After a way to long process of having a tooth removed, bone graft, rod implanted, abutment placed, my periodontist finished the whole thing up by adding a crown yesterday. I paid my $600+ co-pay and went on my merry way. Later, in the afternoon, I got a call from the dentist’s office, saying that they had forgotten to do an x-ray.
“Why do you need to do an x-ray?”, I asked naively.
They responded that the insurer requires this for proof of service performed. I find this odd, since there’s already a ton of paperwork and proof of service around this whole process, which has taken between 2-3 years to complete. All they did yesterday was glue on the crown. It’s external. You could take a picture of the inside of my mouth with an iPhone and show that there’s a pseudo-tooth there now where there was one before.
I’m not wild about getting any more x-rays done than absolutely necessary. The person from the office told me that their x-rays are really quite harmless, less than I’d get from going outside in the sun, but then she declined my offer to sit in my lap and hold my hand while the x-ray is taken.
I guess, technically, there’s not much that they can do now that I’m gone, although I suppose that they could try to charge me for whatever that they can’t recover from my insurer. The dentist is a nice old guy, don’t want to screw with him financially, but I also don’t really want to get an x-ray to keep an insurance company happy.
Suggestions? Any ideas on the “requirement” to comply?
I am going with “failed to meet standard of care by not performing X-ray prior to surgery and now attempting to cover their arses”. However, this being GQ, I suggest you call your insurer and ask if it’s true.
I doubt that’s it, RNATB, I’ve gotten tons of x-rays already, between this guy and the original periodontist. Also, as I mentioned, there hasn’t been in any surgery in this part of the procedure.
The tooth extraction was done by an oral surgeon (different practice) and the implant was done by a different periodontist (different practice). This guy is just finishing things up. And they did take x-rays before they started.
Oops. I misread the OP. I still don’t think their story is true, though; insurers just want the HFCA form and the written notes.
My dental provider is an unusual pain in the ass. It wouldn’t surprise me.
Something tells me that they are doing it wrong.
I’ve heard of this. It only applied to oral surgery though - when getting my wisdom teeth removed. They were going to do the surgery, but because the time between my previous x-ray and the procedure was too great (over a year) they had to start over again and get a new x-ray, or else the ins. co could possibly decline coverage.
I don’t know if it was legit, just that it happened. so they took another x-ray, it was the same as the first, and they yanked the teeth.
The two mostly likely results (assuming the denist is being honest with you) are:
- claim is denied for failure to meet the ins. co’s claim/utilization procedures for the type of care provided and you are billed for everything.
- claim is denied for failure to meet the ins. co’s claim/utilization procedures for the type of care provided and because of the dentist’s network agreement with the ins. co, they are not allowed to charge you - they have to eat the costs minus what you paid.
Another possibility, if they are not being honest with you, is that their reimbursement could be reduced (the allowed amount) for failure to show evidence of this or that.
This is more of an advice question than a factual question.
Moving thread from General Questions to In My Humble Opinion (IMHO).
I just had a bridge replaced (there was a cavity under it) and my dentist took an x-ray beforehand and attached it to the insurance with a request to return it. He certainly didn’t make one after.
Another likely explanation: The insurance company, being a big mindless robot-like bureaucracy, has established fixed and immutable procedures to cover everything – BUT – their procedures have a sort of one-size-fits-all (or just a few sizes fits all) nature about them.
That is, they may have 100 different required forms and procedures that cover 10000 different kinds of cases in all their myriad variations. So they require the dentist to follow whatever established one-size-fits-a-lot-of-cases procedure/documentation that more-or-less fits the kind of treatment you had.
Also, I note that you had a vast multitude of different dentists performing different parts of this procedure. Chances are that no documentation from any of them, no matter how extensive, will cover the treatment you got from any other of them. That last dentist may have needed some kind of extensive documentation of his own, that would NOT be satisfied by any X-rays or other documentation from any of the other dentists, no matter how relevant it might have been In Real Life.
You get the same kind of bullshit dealing with the Department of Motor Vehicles, or the IRS, or your bank or credit card company, or any other big out-of-control bureaucracy.
This last one sounds as likely as any other.
FWIW, I got a call from their office this morning - I didn’t go in on Friday morning and comply. The woman that I spoke with this time said the problem was that they just had the hard copy x-rays from the referring dentist, but didn’t have their own (soft copy?) x-rays to submit. I’m pretty sure that they did x-rays there, and told her so. She’s going to check and see if they have them. I could be mistaken on this, confusing one office with another, but I don’t think so.
Anyway, I am 2000 miles away for the next 2 weeks, so it will give them a chance to look.
I am a dentist and yes the insurance companies often require a “post op” x-ray or the won’t pay the claim. Require “pre op” for many procedures also. If say a patient breaks a tooth on popcorn or something I can tell just looking it is a fracture and there is no decay or pupal involvment I still have to take an x-ray. If I don’t take an x-ray prior to crowning the tooth the insurance company may say the services weren’t needed and deny the claim.