I need a three crown bridge for my lower back teeth and am worried I’m being dealt some funny business by my dentist. First, he said the ceramic crowns, which my insurance covers, are not strong enough for the biting forces on back teeth so I need to have porcelain-fused-metal crowns. Though, he wants to add a 20% fee for the upgrade from the standard material. Here are my concerns:
1. Which is the better material?
2. Can he upcharge the insurance company like this on a PPO?
3. If I can’t afford it will that force me out of network?
4. If I have a bridge on the upper arch already, will it matter which material I use on the bottom arch?
I’m glad you wrote. It does sound like some funny business is going on here. Before I answer your questions, I want to mention for others reading who may not know a PPO is a type of dental insurance called a Preferred Provider Organization. With these, the in-network dentists contract what fees they will charge their patients with the insurance company.
Which material is better?
It’s likely the code for the insurance he’s referring to is procedure code D6740 – retainer crown porcelain/ceramic. While porcelain would not be strong enough for a dental bridge on back teeth, there are other ceramic options which are, such as zirconia. Has he offered you those?
As for the porcelain fused to metal, yes that is also strong enough, but it is not an “upgrade”. The high-strength ceramics would be considered a better, more expensive material than the metal-based crowns. These would also have codes on the fee schedule, such as D6750 (high metal), D6751 (base metal) and D6752 (noble metal). So he’s not being honest when he tells you this isn’t covered.
Can He Upcharge?
He can’t charge more for something than the insurance allows, but he can charge for something you are getting above what insurance covers. For instance, it used to be that insurance would only cover silver amalgam fillings, but (as you could imagine) many patients weren’t too comfortable having mercury in their mouth. As a result, they would pay a little extra to get the white composite fillings their insurance doesn’t cover.
Can He Require You to Upcharge?
Short answer. No. It seems to me that would be a direct violation of his contract with the insurance company.
Should the Material Match What is on the Upper Arch?
That would be ideal. Call the dentist who did that and find out what they used. You don’t want one to be a stronger material than the other because it could cause some grinding.
Let me ask you this. Do you trust this dentist to actually use the material you ask for? If he’s willing to be unethical at all, which it looks like he is, what is to prevent him from being more unethical?
You may be better served by getting a different dentist, if possible.
This blog is brought to you by Auburn, AL Dentist Dr. Raymond Potts.