I don’t want to get anyone in trouble, but I feel really uneasy about something that happened when I visited an emergency dentist. The guy was really good and his staff was nice. I have no complaints there at all. I went in with some serious pain on my lower left. I couldn’t bite at all and had an almost constant throbbing. They agreed to try a filling for me first, to see if that would be enough to calm down my tooth. If not, they said I was looking at a crown or root canal. I was ok with all that, so we went forward and I paid my portion of the filling when I was in the office that day. I’m pretty sure the filling was all I needed because my tooth feels fine now, but here’s the weird thing. I got something in the mail from my insurance company pricing out the cost of the crown and root canal and it had the doctor’s name on it too. They told me they’d check on the exact rates for me, but this looks like they billed for work they didn’t do. I don’t want to be a rat because they all seemed so nice, but I don’t feel good about it at all. Should I report this to someone? Will the emergency dentist get in trouble for it?
Yes, billing for procedures that were not done is considered fraud. It’s a crime and the emergency dentist could be held legally liable for it. However, before jumping to conclusions, it also sounds like you could be looking at a preauthorization for work. You mentioned that the office was going to get the exact rates. That usually means they talk to the insurance company. Insurance companies are notorious for making offices jump through hoops. They have to send copies of x-rays and documentation saying what was wrong with the tooth and what was done to correct it. It’s possible they sent all that to the insurance company to get them to commit to payment, if you do need the work later. If this is the case, the page you received should say “pre-determination,” “pre-authorization,” or something similar.
If the insurance company actually paid out on this, they will likely have noted a check number or at least the date they paid. You may have to scrutinize the document a bit more, but what you’ve said so far is not a smoking bullet. Equally, billing errors also happen. Even if they did bill the insurance company by accident, there probably won’t be much trouble for the office. They’ll have to repay the insurance company, but if they don’t have a history of incorrect billing, it’s likely nothing will come of it, other than correcting the mistake.
This blog is sponsored by Elgin dentist, Dr. Steve Sirin.