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Ever looked at a dental bill and wondered how a routine cleaning turned into a tangle of codes and surprise charges? We dig into the hidden world of dental insurance fraud—upcoding, unbundling, phantom billing, and double charging—and explain how these tactics quietly raise your costs and erode trust. Drawing from a first-hand story about a $26 “gingival rinse” that was just tap water, we unpack the excuses patients often hear, like “the insurance made us code it this way,” and show you how to separate fact from fiction.

We walk through specific red flags on invoices and Explanations of Benefits, from duplicate entries to premium materials you never received. You’ll learn how to request the exact CDT codes your dentist plans to bill, use predeterminations to get clarity before treatment, and compare claim submissions to your EOB line-by-line. For listeners in Texas, we outline the concrete steps and hotlines for reporting suspected fraud to the Texas State Board of Dental Examiners, the Texas Department of Insurance Fraud Unit, and the Health and Human Services OIG for Medicaid or CHIP. We also share what to include in a complaint so investigators can act quickly.

Most importantly, we focus on protection: choosing in-network dentists to reduce balance billing risk, asking for written estimates, getting second opinions for non-emergencies, and keeping thorough documentation. We even role-play a surprise bill scenario so you can hear how to push back with confidence and professionalism. Knowledge really is power—use it to keep your care honest and your costs fair.

If this helped, follow the show, leave a quick review, and share the episode with someone dealing with a confusing dental bill. Your story could help another listener spot a red flag and save real money.

• Texas Department of Insurance (TDI) — reporting insurance fraud
   
  • Fraud Hotline: 1-800-252-3439Texas Department of Insurance+3Texas Department of Insurance+3Texas Department of Insurance+3 
• Alternate toll free: 1-888-327-8818 (shown on fraud report form) CloudFront 
• Email for suspected fraud: FraudReport@tdi.texas.govTexas Department of Insurance 
• Texas State Board of Dental Examiners (TSBDE) — for complaints about dentists
   
  • Complaints email: complaints@tsbde.texas.govTexas State Board of Dental Examiners 
• Fax: 512-649-2732 Texas State Board of Dental Examiners 
• Phone (fraud / investigations): (512) 936-9500 Texas State Board of Dental Examiners 
• Texas HHSC / OIG (Medicaid / provider fraud)
   

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