LAS VEGAS (KTNV) — A Southern Nevada business owner is sharing her experience as a consumer warning after she says a routine trip to a new dentist resulted in a recommendation for a crown and questions about her dental insurance claim.
WATCH | Woman gets 2nd opinion after dentist recommends crown, shares consumer warning
Veronica Markowsky owns a local bridal store, and pays for her own dental insurance. She said that after her longtime dentist retired, she contacted her insurance company and selected a new dentist near her home from her provider list.
“I did a lot of research first, and I found 5-star reviews, and I ended up going to North Las Vegas Modern Dentistry,” Markowsky said.
Markowsky said she primarily wanted a cleaning and also wanted the dentist to examine what she described as a “tiny chip” on one tooth.
She called North Las Vegas Modern Dentistry and said the office was able to get her in quickly.
“You can come in in about two hours and we can take a look at everything and do a cleaning and a full exam, and I said, that's great. I was like, oh my gosh,” Markowsky recalled.
Markowsky says she began asking questions during the visit
Markowsky said that when she checked in, she was offered an additional screening for $39.95.
“I looked at her and I was like, ‘Is that something I need?’” she said.
Markowsky said she questioned the screening because she wasn't experiencing sores or cuts in her mouth and had primarily come in for a cleaning and to have her tooth examined.
North Las Vegas Modern Dentistry declined to discuss or confirm details surrounding Markowsky's care, citing patient privacy laws and the absence of written authorization to discuss a specific patient's treatment, diagnosis or account.
The office did address oral cancer screenings generally.
In its statement, the office said oral cancer screenings are part of a thorough dental examination and that any technology used during a screening is supplemental to a dentist's visual and tactile examination and is not, by itself, a diagnosis.
A recommendation for a crown
Markowsky said the biggest surprise came after X-rays were taken and her tooth was examined.
“He puts the instruments down. He goes, ‘OK, well it's not bad enough for a root canal, but we're going to need to go ahead and do a crown on it". Markowsky recalled.
A treatment plan Markowsky provided to Channel 13 lists a proposed crown and an estimated patient cost of $620.80. The treatment plan also lists a procedure identified as a core build-up.
Markowsky said she was not experiencing pain and wasn't comfortable proceeding with the proposed treatment that day.
“I just felt uncomfortable and I told her, I said, ‘Well, I don't know if I want to do this today,’” she said.
Instead, Markowsky decided to gather more information.
She said she returned to the office and obtained copies of her treatment plan and X-rays. She also sent the treatment plan to her mother, who Markowsky says works as a dental assistant and handles dental billing for the office where she works in Georgia.
Then Markowsky decided to get a second opinion.
Second dentist, different recommendation
Markowsky said the second dentist came to a very different conclusion about the tooth.
“He said there's nothing wrong with that tooth. It looks great,” Markowsky said.
North Las Vegas Modern Dentistry said in its statement that a difference in treatment recommendations does not necessarily mean either provider lacked a clinical basis for their recommendation.
The office also said it welcomes and supports a patient's right to seek a second opinion.
Click here to read their full statement.
Questions about the insurance claim
Markowsky's concerns didn't end with the proposed treatment.
She said she also contacted her insurance broker, Daisy Garcia, and began questioning what had been submitted to her insurance company in connection with the July 20 visit.
Markowsky subsequently filed a formal appeal with her insurance company, asking the insurer to reverse a claim for the recommended services that weren't rendered.
Markowsky said she later contacted the dental office about the insurance issue. In an email Markowsky provided to Channel 13, the office manager said a “corrective claim” had been sent to her insurance company.
North Las Vegas Modern Dentistry did not discuss Markowsky's specific account or treatment, citing patient privacy requirements.
What consumers can do
For Markowsky, the experience has become a warning for other patients: If you're uncomfortable with a recommended procedure, especially one that could be costly or irreversible, ask questions before agreeing to treatment.
Patients can ask for copies of their treatment plan and X-rays and seek a second opinion from another dentist.
Consumers who have questions about a dental bill or insurance claim can also:
- Ask the dental office for an itemized breakdown of services and charges.
- Compare those services with the Explanation of Benefits, or EOB, from their insurance company.
- Contact the insurance company directly if something on the claim does not match their understanding of the treatment they received.
- Keep copies of treatment plans, X-rays, bills, emails and correspondence involving disputed treatment or insurance claims.
For concerns involving the professional conduct of a dentist practicing in Nevada, consumers can also contact the Nevada State Board of Dental Examiners regarding its complaint process.
For Markowsky, the biggest takeaway is simple: She is glad she stopped before approving the proposed treatment and sought another opinion.
Her experience is also a reminder that two dentists can reach different clinical conclusions. North Las Vegas Modern Dentistry maintains that differing treatment recommendations do not necessarily mean either dentist lacked a clinical basis and says it supports patients who choose to seek a second opinion.
