What to do ? Dental

[Moemg]

My Dentist retired in 2016 . I found another Dentist that I like and am happy with but I dislike the hygienist . I had two cleanings with her . Regular cleanings like I have been having for years but she billed my dental insurance for Full Mouth Debridement and then for post Periodontal maintenance .My insurance refused to pay since I have not had periodontal treatment in 17 years . I spoke to the office and they stood up for the hygienist and said next time I would be charged again for the post periodontal maintenance and have to pay the full amount . I have no problem paying for extra work but those cleanings were no different than a standard cleaning . I guess I have to search for another Dentist which is too bad because I like this one .

[IMATERP]

I really HATE change, but I agree, it's time to move on.

Maybe you can seek out recommendations from friends...

Michael

[MichaelB]

Quote:

Originally Posted by Moemg My Dentist retired in 2016 . I found another Dentist that I like and am happy with but I dislike the hygienist . I had two cleanings with her . Regular cleanings like I have been having for years but she billed my dental insurance for Full Mouth Debridement and then for post Periodontal maintenance .My insurance refused to pay since I have not had periodontal treatment in 17 years . I spoke to the office and they stood up for the hygienist and said next time I would be charged again for the post periodontal maintenance and have to pay the full amount . I have no problem paying for extra work but those cleanings were no different than a standard cleaning . I guess I have to search for another Dentist which is too bad because I like this one .

That's a bummer. It is difficult to find a good dentist.

[Meadbh]

I think you should speak with your dentist, who may not be aware that the hygienist is basically committing fraud. If the dentist is aware, and approves of this, then it's time to get a new dentist.

[Moemg]

Quote:

Originally Posted by Meadbh I think you should speak with your dentist, who may not be aware that the hygienist is basically committing fraud. If the dentist is aware, and approves of this, then it's time to get a new dentist.

I think the office is aware of this and condoning it .

[W2R]

Of course it is up to you, but I'd keep looking for a new dentist, if it was me. Maybe you can find a well qualified, skilled young dentist that you like, somewhere nearby, that doesn't permit his hygienist to do this sort of thing.

[Walt34]

Quote:

Originally Posted by Moemg I think the office is aware of this and condoning it .

I would definitely talk with the dentist to make sure he/she is aware of it. If so it is time to move on.

[Brat]

If you have a school nearby that has a Dental Hygienist program see what it takes to sign up as a patient. You may have a long wait but at least you are on their list until you find a practice you can trust.

[omni550]

Be a whistle-blower?

I realize you're a patient and not part of their staff.

Recently the paper here reported on a huge local urology practice that was routinely subjecting and billing patients for unneeded tests. (Compared to other urology practices, theirs were many factors of 10 higher). One of the staff women reported them. She was awarded a $1 million+ award, and several doctors in the practice were fined several millions of dollars.

omni

[H2ODude]

We really like our dentist and hope he hangs in there a while.

I don't quite understand your predicament as I understand how our dentist works. You sound like the hygienist is almost an independent contractor doing stuff as she sees fit. That isn't anything like how our dentist's office works. Admittedly for many years it's same ol same ol; DW gets 3 cleanings a year and I get two. Doc always comes in, pokes around and pronounces us good to go. It's just never appeared that the hygienist was in any position to determine what needed to be done or charged for. Does occasionally point out to doc some fracture that needs to be watched or such. We don't have insurance for whatever that matters.

[Sojourner]

Quote:

Originally Posted by Walt34 I would definitely talk with the dentist to make sure he/she is aware of it. If so it is time to move on.

+1

Your dentist is likely pretty oblivious to all the ins and outs of day-to-day billing and insurance, but I can bet he(?) would be very unhappy at the thought of losing you as a long-time patient over something like this. Whenever I have any sort of issue similar to this at my dentist's office, I always politely talk to the person at the desk and they end up escalating it to the dentist for final approval. And I always get a reasonable rate that I can live with. You should absolutely talk directly to the dentist about this.

[Texas Proud]

I am in the talk to the dentist first camp... if you like him you might as well try....

Also, is this the only hygienist? Where we go there are two dentists and 3 or 4 hygienists and a couple of people who help out the dentists on their work... all seem to be good, but I would bet if I had a problem with one they would assign me another....


