Shady practice by dental office

[shoreparty]

What is the name of your state (only U.S. law)? florida


This isn't a problem with malpractice, but I don't know where else to post this.

Last year I visited my dentist to have a small procedure done. before the procedure, I was told how much the procedure would cost, and how much my insurance would cover. The procedure was about $600, and I was told my insurance would pay X amount (in the $300 range) and I would would have to pay the remainder. Since this wasn't a typical procedure, I wasn't sure what the technical name for it was so I couldn't look it up before hand to make sure it was covered under my dental insurance. I figured my dental office was competent enough to know how much to bill me and whether what I was getting done was covered. I got the work done, paid my amount and was on my way. About 2 months later I got a bill in the mail from the dental office saying the procedure I had done was in fact NOT covered by my insurance, and along with it was a hefty bill for the remainder. I refused to pay it because in my mind I had already paid what was agreed upon before the work was done.

Am I liable to actually pay this? They are now threatening to send this to collections, which is something I would rather avoid. Had I known I would be on the hook for the full amount, I would have waited and made an appointment with the VA dental clinic (I'm an OEF vet) which would have taken longer, but would have been free. I feel that I have been wronged and am wondering if this is something I should talk to a lawyer about.

Any help would be appreciated, Thanks.

 

[Willlyjo]

What is the name of your state (only U.S. law)? florida


This isn't a problem with malpractice, but I don't know where else to post this.

Last year I visited my dentist to have a small procedure done. before the procedure, I was told how much the procedure would cost, and how much my insurance would cover. The procedure was about $600, and I was told my insurance would pay X amount (in the $300 range) and I would would have to pay the remainder. Since this wasn't a typical procedure, I wasn't sure what the technical name for it was so I couldn't look it up before hand to make sure it was covered under my dental insurance. I figured my dental office was competent enough to know how much to bill me and whether what I was getting done was covered. I got the work done, paid my amount and was on my way. About 2 months later I got a bill in the mail from the dental office saying the procedure I had done was in fact NOT covered by my insurance, and along with it was a hefty bill for the remainder. I refused to pay it because in my mind I had already paid what was agreed upon before the work was done.

Am I liable to actually pay this? They are now threatening to send this to collections, which is something I would rather avoid. Had I known I would be on the hook for the full amount, I would have waited and made an appointment with the VA dental clinic (I'm an OEF vet) which would have taken longer, but would have been free. I feel that I have been wronged and am wondering if this is something I should talk to a lawyer about.

Any help would be appreciated, Thanks.

If during your initial consultation regarding the procedure you were told half was covered by your insurance, you recieved any paperwork (documentation) reflecting what you were told, you should have a pretty good case in refusing to pay what they say is a balance. If you have no documentation other than what was said, you're out of luck!

 

[sandyclaus]

What is the name of your state (only U.S. law)? florida


This isn't a problem with malpractice, but I don't know where else to post this.

Last year I visited my dentist to have a small procedure done. before the procedure, I was told how much the procedure would cost, and how much my insurance would cover. The procedure was about $600, and I was told my insurance would pay X amount (in the $300 range) and I would would have to pay the remainder. Since this wasn't a typical procedure, I wasn't sure what the technical name for it was so I couldn't look it up before hand to make sure it was covered under my dental insurance. I figured my dental office was competent enough to know how much to bill me and whether what I was getting done was covered. I got the work done, paid my amount and was on my way. About 2 months later I got a bill in the mail from the dental office saying the procedure I had done was in fact NOT covered by my insurance, and along with it was a hefty bill for the remainder. I refused to pay it because in my mind I had already paid what was agreed upon before the work was done.

Am I liable to actually pay this? They are now threatening to send this to collections, which is something I would rather avoid. Had I known I would be on the hook for the full amount, I would have waited and made an appointment with the VA dental clinic (I'm an OEF vet) which would have taken longer, but would have been free. I feel that I have been wronged and am wondering if this is something I should talk to a lawyer about.

Any help would be appreciated, Thanks.

Yes, you must pay.

It's YOUR responsibility to ensure that the procedure was covered before giving the dentist the go-ahead to proceed. Once you did that, you were obligated to pay, whether or not your insurance covered the unpaid balance. (You'll note that on most dentist intake forms, it specifies that you agree to pay any remaining balance not covered by insurance coverage and/or co-pays.)

If you were concerned about the cost, you needed to do your due diligence and check with your insurance company before agreeing to let the dentist perform the procedure on you.

If you want to avoid collections, I suggest that you pay the bill, or discuss a payment plan with the office manager.

 

[swalsh411]

This comes up about once a week. You are responsible to pay for medical care you receive. You are responsible for verifying your insurance coverage. You specifically agreed in writing to pay for care that your insurance does not cover. On what basis do you believe you should not be held to that?

