{"id":1004,"date":"2020-10-22T14:37:38","date_gmt":"2020-10-22T18:37:38","guid":{"rendered":"https:\/\/www.regiondental.com\/blog\/?p=1004"},"modified":"2021-06-22T14:37:59","modified_gmt":"2021-06-22T18:37:59","slug":"dentist-cheating-insurance-fees","status":"publish","type":"post","link":"https:\/\/www.regiondental.com\/blog\/dentist-cheating-insurance-fees\/","title":{"rendered":"Is My Dentist Cheating on Insurance Fees?"},"content":{"rendered":"

My dentist is recommending porcelain fused to metal for two lower three crown bridges for my back teeth. He says that it is a stronger material than all ceramic. So he is saying he is upgrading that to porcelain fused to metal and wants to charge me 20% above the PPO contract rate for all ceramic, for upgraded crown materials. So I have three questions that I am hoping you can help me with.<\/p>\n

1) Which type of crown would you recommend that is less likely to crack?<\/p>\n

2) My dentist is labeling the 20% upcharge as “lab fees,” but my insurance does not cover that. Can a dentist charge above the PPO contract rate? Can he also refuse to do the standard crown? The standard crown is covered by my insurance, and I’m just not sure I can afford the upgrade. He is an “in-network provider,” and I really don’t want to switch dentists.<\/p>\n

3) I also have porcelain upper bridges on each side of my mouth, so my last question is, will it cause cracking having a stronger material grinding against a softer material?<\/p>\n

Thank you,<\/p>\n

Jeff from Minnesota<\/p>\n

 <\/p>\n

Jeff,<\/p>\n

It sounds to me like your dentist is playing some games with the insurance fees. First, I want to make sure you and the readers understand what PPO stands for. PPO stands for preferred provider organization, and it is a network of dentists that have agreed with the insurance companies to offer discounted fees<\/a> to the subscribers of the plan.<\/p>\n

Let’s talk about your first question. I’m guessing that your dentist is using procedure code D6740 – retainer crown porcelain\/ceramic. Ceramic is important because the porcelain isn’t strong enough on the back teeth; it will crack when chewing. There are ceramic bridges available now that are strong enough to serve as a bridge on back teeth, where porcelain isn’t strong enough.<\/p>\n

Your dentist is definitely playing games with the terminology because the fee upgrade would typically be in the other direction. Porcelain fused to metal, while it is a little stronger than the newer ceramics,\u00a0 would be a lower fee than the all-ceramic crowns<\/a>. Besides that, I’m sure that your insurance company recognizes the codes for porcelain fused to metal crowns. A typical code would be D6751 – retainer crown porcelain fused to noble metal. So it sounds like your dentist does not want to accept the insurance fee for a porcelain fused to metal bridge and has thought of this clever work-around, which seems very unethical to me.<\/p>\n

Also, your dentist should not make it mandatory to upgrade. That seems like a violation of his insurance contract. If he has some upgrade he wants to offer, that should be optional to you, not mandatory.<\/p>\n

As far as the high-strength ceramic, it is definitely strong enough for a bridge on the back of your teeth. The porcelain fused to metal is a little stronger but not necessary.<\/p>\n

To answer your third question, they will not crack being different materials on the top and bottom, but they will wear. If one surface is a little more abrasive than the other, the one will wear the other. It would be best to have the same material on both.<\/p>\n

It is important that you trust your dentist and understand it is your right to say no to the upgrade.<\/p>\n

This blog is brought to you by Tulsa Dentist<\/a> Dr. Ryan Noah.<\/p>\n","protected":false},"excerpt":{"rendered":"

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