![]() This leaves patients vulnerable to receive a treatment that may not be best for him or her, but is the most likely to be reimbursed by an insurance company. So before you walk in the room, a dentist has a list of everything he can bill for during your dental visit. The Way Dental Insurance Worksīefore a patient first comes to a dental office, a member of the office staff will contact their dental insurance company to find out what’s covered under the dental plan. This kind of example is one reason you should make sure you trust your dentist and s/he has a great reputation in the community. She has no idea that her records didn’t indicate such extreme treatment and that her insurance company would refuse to pay their portion of these costs. Unfortunately, because her dental insurance only covers 50% of the cost (after she’s met a deductible), so Lori is stuck with a large bill after her many procedures. Lori takes it for granted that her dentist has her best interests at heart, so she goes forward with the four root canals and three fillings she’s prescribed, as well as a scaling and root planing. She’s told she has signs of receding gums, gum disease, and several cavities that need filled. Lori’s insurance company recognizes this as a non-fraudulent transaction because the treatment lines up with the diagnosis, which was reached with specific data points (A1c and blood sugar levels). She is prescribed a blood sugar-lowering medication, a prescription she’ll have to fill once a month. Lori visits her primary care physician and finds out that her A1c and blood sugar levels indicate a diagnosis of diabetes. There is inherently more variation in treatment standards, and it’s more difficult to pin down a procedure as truly unnecessary. This is normal, and it’s to be expected.īut it means that the usual signs of insurance fraud-a practitioner prescribing more procedures than his or her colleagues-are more difficult to detect. One dentist will say one thing, one will say another. The decision as to whether you need a dental treatment is often in a gray area. The Subjective Nature of Dental Diagnosis There are certain aspects of dentistry that leave the profession more vulnerable to fraud than, say, the medical profession. The Coalition Against Insurance Fraud describes the problem as involving “a small but disturbing number of dentists.” Why Is Dentistry Vulnerable to Fraud? For one thing, building a successful practice takes years of hard work, and it’s exceedingly foolish to risk losing it.īut, like many industries, a potential for taking shortcuts for financial gain will attract a small but not insignificant number of people who feel they can take advantage of others. The vast majority of dentists are honest. This is my advice on how to find an honest and ethical dental practice that will be your partner in health for a lifetime. So, how do you differentiate between the two? ![]() The wrong dentist can wreak havoc on your mouth and do permanent damage with too much work you don’t need. The right dental health partner for you is the dentist who is wholly concerned with your overall health and not the health of her pocketbook. The dentist you have can make a huge impact on your life-positive or negative.Ī good dentist is your partner in health who works with you to optimize your well-being and prevent disease. It gave me a sick feeling in my stomach.įraudulent dentistry doesn’t go on in the majority of practices, but I still see it far too often. I had seen this plenty of times before, but this abuse of patient care was egregious. The dentist had sold his practice to another dentist, inflating the margins and inflating the value of the practice with procedures that people didn’t need. The case was an elderly mother against a dentist in practice for 20 years. I’ll never forget the long nights I spent poring over x-rays and charts in order to assist the lawyer paying me as an expert witness on a case of fraudulent dentistry. It’s one thing to figure out how to find a good dentist your family loves…And an entirely different question to make sure your dentist’s office isn’t going to commit fraud at the expense of your checkbook. Be choosy: Pick the Best Dentist for You.Be Skeptical of a New Dentist That Prescribes a Ton of Treatment.Stay Away from Practices That Advertise.Choose a Dentist Based on Referrals, Not Who Your Insurance Company Tells You to See.How Can I Protect Myself Against Dentistry Fraud? + −.Diagnosing a Lot of Procedures Not Covered By Insurance 4 Warning Signs of a Fraudulent Dentist + −.The Subjective Nature of Dental Diagnosis.Why Is Dentistry Vulnerable to Fraud? + −.
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