the insurance company.
 
Will do. I think I will discuss it with the dentist calmly, advise them of the situation. Let them know that I will speak further with the insurance company. I will let them know that I am dissatisfied, but since they are a part of some corporate BS, they probably have no option to help keep me as a customer at the office.
 
Originally posted by: homestarmy
Originally posted by: moshquerade

did you have a pre-authorization done? dental insurance companies require that you get prior approval before a costly procedure such as a crown.
Click to expand...

I assume that none was done. Should I go to my local dentist office and ask if a pre-authorization was done, and if not, why was it not done?. Is this considered protocol or something that they write off as a "courtesy" to their patients?
Click to expand...
in our office we always have a "pre-estimate" sent in so that patients know what their insurance company will pay and what they are responsible for. it also serves as proof that the insurance company reviewers accepted the impending treatment.

i would ask them what their policy is on sending in pre-authorizations. if they did send one in for you you would have gotten a copy of the reply form the ins. co. sent them in the mail also.

sounds to me like they did no pre-estimate, and now the insurance company is copping out and saying they won't pay. the pre-authorization seals the deal on what they will pay.

 
Originally posted by: homestarmy
Originally posted by: mugs
Originally posted by: homestarmy
Originally posted by: mugs
Ask another dentist.
Click to expand...

That might be a good idea... so take my info to a prospective dentist letting them know that if they help me out that I will become their new customer?
Click to expand...

Sure, something like that. A second opinion could help you figure out who is trying to screw you, the dentist or the insurance company. Insurance companies hate paying for stuff, so if they can justify denying it they will.

FWIW I recently had two cavities in adjacent teeth. One was down to the root and I had to have a root canal and a crown. The other was nearly as deep (sounds like a similar situation to yours) but my dentist just put a filling in. If there was a chance of the tooth breaking I'm confident he would have let me know and given me the option of doing a crown (insurance wouldn't have been an issue in my case, I ran out of my $1500 of coverage already). That's not to say that your dentist was necessarily ripping you off, it could depend on which tooth it was and where the cavity was.
Click to expand...

Should I and can I go to my current dentist and demand the x-rays to show to the other dentist?
Click to expand...
yes. you've paid for the xrays. they are your property.
although this second opinion idea is probably not going to get you anywhere. if your tooth was like "a shell" it most likely needed a crown.

 
Originally posted by: moshquerade

in our office we always have a "pre-estimate" sent in so that patients know what their insurance company will pay and what they are responsible for. it also serves as proof that the insurance company reviewers accepted the impending treatment.

i would ask them what their policy is on sending in pre-authorizations. if they did send one in for you you would have gotten a copy of the reply form the ins. co. sent them in the mail also.

sounds to me like they did no pre-estimate, and now the insurance company is copping out and saying they won't pay. the pre-authorization seals the deal on what they will pay.
Click to expand...


They always have an estimate that they show me before I actually have the procedure done, showing how much the insurance will cost and how much I will as well. Of course that is no indication that they actually contacted the insurance company. I will ask them if they got a pre-authorization, and if not, ask why and if they are going to do it in the future, or if they want me to take my business elsewhere.
 
Originally posted by: homestarmy
Originally posted by: moshquerade

in our office we always have a "pre-estimate" sent in so that patients know what their insurance company will pay and what they are responsible for. it also serves as proof that the insurance company reviewers accepted the impending treatment.

i would ask them what their policy is on sending in pre-authorizations. if they did send one in for you you would have gotten a copy of the reply form the ins. co. sent them in the mail also.

sounds to me like they did no pre-estimate, and now the insurance company is copping out and saying they won't pay. the pre-authorization seals the deal on what they will pay.
Click to expand...


They always have an estimate that they show me before I actually have the procedure done, showing how much the insurance will cost and how much I will as well. Of course that is no indication that they actually contacted the insurance company. I will ask them if they got a pre-authorization, and if not, ask why and if they are going to do it in the future, or if they want me to take my business elsewhere.
Click to expand...
PM me if you have anymore questions on this.

 
..I got a mouth full of crowns and bridges and never had any prob's wit insurance. even had crowns replaced and they paid. (never eat corn nuts)..your dentist has to act as your advocate and based on his professional experience you needed the crown. Talk to the doc and get this right.
 
Originally posted by: IGBT
..I got a mouth full of crowns and bridges and never had any prob's wit insurance. even had crowns replaced and they paid. (never eat corn nuts)..your dentist has to act as your advocate and based on his professional experience you needed the crown. Talk to the doc and get this right.
Click to expand...

I would think the dentist should be able to get this resolved.
 
Originally posted by: homestarmy
Should I and can I go to my current dentist and demand the x-rays to show to the other dentist?
Click to expand...

I would *ask* for the X-rays, not demand them. Explain that you want to get a second opinion to prove to your insurance company that you needed the crown. Proving that is your best case scenario, because as others have said you're probably responsible for the charges whether you needed the crown or not, so you want to get your insurance company to cover it. If it turns out it was not necessary you *may* have a case for malpractice (I am NOT a lawyer) but it would end up costing you more to get your money back than the crown cost to begin with.
 
You must log in or register to reply here.

TRENDING THREADS

Back
Top