Dentist committed fraud?!?

Okay .. kind of a long story, but i had several crowns done at a local dentist. He told me they would be porcelain crowns, NOT porcelain fused to metal. He wanted to charge me the full fees, but part of my PPO dental insurance plan states that since he is a participating dentist, I only have to pay the fee schedule amounts. The dentist submitted the claim to insurance as a porcelain crown (and charged me the corresponding fee schedule amount). I have since discovered they actually put on porcelain fused to metal crowns (the line is already showing). Is this not insurance fraud? I'm very upset about this and considering legal action. Mind you, I have spent over $6,000 on these crowns.

Dentist committed fraud?!?
Your Dentist should have told you that you had the choice to chose from the type of crown (there are many).


The ussual are the Porcelain with a metal base.


But there are a full range of Crowns that are Metal free and more Esthetic.


It depends on the Technician that the Dentist use.


If he didn´t specifically told you that you had choices, he should replace them with the other (which are more expensive I might say).


If not, you might have a case!
Reply:I'm not sure about Fraud... but I wanted to say that I too have a crown that shows the metal lining. I'm not sure how protective these are in protecting the tooth underneath but as soon as all my other teeth are done, I am going to see about getting this one replaced. It is on the side on a back molar but when I smile big enough, you CAN see it. I feel for you. Hope it all works out.
Reply:This is not fraud, it's miscommunication. (a dentist will NOT lose his license for this--geez). Porcelain fused to metal crowns have been the norm for quite some time, it was that or gold. There have been a lot of advances in the last few years on all porcelain crowns. They do look better and DO cost a little more than PFM's but not a huge difference. The metal on PFM's usually doesn't show when they are first placed but birthdays and poor hygiene can cause the gums to recede and expose the metal. Just because the metal shows doesn't mean that it isn't protecting your tooth underneath. X-rays will show if it has good margins (edges) or decay underneath. I doubt they were trying to decieve you with what they submitted unless they submitted all porcelain and placed PFM. It's just a 4 digit code number. PFM'S have one and all porcelain has one. Make sure they submitted what was put on you. Most insurances that cover "major" dental work--which includes crowns--will pay 50% of the crown. Participating dentists adjust their fees according to their contract with the insurance company. The billing person at your dental office can explain your EOB (explanation of benefits) to you. The doctor can replace them but it doesn't have to be at his expense unless you have a written treatment plan that states they were to be all porcelain crowns and he or the lab made a mistake. Removing PFM's isn't the easiest thing to do either. I don't think you have much recourse legally but if you want to spend more money trying, it's your choice.





ASK QUESTIONS PEOPLE! Too many people just bumble along blindly. You have to take responsibilty for your own health care these days and be informed on what is being done to you. Whether it's your dentist, doctor, surgeon, pharmacist............ASK QUESTIONS!

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