Three crowns were done(14,19,31) using crown porcelain fused to high noble metal D2750 and core buildup D2950. For $150 each, the dentist suggested I upgrade to crowns with added porcelain, so there would be no black line on my gum line in the future. On his advice I agreed. When I got the insurance paperwork I noticed there was a charge on all 3 crowns for pulp cap direct D3110. Nothing was ever said to me about the pulp cap direct, so when I questioned it, his office insurance lady said that the insurance takes care of that, and whatever they don't take care of she will write that portion off at no cost to me. Two months after getting crown 31 it fell off. To my surprise it was a very very small partial crown. I questioned why I paid for an upgrade when there was no gum line involved, since it was such a small crown. The insurance lady told me the crown was all porcelain and the metal would have shown, if the upgrade hadn't been done. I also asked why there needed to be a build up and why it needed pulp cap direct. She told me he had to build up the tooth and the root was almost exposed which does not make sense to me. The dentist re cemented the crown and charged my insurance company, but did not charge me. I would appreciate your feedback on my issues. Thank you so much for your time.
Crowns
- Thread starter Susan M
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Zuri Barniv
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We are only getting one side of the story, which is never fair. But if your version is accurate, it sounds like your dentist is billing the insurance for services not rendered and then "writing off" your portion so you don't complain. I would contact your insurance company and let them know your concerns and consider finding a more ethical dentist.
I truly appreciate you responding to my post. Because of you writing, getting one side of the story is never fair, I emailed the office insurance lady exactly what I posted and added this:
The above statement has been reviewed by two dentists.
The first dentist gave us his opinion if the above is accurate, but he also wrote the following:
We are only getting one side of the story, which is never fair.
The second dentist also gave his opinion if the above is accurate and wrote us the following:
I'm an accredited cosmetic dentist who saw a lot of appearance-conscious patients, and I never did porcelain margins or anything like that for esthetic purposes on lower molars, and two of these teeth you reported to me were lower molars. One was a second molar. Even if there were a black line there, no one would ever see it.
Within 15 minutes the dentist called us on the phone. He explained to my wife and me that he did not say anything about the pulp cap directs because he only charges the insurance and not the patient. Just to make sure we understood my wife restated, "So you didn't say anything about the pulp direct because there would be no charge to us", and he said that was correct. Regarding the $150 upgrade he said he did EMAX crowns which are all porcelain without any metal. We told him my wife recently had EMAX crowns done by a different dentist, and that dentist charged the insurance company D2740 without any upgrade fee. He said there is no code for EMAX crowns. Several times in the conversation he mentioned all charges were legal. I asked him to respond in writing what he told us in this conversation and he said he would. Once again I would appreciate your remarks.Thank you for the time you are spending on this.
The above statement has been reviewed by two dentists.
The first dentist gave us his opinion if the above is accurate, but he also wrote the following:
We are only getting one side of the story, which is never fair.
The second dentist also gave his opinion if the above is accurate and wrote us the following:
I'm an accredited cosmetic dentist who saw a lot of appearance-conscious patients, and I never did porcelain margins or anything like that for esthetic purposes on lower molars, and two of these teeth you reported to me were lower molars. One was a second molar. Even if there were a black line there, no one would ever see it.
Within 15 minutes the dentist called us on the phone. He explained to my wife and me that he did not say anything about the pulp cap directs because he only charges the insurance and not the patient. Just to make sure we understood my wife restated, "So you didn't say anything about the pulp direct because there would be no charge to us", and he said that was correct. Regarding the $150 upgrade he said he did EMAX crowns which are all porcelain without any metal. We told him my wife recently had EMAX crowns done by a different dentist, and that dentist charged the insurance company D2740 without any upgrade fee. He said there is no code for EMAX crowns. Several times in the conversation he mentioned all charges were legal. I asked him to respond in writing what he told us in this conversation and he said he would. Once again I would appreciate your remarks.Thank you for the time you are spending on this.
Zuri Barniv
Verified Dentist
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So if I understand correctly, the dentist charged your insurance for a service he did not actually do (a pulp cap)? Did I get that right? He felt that since he only charged the insurance and not you, that would be ok. If true, that would be considered insurance fraud. Please check this site: http://www.insurancefraud.org/scam-alerts-dental.htm
As for D2740, that is an ADA Code for an all ceramic crown (including EMAX and Zirconium crowns), so there is nothing to "upgrade" to. It already is not supposed to have any metal in it. Some insurance policies do not cover this code and they will "downgrade" D2740 to a lower code such as an all-metal crown or similar. They will pay less for this and expect the dentist to accept that lower fee if the dentist is contracted with the insurance company. So some dentists anticipate that and bill the insurance for the "cheaper" crown they know they will pay for and then charge you more to "upgrade" it. There are too many variables here to discuss it all on this site, so there could be other issues at play that I'm not aware of.
