UPDATE, 5/23.....Can I be on the hook for this dental situation?

RedCelicaGT said:   holy crap. 8 crowns.
I am a night grinder, therefore my teeth are short. I want a more natural look, thus the crowns to make my teeth longer.

I'm a night grinder too

Without an estimate approved by you, there isn't to much you can do to argue prices afterwards.

When the bills come you can demand itemized statements complete with cpt procedure codes and icd diagnostic codes. Since you say you are in network, he cannot bill you for more than the negotiated rate with the insurance company EVEN if ether insurance does not cover the payments.

Also, he can only bill for services rendered.

I suggest you find a dental forum dedicated to getting crowns and start reading up. They will help with proper protocol to protect yourself and maximize insurance benefits.

With dental treatment. You are liable for everything not covered by your insurance IF you had proceeded with the treatment prior to approval.
You dont have to go back, and argue that it was the doctor who made the decision to proceed with the treatment assuming it would be approved(leaving out the costly lab work until the approval comes in).

suezyque said:   The question remains though, can he me bill for services I never agreed to pay for out of my own pocket? He must have been certain they would pay, or he wouldn't have started the work. They most likely WILL pay, once they get the proper paperwork from his office. The situation is I don't want to go back there for a variety of reasons.

My guess is that you signed the form acknowledging that you accept primary financial responsibility. With that form, the only other agreement compelling the dentist to bill the insurance before he bills you is his agreement with the insurance (FYI with dental, it is usually an indemnity and not a true insurance plan). Look at what I posted above. You will not get too much hand holding here. You need to read up on your rights and learn them. I already posted some of the key topics to help you get started. I wouldn't worry about the dentist until he actually bills you, then demand the itemized statements. Once you know which procedures he is billing for along with the diagnostic codes, you can start to research even more to learn whether or not the procedure was performed AND whether or not the procedure was "medically" justified (hence the diagnostic codes).

If you don't like the dentist, move on. You will never be satisfied with the work from a dentist you are not happy with. Even if it is textbook perfect work, you will always find something "wrong" with it. So move on.

Like I suggested, find a forum dedicated to getting crown work done. There will be plenty of people from all kinds of backgrounds with experience obtaining the service you desire. They may not be able to tell you exactly what to do, but they will provide valuable insight into being happy with the work you are getting done on your mouth. Insight that you cannot get from a financial forum like FWF.

Consider this post pointing you in the right direction an early christmas present. Most non-financial threads in FWF get voted red pretty fast.

A couple other things to keep in mind, just because you are not happy with the outcome does not mean that a medical professional did not achieve the best possible outcome. Furthermore, there really isn't much you can do to know whether or not you obtained the best possible outcome since every situation is different. I said to move on because the best you can hope for is to trust your medical professional's judgement and believe them when they tell you that the outcome was as good as you were going to get (or in many cases, as good as you are going to get for the money you are willing to spend).

Good Luck

Gatzdon. This is definitely a financial matter. If I were to walk away from this situation, what is my financial obligation? I don't want this to affect my credit by it going to collections, nor do I want to have to pay for work I never completed. If I walk away from it now and have to pay for what's been done, then I will have to pay another dentist for the same work all over again. Dinging my credit isn't an option, but paying $800 for work that I'd have to get done again isn't a great option either. I can go ahead and have him resubmit and finish the partials, but I can't stand him and his office either. If I decide not to go back and he bills me for the work to date and I pay it, can I legally get my impressions, etc from him to take to another dentist to finish the work?

I'd make sure you do root canal on those before you get crown.

Why would you even want them working on your teeth.

suezyque said:   The question remains though, can he me bill for services I never agreed to pay for out of my own pocket?

The point is that you agreed to pay for them...maybe you didn't envision that being from your own pocket, you agreed to pay for them. It's not his fault your insurance sucks.

A few things come to mind as I read this.

First, if you don't like your dentist (or doctor or lawyer or any professional for that matter) in the first 90 seconds, you never will. Just walk away and find someone else.

Second, eight crowns from night grinding is very, very rare, and it's unusual that it would affect the front teeth (unless you have bite issues to begin with). If it truly is a grinding issue, you need a separate dentist who specializes in things like that and can make you a hard-acrylic splint and maybe even offer drastic treatment for grinding (e.g. Botox). I'm a severe night grinder too, one of the worst my dentists have seen, but I've never had a secondary dental problem from it. The key, though, is prevention--I wear a hard splint every night.

