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