As for D2740, that is an ADA Code for an all ceramic crown (including EMAX and Zirconium crowns), so there is nothing to "upgrade" to. It already is not supposed to have any metal in it. Some insurance policies do not cover this code and they will "downgrade" D2740 to a lower code such as an all-metal crown or similar. They will pay less for this and expect the dentist to accept that lower fee if the dentist is contracted with the insurance company. So some dentists anticipate that and bill the insurance for the "cheaper" crown they know they will pay for and then charge you more to "upgrade" it. There are too many variables here to discuss it all on this site, so there could be other issues at play that I'm not aware of.
Sorry I was not clear, but the dentist told me he did the three pulp caps, but when he did them he never informed me that he was doing them. He told me the reason he didn't inform me was because he said he would accept only what the insurance company paid, and I would not have to pay anything. I then explained to him that my secondary insurance had a $1300 calendar maximum and because I eventually went over the $1300, the $39 paid by the secondary insurance company for the first pulp cap actually took away from other covered procedures that I had to pay for. The other two pulp caps he charged my primary insurance company, but when he charged my secondary insurance it was declined because I had reached my $1300 maximum. The dentist did not charge me for the remaining balance on the other two pulp caps.
As far as the upgrade, which I questioned because it made no sense to me, he started talking about the upgraded crown being a better material. I really wasn't understanding his explanation, so that is when I asked him to respond to my email in writing about everything we had discussed. I am waiting for his written response.
Once again I cannot express to you how much I appreciate your time with this matter.
As far as the upgrade, which I questioned because it made no sense to me, he started talking about the upgraded crown being a better material. I really wasn't understanding his explanation, so that is when I asked him to respond to my email in writing about everything we had discussed. I am waiting for his written response.
Once again I cannot express to you how much I appreciate your time with this matter.
Zuri Barniv
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Susan, I can count the number of times I needed to do a pulp cap in the last 15 yrs on a patient on one hand. A cavity has to be extremely deep to get to that point and in most cases, the teeth are exquisitely sensitive afterwards. This is why many pulp caps ultimately end up as a root canal. The chance 3 teeth in a row needed pulp caps is so remote that I would really recommend you show the x-rays to another dentist for a second opinion. The dentist may be fluffing his bottom line by saying he did this procedure and didn't actually do it. I don't have the x-rays and all the details, so can't say for sure. But my Spidey-senses are tingling with this one. Be wary. I am also concerned he immediately said, "all charges were legal". Think about why someone would say something like that??
And always be cautious when any dentist does a bunch of unplanned procedures and then doesn't mention them to you even though there was theoretically a co-payment due. I also always caution folks to be extra careful when dentists waive co-pays in general. They are making their money in other ways, which may not be to your advantage.
Dr. Barniv
And always be cautious when any dentist does a bunch of unplanned procedures and then doesn't mention them to you even though there was theoretically a co-payment due. I also always caution folks to be extra careful when dentists waive co-pays in general. They are making their money in other ways, which may not be to your advantage.
Dr. Barniv
Just to clarify I, Susan, have been writing the messages for my husband with his assistance. Dr. Barniv, we also want you to know the following (crown 31 was replaced in September) was never mentioned to you, but it was included in the email we sent to the dentist's office.
The following was included in the first and only email we sent to the dentist's office insurance lady:
(her name), because of the first dentist telling us it is not fair to get only one side of the story, I am asking you to read over what we have written and explain to us if there is anything you do not feel is accurate. We realize we did not include the fact that crown 31 was replaced with no charge in September. We appreciate that this was done, but it was not included because we do not feel it was relevant to what had taken place before it was done.
Tonight I received the dentist's response to our email. He said he recommended emax crowns because of strength and esthetic qualities. He also stated he had to build up the teeth to ensure proper substructure for the crowns. He placed the liner in order to protect the pulp as it was very close to the defect. On #31 he said originally he did a conservative restoration as a partial crown to preserve as much tooth structure as possible. Unfortunately the partial crown didn't stay on due to its smaller surface area. He then converted it to a full coverage crown.
.
Nothing was mentioned in his email about not informing that the pulp caps were being done.
