Early December before my insurance with Emblem Health was about to expire, I realized that I had not taken advantage of the dental benefits which as explained by Emblem Health very clearly included a check-up and a cleaning. I clearly explained to the doctor's office that A. I am disabled and traveling is an ordeal not only because of the physical exertion but also due to unrelenting fatigue and the 'consequence' which follows. I must plan for such outings and so make every effort to pace and manage my time and energy output so that I can function. I was assured all would be in order and that my visit would not be a problem. When I arrived at the office, I was told that x-rays are not part of the exam, that I would have to pay for x-rays. This is not what Emblem Health explained. (I find that insurance companies and medical providers love playing ping pong with their customers/patients). Soooo, after re-scheduling to discuss this matter with Emblem Health to make sure that this 'policy' is correct I visited the office a second time. I met with a Dr. Messinger I believe was her name. She called herself conducting a checkup by tapping a few of my teeth with the hooked shaped dental instrument and that was the 'exam.' I then asked about the cleaning and she called polishing my teeth with paste and the mechanical tooth polisher (I'm 47 I know what a cleaning is and what a polish is) a prophylaxis. There was no scraping of tartar, nothing. What is most upsetting...I tried to speak with Dr. Weiss about this under the assumption this was his clinic and therefore he'd be interested in knowing the risk he's under with a doctor who is clearly fraudulently billing insurance companies for services that are not rendered but his response was colder than a raw clam. When I called Empire, they too were not interested. It's medical providers like Dr. Weiss, Dr. Messinger and insurance companies like Emblem Health that contribute to the decline of affordable medical care. If dentists cannot conduct business ethically, competently and under the terms of an agreed upon contract with an insurance company as they have taken the oath to do, and if Emblem Health cannot enforce terms of their contract, personally, I would not do business with any of them and certainly would not trust a dentist who after years in business with an associate who has been professionally trained to know the distinction between a cleaning and a polishing cannot bring herself to perform the covered services (whether its because she's unhappy with the amount insurance is paying her or for some other unknown reason. If a medical provider is not happy with the terms of a contract, don't sign it. What you should not do is sign up as a participating provider then skimp on the contracted services and bill for services that are not rendered. It's called FRAUD.
While it seems as of late the medical industry has morphed into a commercialized sales organization with a 'health' theme, it is essential for patients to be aware of what services are covered by their health insurance and to read their bills carefully. Medical billing codes can easily be researched online. I learned this when a previous dentist billed another insurance company for a 'surgery' mind you, it was a simple check up and not one needle used for the 'fabricated' surgery that never happened. The other reason why this is important is because if you don't challenge it, you are the only one who stands to lose. In the case of dental care, most companies limit the number of checkups and cleanings one can have in a calendar year. With Emblem Health the limit was one, so essentially Dr. Messinger stole from me and lied to Emblem.
There are what are known as 'dental checkups' and comprehensive dental exams, NOTE that an exam includes a cleaning, and don't let anyone fool you. I was cheated out of my benefits by Dr. Weiss' office and Emblem Health allowed it. Emblem Health's position was it was basically my word against the doctor's. I retorted you could clearly look inside my mouth and see nothing was done, but since I don't get paid to play medical administrator I had to take it on the chin, my time is money too and if Emblem Health did not feel inspired by such blatant theft, then I presume until enough patients are fed up with the rising costs of healthcare due to such abuse, I was not willing to drag the issue out - but I have instead elected to provide a very candid sketch of my experience. I hope it's been helpful.
http://www.simplestepsdental.com/SS/ihtSS/r.==/st.31855/t.32270/pr.3.html
Note to Dr. Messinger...it's clear you missed a few lessons during your training, there are many videos on you-tube and google references which might bring you up to date. Never assume that big words will intimidate your patients, arrogance is not a good look. This one is on the house.
http://www.dentalfearcentral.org/faq/scale-and-polish/ read more
