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Old 07-03-2002, 10:49 AM   #1
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hllmail HB User
Post Dental Insurance fraud?

I went to the dentist for a cleaning.The dentist took x-rays of my teeth and then sent a hygenist in to clean my teeth. When she was finished the dentist came in and spoke with me about some work i needed done and checked over my teeth.
When i went to check out they wanted to consult with me on the cost of the suggested work. It was then that they informed me that they did not do a routine cleaning, and instead had done a "scaling and rooting" procedure. So instead of my insurance paying 100% of a cleaning, they would only be paying for 80% of this procedure.
They then went over the cost of the work and asked if I would like to make an appt for these procedures. I declined saying I needed to recover from this procedure first.
Now i have recieved a notice from my insurance saying they will not pay for any of the "scaling and rooting" procedure, due to the fact that the dentist did not provide "pocket depth measurements", which is part of the supposed procedure, they performed.
I have spoken with the dentist and they are wanting me to come back in do that they can take these measurements and re-submit the claim.
I am extremely uneasy on doing that due to the fact that i do not feel the did this procedure and if they did, they did not notify me before doing a 400.00 procedure on me. Curious on what others think...Should I contact my insurance provider and see what they say or should I just visit the dentist to get the needed information and pay the 20% my insurance will not cover.
I do not want to be part of insurance fraud but i am worried that I will get stuck with a 400.00 bill!

 
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Old 07-05-2002, 07:36 AM   #2
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Hi hllmail, Here is my understanding of root depth measurements: The doctor will place a small tool into the space between your gums and teeth to see how many millimeters of gum tissue you have above the bone line on each tooth. More than so many millimeters (I'm not exactly sure of the exact #) will qualify as a "pocket" that justifies the special cleaning they refer to as root planing. That number should be the same as it was before they cleaned your teeth, so, I'm no lawyer, but it doesn't sound like fraud to go back in after the cleaning to provide the insurance with the measurements. If you're still concerned, call and ask your dentist if this is the situation. When you are sure it's okay, then you won't have to worry about them resubmitting your claim. -k.

 
Old 07-06-2002, 12:32 PM   #3
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SherryCasey HB User
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Hi HLLMAIL: I am no expert, but if you suspect that a procedure your insurance was billed for was not done, that is indeed fraud. I would suggest pressing the dental office for more information (maybe say you think you just had a cleaning as it seemed no different, etc.). The hygienist should have had the measurements before starting the procedure. Also, I would suggest looking for another dentist if this does not end satisfactorily. Something like this would surely erode my trust quickly.

 
Old 07-06-2002, 02:59 PM   #4
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Deb47 HB User
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Hi there. I think you've been taken. My husband had a deep cleaning done not long back, and he says they have to deaden up each area they work on...they use a tool to go in, deep under the gums line. My hubby says there is NO WAY they could have done this procedure, and you not know about it beforehand. Were you given novicane shots before they started the procedure? Did they use a tool and go under your gums? If your answer is no to these questions, and they never bothered to note the depth of your gum pockets, you can be sure you did not get a deep cleaning. Sometimes dental places will do this. I've had really light dental cleanings; hardly anything done, and they will bill my insurance full price for a cleaning...Call your dental provider ASAP. Tell them that you went in for a routine cleaning; and what exactly they did during this "deep cleaning"...tell them you were informed afterward, that you were given a deep cleaning. To me, that is fraudulant in itself. Why weren't you told what was happening BEFORE they started. how dare they just start doing this work on a person, without their knowledge?! If you weren't all numbed up for the procedure, and you don't remember them using a tool to go under your gums, then they are lying. Even IF this had been done, why weren't you told beforehand, so you could make the decision WHEN you wanted it done? Plus, usually they will take your gum measurements, THEN discuss the treatment plan...that's how it should be done...I bet if you made a complaint, this dentist's office will not charge you for this "deep cleaning". I would file a formal complaint before paying that bill, that's for sure. Be sure and change dentist's, also. The one you went to doesn't seem very honest to me at all. Let us know how it went...Deb47

 
Old 07-07-2002, 04:58 PM   #5
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hllmail HB User
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Thanks for the advice. The only things they did was take x-rays of my teeth and clean them. It took maybe an hourand half for my appt and most of that was waiting. Not really sure how they would take the "pocket depth" measurements but I am 100% sure they did not do this.
I am definately going to speak with the dentist and let them know that i plan on talking to my insurance company.
i will let everyone know what happened.

 
Old 07-07-2002, 05:52 PM   #6
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Deb47 HB User
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You are doing the right thing, Hllmail. From what you describe, they did not do that procedure on you. Checking for gum pockets, they go around your teeth, sticking a little probe thing into your gums. That shouldn't take long to do; but even IF they did get the pocket measurements, that doesn't mean you got your gums deep cleaned...and why, when they submitted the bill, didn't they include the pocket measurements when it was submitted? Your dentist will probably want to just forget about the bill, rather than have a patient make a complaint against him. I would not go back to this doctor though. Something isn't right about how he operates...Deb47

 
Old 07-16-2002, 01:05 PM   #7
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hllmail HB User
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well i finally reached the dentist...only one person was able to talk to me about it and they were on vacation last week.
i explained i did not think i recieved service billed and now are requesting for me to come in and speak to the dentist regarding this. I told her i would do this but that I was not doing any further procedures until this matter was settled.

 
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