These are our questions. 1) If he did emax crowns should have he coded them as D2740 and not charged us an upgrade? We can't figure out why he coded them as porcelain fused high metal D2750, when according to him there was no metal. 2) If 31 was conservative, only covering the top of the tooth (when it fell out we saw how small it was), how could have the pulp been involved? 3) Is it customary for a dentist to do pulp caps without informing the patient? 4) Because of the pulp caps and crown build ups have according to the dentist already been done, is there any way of knowing if they were actually done?
We are totally aware that we know nothing about dentistry, so one more time we greatly appreciate your time.
The following was included in the first and only email we sent to the dentist's office insurance lady:
(her name), because of the first dentist telling us it is not fair to get only one side of the story, I am asking you to read over what we have written and explain to us if there is anything you do not feel is accurate. We realize we did not include the fact that crown 31 was replaced with no charge in September. We appreciate that this was done, but it was not included because we do not feel it was relevant to what had taken place before it was done.
Tonight I received the dentist's response to our email. He said he recommended emax crowns because of strength and esthetic qualities. He also stated he had to build up the teeth to ensure proper substructure for the crowns. He placed the liner in order to protect the pulp as it was very close to the defect. On #31 he said originally he did a conservative restoration as a partial crown to preserve as much tooth structure as possible. Unfortunately the partial crown didn't stay on due to its smaller surface area. He then converted it to a full coverage crown.
.
Nothing was mentioned in his email about not informing that the pulp caps were being done.
These are our questions. 1) If he did emax crowns should have he coded them as D2740 and not charged us an upgrade? We can't figure out why he coded them as porcelain fused high metal D2750, when according to him there was no metal. 2) If 31 was conservative, only covering the top of the tooth (when it fell out we saw how small it was), how could have the pulp been involved? 3) Is it customary for a dentist to do pulp caps without informing the patient? 4) Because of the pulp caps and crown build ups have according to the dentist already been done, is there any way of knowing if they were actually done?
We are totally aware that we know nothing about dentistry, so one more time we greatly appreciate your time.
Zuri Barniv
Verified Dentist
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1. I recommend you double check with your insurance to answer this questions, because I am no insurance expert. But my initial response is "yes", if he did an E-Max crown, he should have coded it D2740, not a PFM + upgrade.
2. It is unlikely the pulp was involved as you point out. As I said, when a pulp cap is done, the patient usually "knows it" as the tooth can be extremely sensitive for a while and there is a decent statistical chance it will subsequently need a root canal. Also, this is called an "inlay" which is coded differently and is less expensive.
3. No - a dentist should ALWAYS tell you about every procedure he is performing on you. Just because it is "needed" or not charged to you is not an excuse. You have an absolute right to know what is happening to your body.
4. Possibly. The easy way is to take an x-ray of what you have now. Since it is an E-Max crown, the x-rays penetrate the material and you can more-or-less see how deep the underlying material is. It is not perfect, but gives you some idea.
My questions to you are: Are you planning to stay with this dentist once this gets sorted out? Are you planning to find a new dentist regardless of the outcome? Your inquires, discussions, phone calls, etc. will take a lot of your precious time and energy to sort out. In the end your teeth will be unchanged. So think about what you want to accomplish before going into battle.
"We are totally aware that we know nothing about dentistry, so one more time we greatly appreciate your time."
My pleasure, and you are not expected to know anything about dentistry. This is why it is important to have mutual trust with your dentist, doctor or whomever takes care of you and your family.
2. It is unlikely the pulp was involved as you point out. As I said, when a pulp cap is done, the patient usually "knows it" as the tooth can be extremely sensitive for a while and there is a decent statistical chance it will subsequently need a root canal. Also, this is called an "inlay" which is coded differently and is less expensive.
3. No - a dentist should ALWAYS tell you about every procedure he is performing on you. Just because it is "needed" or not charged to you is not an excuse. You have an absolute right to know what is happening to your body.
4. Possibly. The easy way is to take an x-ray of what you have now. Since it is an E-Max crown, the x-rays penetrate the material and you can more-or-less see how deep the underlying material is. It is not perfect, but gives you some idea.
My questions to you are: Are you planning to stay with this dentist once this gets sorted out? Are you planning to find a new dentist regardless of the outcome? Your inquires, discussions, phone calls, etc. will take a lot of your precious time and energy to sort out. In the end your teeth will be unchanged. So think about what you want to accomplish before going into battle.
"We are totally aware that we know nothing about dentistry, so one more time we greatly appreciate your time."
My pleasure, and you are not expected to know anything about dentistry. This is why it is important to have mutual trust with your dentist, doctor or whomever takes care of you and your family.