Now, if dentist does nothing, then he is condoning it or even ordering it and it is time to move...

[socca]

Sounds like the periodontal disease scam is still alive & well in Sarasota. Quite a few years ago my Aetna insurance included dental, and Aspen Dental was in-network. The north Sarasota office refused to do a routine cleaning unless I also had a $600 treatment for periodontal disease. I went back to my previous dentist - no periodontal disease (and still none to date). It's a jungle out there. 😑

[EastWest Gal]

In 16 states dental hygienists can be independent contractors. Otherwise they work for the dentist. Check your bills-that may be one way to tell. The dentist is probably benefitting from the hygienist upcoding your cleanings, and is likely to be complicit in the practice. If the bill comes from the office, he is ultimately responsible and would be held legally liable for the fraud.

Talk to the dentist and see how he reacts. But in my opinion, I think you'll find he's in on the fraud. I've seen fraudulent practices in medicine as a patient or parent, and have successfully challenged ER up coding and over billing. Medical fraud is easy to commit, as patients don't understand what is ok to be billed, or how the billing system works, and everything is so expensive.Fraudulent dental billing practices don't surprise me one bit. You should be prepared to find another dentist. If you can't trust their billing and their care practices, you need to go elsewhere.

This article lists common signs of fraud. Your experience is #2 on the list.

http://www.dentaleconomics.com/artic...-of-fraud.html

You can contact your state insurance commissioner and report it, if you think that fraud is taking place.

[spncity]

Tried a Dental HMO this year. We're already irritated at what we're being told... Went in for initial exams, which are required before you can get anything else. That's pretty common.

The plan covers two cleanings a year. They say DH must have three crowns and a consult with a peridontist BEFORE they will book him for a cleaning.

Right after that we visited a former classmate in another state. He's a dentist so we got a second opinion. He says one tooth needs a new crown, existing crown needs porcelain added, and one tooth can be remedied with a filling.

Friend's assistant also pointed out that the dentist office (the one that accepts the HMO insurance) seems to be "double coding" the crowns to bump the cost by $400 each (listing both "porcelain crown" and "porcelain over metal crown" for the same teeth) in addition to the prep, buildup, etc.

Wonder how common this sort of thing is...

[euro]

Quote:

Originally Posted by Meadbh I think you should speak with your dentist, who may not be aware that the hygienist is basically committing fraud. If the dentist is aware, and approves of this, then it's time to get a new dentist.

+1 speak with the dentist first - you have nothing to lose.

[Moemg]

I think they counted on me being old and just accepting what they said . After the first cleaning I was just charged for a regular cleaning but they charged my insurance for a full mouth debridement . The second cleaning I was again billed for a regular cleaning but my insurance was billed for Post periodontal maintenance which they refused to pay since their was no previous Periodontal work done . I then checked my insurance that is when I found out the bogus charges .I do not think it is my Dentist but I think it is their office who are up billing .I really have lost faith in this office so even though I like the Dentist it is time to move on .

[Brat]

I live in Portland and have Kaiser Sr. Advantage with dental coverage. My dentist is the best and the assistants do a great job. Before signing up for this coverage my dentist (IMHO) had great skills but there wasn't an expensive procedure he didn't propose.

In Portland Kaiser Dental is a private practice. They employ their own staff, sent me out only for a complicated root canal.

[nwsteve]

Quote:

Originally Posted by Moemg I think they counted on me being old and just accepting what they said . After the first cleaning I was just charged for a regular cleaning but they charged my insurance for a full mouth debridement . The second cleaning I was again billed for a regular cleaning but my insurance was billed for Post periodontal maintenance which they refused to pay since their was no previous Periodontal work done . I then checked my insurance that is when I found out the bogus charges .I do not think it is my Dentist but I think it is their office who are up billing .I really have lost faith in this office so even though I like the Dentist it is time to move on .

It sounds like you have settled on a path which I agree with btw. If you want to want to confirm where the issue is, you might consider using the insurance as the "bad guy" and take their information to your dentist and ask him why you are being billed for perio treatment when he has never mentioned it in his exams. His response should be telling.
Nwsteve

[kcowan]

I have had a discussion with my dentist about what my insurance covers. He does not bill for anything not covered. And he knows everything that gets billed by his hygienists.