Third, you will be liable for everything the dentist has done, so just set aside the money you will owe and plan on paying it in full. They will bill you for everything. I had an idiot dentist chip a tooth during a nightguard fitting (I still can't figure out how he managed to do it, but he was clearly incompetent), and in the end I footed the bill for the repair in spite of my best efforts to get him to cover it. Fighting a dentist is always a fruitless endeavor. In my experience they tend to view their patients as dollar signs rather than people, so you won't get anywhere with them.

Good luck.

suezyque said:   I've been going to a dentist I can't stand, but he's in my insurance network. I need a bunch of dental work done. The treatment plan is to get both upper and lower partials and crown eight front upper teeth. The initial plan was to crown 2 teeth as an abutment for an upper partial. The insurance company approved one crown and the partial. The crown was done (temporary currently).

I decided to go all the way and crown all front upper 8 teeth, which changed the treatment plan to include a lower partial. They never got back to the insurance company and the window closed on the approval for the upper. My dentist had to re-submit but now for upper and lower partials. He went ahead and started the work for the partials by doing first and second impressions, bite registration, etc. Everything is done, except having the lab make them, which he would do once the approval came through. I will be paying for the crowns myself.

It's been 6 months of nothing but screw up after screw up by his office and today I get denials for both partials as the dentist failed to submit a mouth charting and full treatment plan. I've seen on my chart the bill so far is over $800.

This is the most incompetent place I have ever been to. They've gone through dozens of staff because the Dr. is an insufferable bast@rd. It would take me pages to describe all the crap I've been through with his office. I am sick of all of it and want to take my business elsewhere which brings me to this dilemma. He started work on the partials (without discussing it with me) in anticipation of the insurance company footing the bill. Not he nor anyone else there ever discussed money, prices or bills with me. I verbally agreed to pay $3500 for the 7 additional crowns ONLY. I never was given any sort of paperwork with estimates, etc. I haven't signed anything in regards to any work.

If I choose to never go back and have the work done elsewhere, can I be held liable for the work he did? If he bills me for the work, do I have any leg to stand on against paying it since I never agreed to pay anything for the partials? IMO he never should have taken it upon himself to start work on the partials without the insurance approvals in advance.

I will start by saying that I haven't read my dental insurance plan, just to get that out there.

However, with my medical plan, if I go to an in-network provider, it is the provider's responsibility to make sure that they get proper authorization from my insurance company. Is that not the case for dental coverage?

Sorry to hear you're having trouble with your dentist. A few years ago, I had a dentist bill my insurance for procedures they did not do. I had a feeling they were shady after my experience there, especially because even their receptionist was salivating over the fact that my plan was a dental PPO when she checked me in. I told my insurance, and they opened an investigation, which they didn't tell me the results of except to say that the billings were reversed and would not be counted against my lifetime maximum benefit. Most people would not have gone to the trouble of disputing it, but it can be a big problem if you have to get more dental care and the fraudulent transaction either a) pushes you over your yearly maximum, or b) pushes you over your lifetime maximum.

suezyque said:   If I decide not to go back and he bills me for the work to date and I pay it, can I legally get my impressions, etc from him to take to another dentist to finish the work?

I don't see why not. I would certainly ask for them instead of going to this fool.

arktc said:   suezyque said:   If I decide not to go back and he bills me for the work to date and I pay it, can I legally get my impressions, etc from him to take to another dentist to finish the work?

I don't see why not. I would certainly ask for them instead of going to this fool.

Yes, do ask, but keep in mind the impressions don't belong to you. If they want to send them elsewhere or give them to you, it is completely at their discretion. You can ask, but you don't have a "legal" right to them. Be nice when you do it and perhaps they will comply.

Keep in mind that some impressions have a very limited shelf life. My dentist throws away his after just one or two weeks, so time may be of the essence.

Grinding teeth at night using what power tool?

Update. I went to the dentist this past Friday for my cleaning appt. They took a PanX and while he and the hygienist were looking at it he was mumbling something about #8 and an endo. I know that means root canal. He just walked away and never bothered to talk to me. He just told her to write it down and that's what we'd do next.

I asked the hygienist what was going on and she told me there's an abscess at the apex of #8, (which is a front tooth) and it would have to have a root canal before doing a post/crown. I asked how can that be if I'm not even sick or in pain. She really didn't have an answer. Well I've had it. I'm done with the office and didn't make another appt. I'm seeing my old dentist next week who is 70 miles from here. It's worth the trip. I'm going to have him give me a second opinion and see where I go from here.

