Dr. Office gave false information

[ngrassel]

I went in for an evaluation for my wisdom teeth extraction on Jan. 15th. Going over the payment plan, the office told me that everything was covered except for the anesthesia, which I would have to pay $360.00 for the day of surgery. Feb. 1st, I had my surgery, paid my $360.00 and went home to recover. Now, I am receiving a bill for $739.00 from the office saying my insurance won't pay for the surgery. I called the insurance company and they told me that on the 15th, when the woman from the doctor's office called, they told her it was not covered. I called her, and she admitted that it is their mistake, but that the payment plan was an estimate anyways, so they are not liable. This seems incredibly illegal and misleading to me. Any help would be greatly appreciated.

 

[COlandlord]

You could have called your insurance company or reviewed your policy prior to the procedure to see if they would cover. I don't think what happened was illegal, as ultimately it is your responsibility to know what your policy covers. In my experience (personal), you more than likely signed a form that states that if your insurance fails to pay you would be responsible.

 

[cbg]

It is not in any way illegal.

At what time did YOU call your insurance carrier and ask what would be covered? It was your responsibility, not theirs. Unless the insurance policy SPECIFICALLY says otherwise, they have no legal obligation to determine your insurance benefits. That's YOUR job.

 

[ngrassel]

my concern is that the office knew fully well that it was not covered at the time of evaluation, yet proceeded to tell me otherwise.

 

[ShyCat]

Dental or medical insurance? When I had 3 impacted wisdom teeth removed by an oral surgeon, it was covered under my medical insurance policy, not dental. If it was your dental insurance plan that did not cover wisdom teeth removal, have you tried submitting the claim to your medical insurance (if it's covered there) after paying the bill?

 

[ecmst12]

The office must have called AFTER your conversation with them. Now you're right, they didn't call you to tell you that it wouldn't be covered, but they probably figured when YOU called your insurance to verify that it would be covered, you would find out. You failed to verify YOURSELF that it would be covered, and you are responsible for the bill.

Now, what is the specific reason your insurance is saying it isn't covered?

 

[ngrassel]

BCBS dental or medical doesn't cover extraction of wisdom teeth, or maybe it's my plan only. Not entirely sure.

 

[cbg]

It's your plan only. I've seen BCBS plans that did.