Dental Office Billing Procedures....

Silver fillings are ugly but they do last longer which is why some insurance companies only cover them. The white ones are considered cosmetic. A lot of times the insurance coverage depends on whether they are molars. Front teeth are usually covered for bonding.

If you claim went through consider yourself lucky but know they have a pretty long time to pull the money back so don't raise a stink about your husband. Most likely your dentist got caught and is on the straight and narrow now.

In speaking with the very nice and knowledgeable billing lady at our dentist's office, she was saying that reimbursements for dental procedures have not increased since the 70's. So basically, the "reasonable" amount that insurance companies are willing to reimburse the dentist for are not at all reasonable. She said that there is a whole industry (medical billing) around this, where they code procedures so that they will be paid as much as possible AND that the insurance companies have full knowledge it's happening, and don't care. So yeah, it's technically illegal, but it is a widely accepted practice. Doctors who won't bill this way tend to lose patients because they're just too darned expensive for people to afford.

Insurance fraud is insurance fraud.
I'm sorry--if you don't like what your insurance offers and covers--pay for it out of pocket.
Gone are the days of "free lunch" insurance. Well, almost gone.

Perhaps you have a different relationship with them than he does. However, to your point I see an issue if they bill the ins company for white fillings when they actually used silver. Not the other way around. If you are billing the Ins company for a cheaper item then the loss would be on the office. That's their call to make. I wouldn't be a happy ins company if I was being billed for things that were fabricated and yes that's fraud.

It is technically a fraud because they are billing for something they didn't provide. You should consider yourself lucky and not look a gift horse in the mouth!

I'm sure they just got audited or something and now have to be careful.

I just got my first 2 fillings 3 weeks ago, and I was surprised when I opened my mouth & couldn't see them. I said, "Why don't I see them?" And the dentist said, "Oh, we make them tooth colored here." I didn't realize that my insurance only covers the silvers, but would still have chosen to get the whites.

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Oops...I totally read your question wrong. So, this is ETA. Yes, they billed an insurance company and gained money for a procedure they didn't do. That is certainly fraud. They either got caught, were scared they would, or were losing money giving you such a big break.

No matter, you should drop it. They charged for a procedure they DID do. You can't expect exceptions all the time, just because you got them once and twice. Maybe, they wouldn't do it for him, because they can't afford to lose money on your family's dental work again!!

What exactly do you mean by, "doctor credits for the downgrades?"