How can I evaluate if my dentist reported the real treatments I received to my insurance company?

How can I evaluate if my dentist reported the real treatments I received to my insurance company?
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#1

After annual check my teeth, I was told there are around 8-10 cavities to fix. Each filling costs $140 and my insurance can cover 70% which I should pay $40 for each filling. After first treatment of 6 fillings, I was told to pay $240 which demonstrated the treatments I received were normal fillings. The second time treatment should take care of rest 4 cavities. However, after treatment, I was told by dentist that he did 10 fillings for my 4 teeth without informing me. The treatment list he filed to insurance company shows all 15 treatments were surface composite posterior/anterior which are higher cost than normal fillings for cavities. I don’t think he reported the real treatments he gave to me. How can I find dental professional to evaluate the type and number of treatments I received? Any dental board I can contact? How to ensure I pay the right treatments I really received?


#2

I’m very sorry that you are in this difficult and distressing situation.
Did your dentist prepare a treatment plan and review it with you before beginning this work? Were x-rays taken to support the treatment plan? Given the extent of the dental work performed, there is no doubt in my mind that you should have been given a treatment plan before any work was begun.
Based on your post, it sounds as though there has been miscommunication or misunderstanding between you and your dentist about the last four fillings for which your insurance was billed. It is understandable that you’ve concluded your dentist may have misrepresented to your insurance company, or upcoded, the work he performed. This is a serious allegation tantamount to insurance fraud in some states.
If you were given a treatment plan, then I suggest that you request a consultation with your dentist or a member of his staff to review the work that was done and the insurance claims that were submitted. If a treatment plan was not prepared, then request one retroactively and insist on having it explained to you to your satisfaction. Bring a friend with you so that you’ll have a second pair of eyes and ears to listen, take notes, and ask questions.
If you continue to have questions about this dentist’s communication, honesty, and billing practices, then it is time either to find a new dentist or seek a second opinion. Ask your friends, family, and/or coworkers if they are pleased with their dentist and, if so, find out what they appreciate about her or him. Outstanding communication, honesty, and air-tight billing practices should be at the top of your list of criteria for choosing a new dentist as well as impeccable clinical judgment and technical skills. Once you have the names of several dentists, choose one with whom to schedule an appointment and let the office staff know either that you already have a treatment plan from another dentist that you’d like to discuss or that you’ve already had work done that you’d like the new dentist to review.
Finally, most county dental societies will help consumers address concerns and complaints about their member dentists. Call your local dental society or visit its website to find out how to get help. If you believe you are a victim of dental insurance fraud, contact your state insurance commissioner for complete information on insurance fraud in your state. What is illegal in one state is not necessarily illegal in another.
Best of luck to you,
R. Ruth Linden, Ph.D., President, Tree of Life Health Advocates, San Francisco, CA


#3

You can have a medical bill advocate who also handles coding for dental to review your medical records to see what the provider actually did and double check the coding and compare it to your policy to make sure you did not pay more than you should have.
Find an advocate who works on a contingency basis. They normally charge anywhere from (25-35%) of what they save you and if they don’t save you money their services are free.
This will at least give you a piece of mind knowing you did not pay more than the services provided.
Best of luck to you!
Cheryl Welch, MBA
Hudson Valley Medical Bill Advocates


#4

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