Jay Blakesberg/Getty Images
Dental schemes can put the bite on you
You want to be able to trust your dentist, for the same reason you want to trust your car mechanic: Most of us don’t have the expertise to evaluate the diagnosis.
While most dentists are ethical, it’s smart to remember that the degree on the wall isn’t a guarantee of honesty. Dental scams sink their teeth into unsuspecting patients every year, says James Quiggle, a spokesman for the Coalition Against Insurance Fraud.
“The most frequent dental scams are inflating claims, delivering worthless treatment that patients don’t need and billing insurers for phantom treatment that the dentist never delivered,” he says. “Added up, these cons can mean big dollars for a dentist’s bank account.”
If you don’t have dental coverage, the schemes can threaten your hard-earned savings.
The National Health Care Anti-Fraud Association estimates that Americans lose about $68 billion dollars each year to health care fraud — which can include these five dental scams.
Phony-baloney insurance billing
Less-than-honest dental practices may bill insurance providers for more expensive procedures than those actually performed — or fabricate charges entirely.
“From the patient’s perspective, these are things that can happen that they are not even aware of,” says dentist Dr. Katina Spadoni Morelli, dental director for dental benefits company Delta Dental of Illinois.
Inflated claims, known as “upcoding” in the insurance industry, involve charging for a more expensive procedure than the one actually performed.
For example, a simple extraction might be upcoded to a more complicated one. A routine cleaning may be embellished to a pricier deep cleaning.
“Check your explanation of benefits closely to make sure the bill reflects what procedures the dentist performed,” Quiggle says. “Did you really have X-rays or fillings replaced, or is that sneaky billing at work? Are the treatment dates accurate, and did you have as many procedures as the statement says?”
Submitting multiple claims
Another way some dentists might exaggerate a claim, Morelli says, is to break down a comprehensive procedure such as a root canal into its component parts and charge for each one, even though a single code could be used for the whole procedure.
Why should you, as a patient, care about insurance fraud? Isn’t that your insurance company’s responsibility?
“Larding your policy with unfounded billings can increase your premiums, and in extreme cases, max out your policy limits,” says Quiggle, of the Coalition Against Insurance Fraud. “This means the patient may be on the hook for excess billings.”
Patients need to be proactive, dentist Morelli says.
“Ask your dentist to pre-estimate the cost of treatments before any work is done,” she says, “because different dental plans may cover things differently.”
You also might want to ask for a treatment plan outlining exactly what procedures are needed and have the dentist review it with you.
Questionable filling extractions
Some dental procedures are unsupported by scientific evidence and should be avoided, says Dr. Stephen Barrett, an M.D. and founder of Dental Watch, an online watchdog service.
“In the quackery line,” he says, “the clear winner is the removal of amalgam” — the mixture of liquid mercury and an alloy of silver, tin and copper that constitutes traditional “silver” fillings.
The Food and Drug Administration considers amalgam fillings safe, so there’s no need to have them ripped out. The FDA says clinical studies have found no link between the fillings and health problems in adults and children over the age of 6.
There is, however, potential risk from removing dental amalgam, Barrett says.
“When they drill the amalgam out, they also take out some of the healthy tooth around it,” he says, adding that if the tooth is not thick, the removal process can crack it.
Other bogus procedures
Other dental suggestions you might want to question, include balancing your bite with elaborate devices or putting crowns on healthy teeth. Unless you’re a model or an actor, you don’t need costly cosmetic work.
Be skeptical if a dentist recommends implants or bridgework where a simple removable appliance would do.
Patients should be particularly leery of any recommendations of extreme surgery.
“Dentists have cut open people’s mouths with useless and botched surgery that left the patients disfigured and in pain,” Quiggle says. “The treatment of children by some large dental chains has been callous and uncaring. Kids have walked into the office for teeth cleaning and left bloody, with a mouth full of steel teeth.”
The Coalition Against Insurance Fraud advises parents to ask to remain in the treatment room while a child is in the dental chair. That way, you can make sure your child is safe, the procedures are relatively pain-free and only the expected treatments are done.
You go to the dentist for routine services at an advertised price and, after a quick review, the dentist insists you need more costly work. You might easily feel you’re being bullied into something you don’t want or need.
Don’t shrug off your misgivings.
“Medical bullying can be a problem,” Quiggle says. “It’s subtle. Dentists use their authority as the doctor in the white coat to talk a patient into an expensive and possibly painful surgery. It’s so easy to just say ‘yes’ to the impressive white coat.”
If you’re uncomfortable with a diagnosis or recommendations for extensive and expensive work, it’s wise to seek a second opinion.
Keep accurate records of all appointments, and get all your paperwork in order before you undertake any kind of formal complaint.
“Dishonest dentists can doctor records or find an X-ray that will fit your condition,” Morelli says. “The more evidence you have that the dentist wasn’t cooperative, the better case you have.”