I do medical billing for a living so I'm familiar with the process of filing claims and how we are allowed to bill patients. However, with dental it seems much different and I am curious if my dentist's office is being shady or not. I have insurance and they paid my dentist for the following: 1.) 50% of my crown ---$356.00 2.) 50% of crown build-up---$73.00 3.)80% of root canal---$499.00 total of $ 928.00 My dentist charge me $350.00 for "canal preparation" and $210.00 for "post fibercore", but never filed either of these with my insurance. I called my insurance today and they said these are typically not covered because they are included in the price they pay the dentist for root canal procedure. They also told me to have my dentist file these claims with them because they shouldn't be billing me for something that my insurance company hasn't been made aware of. I called my dentist's office and they got very angry and defensive about not filing the claim and said they would do it, but that my insurance wouldn't cover the procedures. In the medical world, you cannot charge patients for something the insurance says is not covered or medically necessary. What are these two procedures for and are they really necessary outside of what my insurance has already paid? I have paid $1100.00 to the dentist, so overall he's made $2000.00 + for my root canal.
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First of all his fees are very reasonable. A post fibercore is a state of the art build up to strengthen the tooth and make a better base for the crown to fit on. My only question is what is meant by canal preparation. Insurance is a contract made between the patient and the insurance company. If they do not pay for a procedure that needs to be done, it becomes the patients responsibility to pay what the insurance does not. It is different than medical insurance when often the treatment is determined by the insurance company and not the doctor. $2000 for a root canal, post build up, and a crown. Good questions Clargy7
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