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.
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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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