I think our pediatric dentist is billing for things that weren’t done. My son started going to this new office about two months ago after our insurance changed. On the first visit, the dentist caught a couple of cavities she said needed to be filled. My son is usually great about brushing. He’s eight, was getting regular checkups at a different office before this one, and never had an issue. I was a little surprised that she found two but I didn’t question it all that much. After all, she’s the doctor.
Anyway, he went in and had those two fillings done and, just the other day, I got a notice from the insurance company. It seemed like the standard post-visit thing that breaks down pricing and what we were responsible for paying, but instead of saying he had a filling, it listed code D2930 and said something about a stainless-steel crown. At first, I thought I was mistaken, but I looked at the work and my son doesn’t have any metal showing in his mouth. So, then I called the office and they gave me a story about how sometimes the insurance company changes the code to allow for al alternative payment.
Does this sound right? If not how should I address it?
Thanks,
Trea
Dear Trea,
You’re correct. Something’s not right here. Either the person who helped you at the pediatric dental office was very confused or there’s something else going on in that office.
Dental Insurance Companies Are Known to Downgrade
Oftentimes, dental insurance companies will pay for the least expensive treatment that will solve the issue. For example, if the dental office had billed for tooth-colored fillings, it wouldn’t be unusual for the insurance company to only pay the price of amalgam (silver) fillings. Dentists rarely use amalgam nowadays because composite fillings allow for more of the natural tooth to be retained and don’t generally have the same kind of leakage and breakage we see with older silver fillings. But, insurance companies see them as an acceptable level of care, and so sometimes they’ll only cover the cost of those rather than white fillings.
When an insurance company downgrades, they make it quite clear that’s what they’re doing. They’ll list the procedure that was billed and note that they’re paying a downgraded fee.
Dental Insurance Companies Don’t Upgrade
What you don’t often see is the inverse—dental insurance companies offering to pay more than the rate the dentist is charging.
There isn’t Much of a Price Difference Between Resin Fillings and Stainless-Steel Crowns
The price for a composite (tooth-colored) filling depends on a few factors, such as whether it’s a front tooth or back tooth and how many surfaces are involved. Generally speaking, a two-surface posterior (back tooth) filling is going to be less than the price of a stainless-steel crown. At three surfaces, the fillings become more expensive. With that in mind, it seems like an odd scheme if an office is intentionally trying to gouge the insurance company. Especially because anyone can look inside your son’s mouth and easily identify if a metal crown is present.
Talk to Your Insurance Company About the Pediatric Dentist
Given how you describe the situation, it doesn’t sound like they’re intentionally up to no good, but they may not be billing accurately. Give your insurance company a call and let them know what your concerns are. They’ll be able to read the documentation sent and any codes submitted to determine what treatment the office is saying was performed. Since it sounds like they have a contract with your dentist, they’re likely to launch an investigation of their own if they have concerns about the validity of the claims being submitted. You may want to ask them to follow up with you to let you know the results. They don’t always do that without a formal request. Best of luck to you and yours.
This blog is sponsored by Dr. Raymond Bolt, a provider of pediatric dentistry services in Auburn, AL.