Screwed by dentist!!

[bonds77]

My girlfriend recently had some dental work done. When she asked her dental office about it in February, they said that her insurance plan had sufficient coverage to handle all the work, without a problem. The work was optional, but covered, so she went ahead and had it done. Recently, they called her and said that they had made a figuring mistake, and that she now owed several hundred dollars because of their mistake. They readily admitted that the mistake was their fault, yet said we had to pay it anyways! Please help.... what is the first step, since she has no intention of paying??

 

[I AM ALWAYS LIABLE]

My girlfriend recently had some dental work done. When she asked her dental office about it in February, they said that her insurance plan had sufficient coverage to handle all the work, without a problem. The work was optional, but covered, so she went ahead and had it done. Recently, they called her and said that they had made a figuring mistake, and that she now owed several hundred dollars because of their mistake. They readily admitted that the mistake was their fault, yet said we had to pay it anyways! Please help.... what is the first step, since she has no intention of paying??

My response:

This is going to be a "change up" in my normal response to such situations (I hope you're reading this Mary).

Anyway, if a dentist assumes the task of checking insurance, and confirming coverages, it then becomes the responsibility of the dentist to ensure that such coverage exists, and in the amounts necessary for the procedure.

The dentist could just have easily said to you, "Please call your own insurance company and confirm coverage", but the dentist didn't - - opting instead to take on the responsibility itself, and to report its findings to your girlfriend. It was those "findings" that your girlfriend relied, to her detriment, in making a decision whether to go forward or not with the procedure. She had a right to depend on the dentist's findings of coverage since the dentist took on that responsibility.

The dentist can sue your girlfriend; however, her defense to the matter will be "detrimental reliance", this estopping the dentist from prevailing on his claim - -
the doctrine of equitable estoppel, a rule of fundamental fairness which bars a party from benefiting from false language or conduct which has induced reliance to the detriment of another.

A party claiming estoppel must prove all four elements of estoppel:

· the party estopped must be apprised of the facts;

· the party must intend (or appear to intend) that his or her conduct shall be acted upon;

· the other party must be ignorant of the true state of facts; and

· the other party must have relied on the conduct to his or her detriment.

Normally, an insured such as your girlfriend, would ultimately be responsible IF she was the one required to confirm coverages. But, since the dentist assumed the task, should likewise assume the risk if the dentist is later found to be wrong.

Inform the dentist that your girlfriend has no intention to pay based upon the above discussion; that if the dentist does anything to report the debt to a collection agency, or to damage her Credit Report, that she will take all necessary legal steps against the dentist. If the dentist wants it's money, then the dentist should sue your girlfriend and let a judge decide who's responsible to pay, or to "eat" the balance.

IAAL



[Edited by I AM ALWAYS LIABLE on 11-14-2000 at 08:47 PM]

 

[ALawyer]

This should be a compromise -- before it gets sent to a collection agency and harms her credit standing or gets into a "he said, she said" mess that produces losers and hard feelings and an end to a relationship.

She did have the work done. And thus is better off now than she was before. That is worth something.

At the same time, the office gave her incorrect iformation (she says) she incurred expenses she may not have if the office gave her correct information. (However she may have been told they will check with the plan but it's her responsibility to make sure, or she may have signed an agreement stating that she bears responsibility regardless of insurance, etc.

What most people do not know is typically when work is done by a dentist under a dental plan (or a physician or hospital under a medical plan) the professional or hospital receives far less than the "retail" fee that he or she or it would bill patients and is paid SUBSTANTIALLY less, like sometimes 50% (or more) off (because the plans negootiate a discounbt and provide lots of patients).

One approach would be to offer pay only what the dentist would have been paid under the plan IF the plan paid anything.



[Edited by ALawyer on 11-14-2000 at 08:57 PM]

 

[bonds77]

Thanks

Thanks for the timely responses

I believe that the work was actually done by a third party.
The dentist's secretary was the individual who took the responsibility of checking on the insurance info, and I believe it should have been fully covered. Upon finding this mistake, the secretary reported her findings and the dentist offered to take off 5%!! This was quite an insult. I will report what you have written so far and have my girlfriend contact the office. We don't want to be the ones that take the legal action; at the same time, we don't want any bad credit, either. One person suggested that since the work was done, we were responsible for the materials of the work only, as a dispute with a home contractor might suggest. Does anyone know about this?

 

[I AM ALWAYS LIABLE]

Re: Thanks

Thanks for the timely responses

I believe that the work was actually done by a third party.
The dentist's secretary was the individual who took the responsibility of checking on the insurance info, and I believe it should have been fully covered. Upon finding this mistake, the secretary reported her findings and the dentist offered to take off 5%!! This was quite an insult. I will report what you have written so far and have my girlfriend contact the office. We don't want to be the ones that take the legal action; at the same time, we don't want any bad credit, either. One person suggested that since the work was done, we were responsible for the materials of the work only, as a dispute with a home contractor might suggest. Does anyone know about this?

My response:

Stop with "contractor" argument. Let's not confuse the issues or go crazy, okay?

Do not have your girlfriend call the dentist; rather, have her write a Certified Return Receipt letter to the dentist, using my arguments above, and your explanations of the situation as you see them, and send it to the dentist. In this way, should matters come to litigation, you'll have a record of what was said, and your reasons for not paying. This letter may become very important evidence for your girlfriend should the dentist sue her in Small Claims Court.

IAAL