Five Dental Insurance Scams You Need to Watch Out For

When you go to the doctor or the dentist, you do so with an air of trust for the person who went to school for this very specific purpose. It is in the dentist you put your trust, assuming that this person is going to do all possible to ensure your smile is beautiful and your oral health is where it needs to be. Aside from the fact that you should brush and floss, you know very little about dental work and what is required for good dental health. After all, you’re not a dentist. Unfortunately, not all dentists are as honest and upfront with their patients as is required by law, and that can be dangerous. What we are here to do is tell you that there are some dental scams that are circulating among dishonest dental professionals at the moment. It is unfortunate, but these scams are big; and they could cost you tremendously. Our goal is to bring awareness to you do so that you are aware of what is going on when you go to the dentist. You might not think some of these situations matter to you since they only affect your dental insurance agency, but that does have a huge effect on the premiums you pay.

Bullying

This is one of the simplest ways to get someone to pay more money than they should, but too many people are afraid to question it. Remember those stories of bullies in the school hallway that would take the money that other kids brought with them? This is essentially the same thing except this time it’s grown adults with medical degrees that are taking your money and making it possible for you to pay more than necessary. What happens here is this; your dentist tells you that you need some work done. You decide that it sounds awfully expensive and not quite that much like something necessary. Your dentist then begins putting pressure on you to get these procedures done, all but threatening you to do it as soon as possible. It’s called bullying. And it’s not always easy to tell when it’s happening since some procedures are real and dentists will become frustrated if you say no because this is your health in consideration. But if you feel a second opinion is needed, get one. It’s the best way to find out if it’s true or not.

Filling Extractions

This is something you might not know much about, and it’s something that you should be very careful about. The Food and Drug Administration has listed several different filling types as completely safe and this does not require that they are removed. However, an untrustworthy dentist might just make it a point to tell you that your fillings need to be removed for your own safety. This is not always true. You will want to familiarize yourself with fillings and what is considered grounds for removal versus what is not so that you know what you can and cannot do to get your oral health on track all while assuring that your dental insurance is not taking a hit.

Upcoding

Your dental office might participate in this scam, and it’s an expensive one. While you have no way of knowing that this could happen, you should do what you can to ensure that this is not happening to you. Dental offices that do not have a moral or ethic code might attempt to upcode, which is the act of billing your insurance company for procedures that you did not have done so that they can collect on them. It’s most common that a dental practice might try to bill your insurance company for an expensive deep cleaning when all they did was a very basic cleaning. Less common, but something that still happens, is when an office will invent expensive procedures that they didn’t even perform so that they can benefit from these thanks to your insurance company.

Multiple Claims

Another very common dental scam is one that most people are not capable of catching unless they work in a dental or insurance facility. This is something called submitting multiple claims. While your dentist might provide a very simple procedure, such as a root canal, that can be coded as one process, he or she might have that coded as something more. They might break down each individual component of the root canal and list them all. They don’t have to add any additional features, upcode or lie about anything they did. They’re simply doing this because these individual treatments are often more expensive submitted individually than they are submitted as a root canal – even though the amount of work is the same.

You might not think this matters to you since it’s an insurance thing, but the more your insurance company has to pay for fraudulent charges, the more they’re going to charge you for your premiums.

Unnecessary Work

This is a big one and it happens all the time to people who see the dentist. You might feel that you have dental insurance so the dentist is looking out for your best interests based on the fact that you can afford it, but it might not be the case. What might be the case, however, is that an untrustworthy dentist might actually be doing nothing more than just overcharging you for things you don’t actually need. The truth is, though, that it’s a lot easier for the dentist to perform work on your mouth that you don’t need done so that they can charge you for it than it is to put things on your insurance claim that are more easily proved false. It’s not always easy to know when your dentist is telling you that you need more work done than necessary. However, if you have a strong suspicion and want to have it checked out, you are always free to get a second opinion. In fact, this is something highly recommended in the medical field when one is looking at an expensive medical procedure.

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