How to Avoid Illegal Dental Billing Practices
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Hi there, welcome to my blog! In this post, I’m going to talk about:
- What illegal dental billing practices are
- How they can affect you and your dentist
- How to avoid them
Let’s get started!
What are illegal dental billing practices?
Illegal dental billing practices are unethical or fraudulent activities related to dental billing, coding, and insurance claims. They can involve:
Upcoding
This is when a dentist bills for a more expensive treatment than was actually done. For example, if you only got a routine cleaning but the dentist bills for a more complex and expensive treatment, such as a root canal, this is called upcoding.
Unbundling
This is when a dentist bills separately for specific services that should be billed together as part of a complete care plan. For example, if you got a crown and the dentist bills for the crown, the impression, the temporary crown, and the cementation separately, this is called unbundling.
Misrepresentation
This is when a dentist or a patient provides false or misleading information on the claim form. For example, if a dentist uses another dentist’s name or license number to bill for a service, or if a patient uses someone else’s insurance card or changes the date of service to get coverage, this is called misrepresentation.
Overbilling
This is when a dentist charges more than the agreed-upon fee or the usual and customary fee for a service. For example, if your insurance plan covers 80% of the cost of a filling and the dentist charges you $200 for it, but the usual and customary fee for that service is $100, this is called overbilling.
How can illegal dental billing practices affect you and your dentist?
Illegal dental billing practices can have serious consequences for both you and your dentist. They can:
- Cost you money
- Damage your oral health
- Hurt your relationship with your dentist
- Risk legal trouble
Let me explain each of these in more detail.
Cost you money
If your dentist engages in illegal dental billing practices, you may end up paying more out-of-pocket expenses than you should. You may also lose your insurance benefits or face higher premiums or deductibles in the future.
Damage your oral health
If your dentist engages in illegal dental billing practices, you may receive unnecessary or inappropriate treatments that can harm your oral health. You may also miss out on preventive care or timely interventions that can save your teeth and gums.
Hurt your relationship with your dentist
If your dentist engages in illegal dental billing practices, you may lose trust and confidence in them. You may also feel cheated or exploited by them. This can affect your communication and cooperation with your dentist and make you less likely to follow their advice or recommendations.
Risk legal trouble
If your dentist engages in illegal dental billing practices, they may face legal action from the insurance company, the state board of dentistry, or the federal government. They may be fined, suspended, revoked, or even imprisoned for fraud. They may also lose their reputation and credibility in the dental community.
How to avoid illegal dental billing practices?
The best way to avoid illegal dental billing practices is to be informed and vigilant about your dental insurance claims. Here are some tips on how to do that:
- Review your Explanation of Benefits (EOB)
- Ask questions
- Report fraud
Let me give you some more advice on each of these.
Review your Explanation of Benefits (EOB)
This is a document that shows what services were billed to your insurance company, how much they paid, and how much you owe. You should receive an EOB after every visit to your dentist. Check it carefully and compare it with your receipt or treatment plan. If you notice any discrepancies or errors, contact your dentist or your insurance company immediately.
Ask questions
Don’t be afraid to ask your dentist or their staff about any charges or codes that you don’t understand. Ask them to explain what services were performed, why they were necessary, and how they were billed. Ask them to show you the x-rays or other records that support their claims. If you are not satisfied with their answers, seek a second opinion from another dentist.
Report fraud
If you suspect that your dentist or their staff is engaging in illegal dental billing practices, report them to your insurance company, the state board of dentistry, or the federal government. You can find the contact information for these agencies online or in your EOB. You may be eligible for a reward if your report leads to a successful prosecution of fraud.
I hope this blog post has helped you understand what illegal dental billing practices are, how they can affect you and your dentist, and how to avoid them. Remember, you have the right to receive honest and quality dental care from your dentist. Don’t let illegal dental billing practices ruin your smile or your wallet!
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