If and when I get a bill from this jerks office (after they realize I'm not coming back) I will deal with it at that time and be sure to have them give me all the billing codes/etc. Eventually I will them get them to set me up on a payment plan and squeeze it out as long as possible instead of paying it all at once.

The billing person did come in and advised me that they heard from the insurance and the company is requesting more xrays. That's a LIE. The letter I got said they never sent in any xrays or mouth charting. She said they would resubmit. I have mind to write a lengthy letter to the insurance co. and let them know what's going on with that office. I'm especially sure they would love to hear about the time he was working on doing my impressions without gloves and his right hand smelled of p@ssy. Sick.

suezyque said:   Update. I went to the dentist this past Friday for my cleaning appt. They took a PanX and while he and the hygienist were looking at it he was mumbling something about #8 and an endo. I know that means root canal. He just walked away and never bothered to talk to me. He just told her to write it down and that's what we'd do next.

Wait, why did you go back in the first place? If they are as sleazy as you say, they will most likely not part with the X-rays and impressions, which means you will have to have everything done all over again. That's additional radiation exposure, expense and time. If you need to have another panoramic done, I would be most worried about the radiation: dental x-rays, even bitewings, aren't as safe as we used to think.

You could have said, I am only here for a cleaning. I do not want any x-rays, nor a clinical. BTW, $500 per crown is very inexpensive for a private practice. A dental school by me, which charges on a sliding scale, charges $680 minimum and their crowns come out like tree Stumps
w/no definition. But, if his crowns are bad, then they aren't worth $50.

You had me at night grinding.

This sucks. There's nothing like feeling vulnerable and at the whims of an incomptent health care provider. Only thing I'd note is that I had success with my dentist crossing out the language that said I'm on the hook for anything that insurance doesn't cover. I made it clear to her that I only want work done covered by insurance. She's an *okay* dentist but exhibits none of the creepy signals you indicate your dentist does.

Go to the dentist you trust and get the work done ASAP. FWF will help you deal with the financial consequences after, but your oral health should be top priority (no pun intended).

I was trying to say that to a point, you are in charge of what dental work the dds does and doesn't do. You knew you were going in to see the hygienist and yet you allowed them to take a panorex.

suezyque said:   I'd already had the appt made from 6 months ago and had forgotten about it until they called the day before. It was too late to cancel without having to pay a no show fee. I knew I was only going to see the hygienist. The doctor ended up coming in and well you know the rest of the story.

My previous dentist is very old school and doesn't do all the X-rays and crap that modern dentists do. I'm sure he'll do a PA to check what the other dentist claims is an abscess. I don't care anymore about the costs of having to go to someone else. My teeth are worth more than the lousy care I was receiving.

Perhaps the 'old-school' nature of your previous dentist, and failing to use any modern dentistry, is why you are in this situation to begin with. It takes a lot of grinding, over a long period of time, to get to the point you are at now. You NEED a night guard. Orthodontic treatment is also likely necessary for the prevention of long term problems.

I can't believe you would ever go back to someone with a smelly hand. That is just gross. I would seriously suggest that you find someone who uses more modern techniques unlike your old dentist (so you don't get into this situation) and someone who is professional unlike your current dentist.

Also, just because you don't have pain or are sick does not mean you don't have an abscess. You seriously need to get that looked at- my grandfather was hesitant to go into a dentist to get an abscess in his mouth treated, and he ended up dying as a result because the infection spread to the rest of his body. While I am sure that had to do partly with his age, it shows that you should at least go to someone competent to rule it out so it can't get worse if there is something there.

I know dentists can be expensive and can overcharge, but you need to find a good one because even though you like your old one, it appears that he failed to help you prevent serious problems that were preventable. You only have one set of adult teeth and not treating them well costs more (not only in money, but in time and pain) in the long run. Grinding causes the permanent loss of enamel (which dentists currently don't have a good solution for besides veneers), and a bad bite just aggravates those problems.

I would suggest doing some serious research on YELP, Google reviews, etc. and finding a new dentist from there. Someone who does Xrays and knows about 21st century dentistry, and also knows how to bill insurance. TODAY.

Update. I went for my second opinion this week. I had him do another X-ray to confirm or deny that there is an abscess at tooth 8. There ISN'T. There is something brewing in the jaw above tooth 10. So, if I hadn't gone for this second opinion I would have ended up with an unnecessary root canal and then at some point had to do another one when the true abscess gave away. All the while thinking that the second one was a new problem rather than a pre-existing one. Im writing a detailed letter to the insurance company, and the state dental board regarding the poor treatment I've received at the hands of this dentist and his office.