Dr. Barniv,
I have contacted both insurance companies regarding the D2750 vs D2740 coding. If they determine we should not have been charged the $150 upgrade, our goal is to recover that money.
The reasons we chose this dentist was because his ratings on yelp were EXCELLENT. Also he was a graduate from a private highly prestigious dental school in southern California, where he served as a clinical instructor. I will not mention the school's name. He is currently serving as an Assistant Professor at a different college of dental medicine.
Last year I also had a crown done by this dentist. I was charged the $150 upgrade, plus a core build up. In addition I had a composite filling and was charged $10 for a composite sealant. Fortunately I was NOT charged for a pulp cap direct. When my husband's #31 crown fell off it really scared me, because I was going to have this dentist put crowns on my worn and chipped front teeth. At that point I changed to another dentist who was highly recommended by several friends.
Over 30 years ago my dentist (retired) accidentally filled my wrong tooth because the xrays were reversed by his dental assistant. He called me immediately to inform me and took full responsibility. Being human I know we all make mistakes, and I admired his honesty so he remained my dentist until his retirement. I am telling you this because we are not the type of people that are out to harm anyone. But this whole situation is beyond our comprehension. We truly hope and pray that everything the dentist in question has done was legitimate. We are extremely disturbed by the fact that he did not inform my husband of the three pulp caps. We are beginning to question everything. At this point we wonder if anything he did was actually necessary. Probably our main question now is this. Is anything he did or did not do going to be harmful to our teeth in the future?
Lastly, my husband is not going back to him. And of course, as always, thank you so much for your time.
Susan
I have contacted both insurance companies regarding the D2750 vs D2740 coding. If they determine we should not have been charged the $150 upgrade, our goal is to recover that money.
The reasons we chose this dentist was because his ratings on yelp were EXCELLENT. Also he was a graduate from a private highly prestigious dental school in southern California, where he served as a clinical instructor. I will not mention the school's name. He is currently serving as an Assistant Professor at a different college of dental medicine.
Last year I also had a crown done by this dentist. I was charged the $150 upgrade, plus a core build up. In addition I had a composite filling and was charged $10 for a composite sealant. Fortunately I was NOT charged for a pulp cap direct. When my husband's #31 crown fell off it really scared me, because I was going to have this dentist put crowns on my worn and chipped front teeth. At that point I changed to another dentist who was highly recommended by several friends.
Over 30 years ago my dentist (retired) accidentally filled my wrong tooth because the xrays were reversed by his dental assistant. He called me immediately to inform me and took full responsibility. Being human I know we all make mistakes, and I admired his honesty so he remained my dentist until his retirement. I am telling you this because we are not the type of people that are out to harm anyone. But this whole situation is beyond our comprehension. We truly hope and pray that everything the dentist in question has done was legitimate. We are extremely disturbed by the fact that he did not inform my husband of the three pulp caps. We are beginning to question everything. At this point we wonder if anything he did was actually necessary. Probably our main question now is this. Is anything he did or did not do going to be harmful to our teeth in the future?
Lastly, my husband is not going back to him. And of course, as always, thank you so much for your time.
Susan
Zuri Barniv
Verified Dentist
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I cringe when I hear about "upgrades" as these are almost always designed to separate you from your money for very little in return. You seem like very reasonable people and I practically have an allergic reaction to dentists that betray the public's trust like this. It's what inspires me to write my blog and participate in these types of forums. It also goes to show you that Yelp is just one source to consider among several.
It sounds like you are doing what needs to be done. Let me know if you need any more advice.
Dr. Barniv
It sounds like you are doing what needs to be done. Let me know if you need any more advice.
Dr. Barniv
Dr. Barniv,
Here we go again.
After finally speaking with the dental office the primary insurance called and explained she was told that D2750 crown is made from pieces of layered porcelain and E.Max, which has no dental code, is one piece of porcelain and it's not layered, so that was the reason for the $150 upgrade.
I then spoke to the secondary insurance and I said we were trying to get back the $150 upgrades on all 4 crowns and wanted her to find out why it was coded D2750 not D2740. She told me that the insurance companies CANNOT tell the dental office how to bill. When she spoke to the dental office she was told that the dental office had signed documentation, (yes we both signed the documentation for PFM crowns) which was a legal contract between us and the dentist for the upgrades.The CIGNA insurance lady told me she would file a financial complaint if we wanted.
Once again I spoke to the dentist's insurance lady and said yes we did sign the documentation saying we would be getting PFM crowns. I told her I did not think,in a court of law, it is a valid contract because we did not get PFM crowns. She then wanted to know if we could meet halfway with a $75 refund on each crown. At that point I became so upset I could not even talk.
