About Mark Bornfeld DDS Expertise I can respond to all questions dealing with the practice of dentistry, from both the dentist`s and patient`s perspective. I am knowledgeable about all dental disciplines, from cosmetic dentistry to surgery, from restorative dentistry to root canal treatment. I have strong opinions about controversial issues in dental practice, including those topics which directly impact on the reputation of the profession in the eyes of both the lay public and our health profession colleagues.
Experience
Past/Present Clients Editor, Queens County Academy of General Dentistry newsletter; contributor to Dentistry.com 29 years practicing general dentistry partnered with brother Steve as one-half of the DentalTwins®
Question Hello, I am trying to figure out the difference between a post and core, pins, and a core buildup. My husband had a root canal and he was billed as having a core build up. Our insurance won't cover core build ups (I do not know why) however they do cover post and core, and pins (pin retention). What is the difference, especially if my husband says he did get pins? Can the dentist change the charge to a post and core? I am so frustrated with my dentist and the insurance. Thanks for any help you can give me.
Answer Dear Chandy,
There is some ambiguity here, because the terms "core", "build-up", "post", and "dowel" are sometimes used interchangeably. (Pins are different, and are less likely to be used in a tooth that has had root canal therapy.)
Because of the potential for ambiguity, the insurance industry and the dental profession have collaboratively developed a set of codes that formally describe nearly all of the existing dental procedures. All dental insurance claims require use of these codes, because it eliminates any uncertainty that may be introduced by semantics.
Assuming your dentist used the appropriate code on the insurance claim form (only he would know, by the way), then the insurance carrier would presumably have processed the claim according to the provisions of the policy. However, it is not a bad idea to check, because claims are sometimes filed or processed inaccurately. You might consider asking your dentist to verify that the correct code was used. If the insurer rejected the claim, your dentist should verify that the explanation code on the statement of benefits makes sense as well. In some cases, insurance carriers will reject a claim for erroneous reasons, while in other cases the service truly isn't covered.
Hope this helps...
Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY
