Terrible dentist experience! How to fight the insurance?

[wonky mcsnaggletooth]

A month ago I found a new dentist who takes both my husband's and my dental insurance, so I could make a PROPHY CLEANING appointment and go with my husband to support him during his cleaning (he has bad dental phobia).
Well. It went so badly:

The dentist was the only one in the dirty office, running the whole show. No assistants, nothing.

The dentist was speaking in Urdu on her earphone thingy headset the whole time (i'm just a blonde white girl, so she probably didn't realize that I speak a little Urdu!) and carrying on a gossip conversation.

She made me hold my x-ray films in my mouth with my finger (is that weird?)

She didn't look at my teeth at all. She didn't do the perio pocket poke, didn't floss, didn't scrape around, didn't even open my mouth. Didn't look at my x-rays (I suspect they didn't turn out).

What she DID do was surprise me with a full mouth debridement. This is only done for really dirty teeth- how would she have even known if my teeth were dirty?! Plus, my ortho always comments on how clean my teeth are (I have an Ultreo ultrasonic brush, totally awesome!) so there was no need for her to give me this painful treatment. She didn't tell me beforehand, she didn't give any warning that it might hurt, she didn't even tell me what she was doing. I thought she was just really rough.

The bill came today, however, and what I thought was a free 6-month prophy turned into a $300 bill, and this is how I found out what a 'full mouth debridement' is and how insurance does not cover it.
I'm not even sure if that's supposed to be done on people with braces!

SO! Long story short, what do I say when I call the insurance company tomorrow to fight this bill? I'm sure the "She didn't tell me about the full mouth debridement and I would not have let her do it" excuse won't be accepted. I know others on this board have experience fighting insurance- what's the magic words?!

I am so upset, and what's worse, my husband's experience was the same- and now he will never return to the dentist.

[Miss Smiley]

First, I would call the office and ask why such a procedure had been necessary, take all my files and x-rays since I paid for them, and then never turn back. That's just what I would do.

[rsprouse]

I'm not sure if it is considered necessary to measure the perio pockets every time, depending on the general oral health and hygiene.

It all depends on the dentist's "Standard of care" and what was billed for. If s/he performed a new patient exam/comprehensive oral exam I would personally consider perio probing to be part of that. But it is not performed by all clinicians at every visit so there is a grey area there.

But with the general level of unprofessionalism evidenced in your account, I have to wonder ... did you check what was actually done against what a FMD treatment entails? I assume also your insurance was billed for these X-rays that were apparently never looked at (and that certainly you didn't get to see)?

Just because you didn't see the radiographs or did not see them viewed does not mean that it wasn't done. If you are concerned then I would get a copy of the radiographs to at least give you the piece of mind about the competence level of the dentist in question.

I'm with Miss Smiley - call the dentist's office and request that they release your complete records to you (they may legally make a "reasonable" charge for this) and move on. But if those records don't include the X-rays you were billed for, that would give you a great starting point for arguing with your insurance that you and they are being billed for services that were not rendered, and that might bolster the rest of your claim that the services you did receive were neither satisfactory, nor pre-disclosed and agreed to.

The insurance company doesn't care and they are not your ally. They are not American Express as you try to deal with a merchant that didn't provide proper service. The insurance company has a contract with you and the dentist to pay certain amounts under certain instances. You are responsible for all payment to the dentist and I assume you likely signed some paperwork indicating that at your visit. That being said, if you are unhappy with your treatment or care then you should bring it up with the dentist in question. There is nothing wrong with telling the insurance company your story or mentioning the radiograph portion so they can better keep an eye on this person in the future. But don't expect any sort of help from them because you will likely not get it.

You could also consider filing a complaint with both the local BBB and the Maryland State Board of Dental Examiners (there's a complaint form here.) and you should probably send a cc of that to your insurance provider too.

Personally I think you are wasting your time here. It is a lot of effort over $300'ish dollars. The state board is concerned about patient negligence and it will be hard to determine negligence in a case where only a gross debridement was performed. This may be one of those "Lessons learned in life" experiences. It sucks and I am sorry that colleague treated you like this. But unfortunately I have heard many stories like this and it irritates me. There are plenty of good dentists out there. May I suggest that you ask your friends and family members for a referral and give somebody good a try. If you were not billed for a prophy/COE then it will likely be covered by insurance right now if you go to a different office. Of course you should check with your insurance company on this. But for your own piece of mind you may want to consider another opinion and get back on the horse. That way you and your husband can continue taking care of your oral health.

If you cannot find a good local referral, then pm/im/e-mail me where you live and i'll see what I can do to help you find a competent Dentist that you can trust.

Good Luck,
Rory

[wonky mcsnaggletooth]

Thanks everyone.
For years I have been going to an amazing dentist in my area, but I decided to make a cleaning appointment with this new dentist to kill 2 birds with 1 stone since I would have to be going there to support my husband anyway. I'm glad I have this dentist to return to. He has chocolate flavored polishing compound!

I called the insurance company and they gave me the phone and address of their assigned complaint sleuth doctor. They agreed that something seemed pretty out of line and encouraged me to request removal of this dentist from the network. They did cover the x rays and this 'exam', so that was settled. They don't cover 'preventative' debridements, or something. This provider (delta dental of va) has been top notch so far. Even if I do have to pay, it's good knowing I had some recourse.

The bill did say "comp oral exam new/established patient" but I think a comp oral exam includes at least looking inside my craw before turning on the dental tools!


At least I can rest easy knowing our mouths are tartar-free thanks to the debridement.....