Within an hour we received a call from the dentist asking what we wanted him to do. I immediately said to refund the upgrade charges. He informed me he was using the D2750 code to minimize what we had to pay out of pocket. Again he said there is no code for E.Max. I informed him if he had coded it D2740 we would have paid $2 more. He said that he used the D2750 code to minimize our out of pocket expenses of $2. He then said he would change the code on the 4 crowns to D2740 and would refund the $600, if we put in writing this would be the end of the issues on everything.
We then told him we could not believe how he never informed my husband of the 3 pulp caps. He said there are a lot of things a dentist does not tell his patients. He then said he would refund the secondary insurance company the $39 paid on the pulp cap because that was taken away from our $1300 benefit maximum.I made it clear to him that the $39 is not the issue here.
My husband is telling me just to give him a written statement and let it go. Like you wrote to me previously, "Your inquires, discussions, phone calls, etc. will take a lot of your precious time and energy to sort out. In the end your teeth will be unchanged. So think about what you want to accomplish before going into battle." You were SO right!! I feel this dentist is ripping people off left and right, but on the other hand, maybe I should just give him the written statement, get the refund, and let it go.
Once again I would appreciate your thoughts.
Thank you so much for your time.
Susan
Here we go again.
After finally speaking with the dental office the primary insurance called and explained she was told that D2750 crown is made from pieces of layered porcelain and E.Max, which has no dental code, is one piece of porcelain and it's not layered, so that was the reason for the $150 upgrade.
I then spoke to the secondary insurance and I said we were trying to get back the $150 upgrades on all 4 crowns and wanted her to find out why it was coded D2750 not D2740. She told me that the insurance companies CANNOT tell the dental office how to bill. When she spoke to the dental office she was told that the dental office had signed documentation, (yes we both signed the documentation for PFM crowns) which was a legal contract between us and the dentist for the upgrades.The CIGNA insurance lady told me she would file a financial complaint if we wanted.
Once again I spoke to the dentist's insurance lady and said yes we did sign the documentation saying we would be getting PFM crowns. I told her I did not think,in a court of law, it is a valid contract because we did not get PFM crowns. She then wanted to know if we could meet halfway with a $75 refund on each crown. At that point I became so upset I could not even talk.
Within an hour we received a call from the dentist asking what we wanted him to do. I immediately said to refund the upgrade charges. He informed me he was using the D2750 code to minimize what we had to pay out of pocket. Again he said there is no code for E.Max. I informed him if he had coded it D2740 we would have paid $2 more. He said that he used the D2750 code to minimize our out of pocket expenses of $2. He then said he would change the code on the 4 crowns to D2740 and would refund the $600, if we put in writing this would be the end of the issues on everything.
We then told him we could not believe how he never informed my husband of the 3 pulp caps. He said there are a lot of things a dentist does not tell his patients. He then said he would refund the secondary insurance company the $39 paid on the pulp cap because that was taken away from our $1300 benefit maximum.I made it clear to him that the $39 is not the issue here.
My husband is telling me just to give him a written statement and let it go. Like you wrote to me previously, "Your inquires, discussions, phone calls, etc. will take a lot of your precious time and energy to sort out. In the end your teeth will be unchanged. So think about what you want to accomplish before going into battle." You were SO right!! I feel this dentist is ripping people off left and right, but on the other hand, maybe I should just give him the written statement, get the refund, and let it go.
Once again I would appreciate your thoughts.
Thank you so much for your time.
Susan
Zuri Barniv
Verified Dentist
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I think you should write whatever he wants to get your refund and then move on. $600 is no chump change and you basically won, right? But unfortunately, there were still many 'losers' in the past and there will be many in the future who will not go through the effort you made. I am not a big fan of airing out your dirty laundry online, but the glowing online reviews are what attracted you to this dentist in the first place. Perhaps some online feedback on the same forums would be beneficial to others trying to avoid your situation in the future.
By the way, any dentist who says, "...there are a lot of things a dentist does [but does] not tell his patients." is probably not the kind of dentist you want to have working on you. I think you already figured that out though. There is NOTHING I do to any of my patients without their consent and knowledge and in most cases, it is in writing. That is your basic right as a patient, that is, to know what a doctor or dentist is doing to you.
By the way, any dentist who says, "...there are a lot of things a dentist does [but does] not tell his patients." is probably not the kind of dentist you want to have working on you. I think you already figured that out though. There is NOTHING I do to any of my patients without their consent and knowledge and in most cases, it is in writing. That is your basic right as a patient, that is, to know what a doctor or dentist is doing to you.