 

[Mass_Shyster]

• I was told my insurance would pay X amount (in the $300 range)
• a hefty bill for the remainder.

If the 'hefty' bill is more than the amount they said would be covered then you can argue that it's excessive.

As others have said, you are responsible for the shortage, but I would be sure to tell them that it's the last $300 they'll ever see from you.

 

[cbg]

I was told my insurance would pay X amount (in the $300 range) and I would would have to pay the remainder.

By whom were you told this?

 

[ecmst12]

Anything you were quoted ahead of time was an ESTIMATE and not a guaranty of payment.

 

[shoreparty]

This comes up about once a week. You are responsible to pay for medical care you receive. You are responsible for verifying your insurance coverage. You specifically agreed in writing to pay for care that your insurance does not cover. On what basis do you believe you should not be held to that?

Think of it like this. You go to buy a car. You trade in your old car for $5000 towards the price of the new car. A week later, the dealership calls you and says they mis-valued the price of your trade in, it was only worth $3000, and they want you to pay the remaining $2000 difference. Would you pay it? That's essentially what the dental office did to me. Its horrible that they can get away with this type of business practice. It's poor business and there should be a law against it. As I have no leg to stand on, I will pay it. But I don't have to like it.

 

[ajkroy]

Think of it like this. You go to buy a car. You trade in your old car for $5000 towards the price of the new car. A week later, the dealership calls you and says they mis-valued the price of your trade in, it was only worth $3000, and they want you to pay the remaining $2000 difference. Would you pay it? That's essentially what the dental office did to me. Its horrible that they can get away with this type of business practice. It's poor business and there should be a law against it. As I have no leg to stand on, I will pay it. But I don't have to like it.

This is not an accurate analogy. You have a contract with a third party to pay some of your dental bills for you (your insurance). There are obviously some exceptions to your coverage, which is ultimately your responsibility to know and understand before undergoing treatment.

It's too bad that you trusted the person who told you it would be covered, and you learned a lesson that you should always get that information directly from your insurer. Not to minimize your loss, but I've known many, many others who learned that same lesson for far more than $300.

 

[sandyclaus]

Think of it like this. You go to buy a car. You trade in your old car for $5000 towards the price of the new car. A week later, the dealership calls you and says they mis-valued the price of your trade in, it was only worth $3000, and they want you to pay the remaining $2000 difference. Would you pay it? That's essentially what the dental office did to me. Its horrible that they can get away with this type of business practice. It's poor business and there should be a law against it. As I have no leg to stand on, I will pay it. But I don't have to like it.

Good business practice is putting all guarantees IN WRITING.

Car dealerships are required to put their deals in writing in the form of a contract. The trade-in value would be listed as part of the contract. If the dealership then suddenly changed their minds by demanding more money due to underestimating the value of the trade-in, then you would have the written contract to fall back on. Since the trade-in value is reduced to writing, the dealership CAN'T change their minds, and you would be able to refuse to pay the extra money they were demanding.

Since you never received any guaranteed charges for the procedure in writing, or anything in writing from the insurance company guaranteeing that the procedure was covered and for how much, you don't have anything to fall back on. Medical and dental providers specifically state on their intake forms that you will be required to pay any portion of those charges that are not covered by insurance, and by signing that intake form, you agreed to that business practice.

You have no one to blame but yourself for not verifying with the insurance provider themselves that the procedure was covered and for how much. You can't then blame the dental office for what you claim is an overcharge. Take what you have learned from this experience away with you and apply as needed in the future.

 

[justalayman]

Think of it like this. You go to buy a car. You trade in your old car for $5000 towards the price of the new car. A week later, the dealership calls you and says they mis-valued the price of your trade in, it was only worth $3000, and they want you to pay the remaining $2000 difference. Would you pay it? That's essentially what the dental office did to me. Its horrible that they can get away with this type of business practice. It's poor business and there should be a law against it. As I have no leg to stand on, I will pay it. But I don't have to like it.

Not even close.

It would be more like (but not quite but I couldn't think of an analogy where you would have a contract with the 3rd party):

you take the car for trade in. The dealer says they know somebody that will likely pay $5k for it and if they will, the dealer will credit your purchase that amount. So, dealer writes up the sale and includes the $5k credit with the stipulation that is a tentative value and if the 3rd party pays less, the contract will be altered to reflect that. He then takes the car to the 3rd party and 3rd party says, no way man. That is only worth $3k. So, dealer sells the car for $3k and comes back to you wanting the remaining $2k.

The dentist you are dealing with cannot control the insurance company. All they can do is tell you what is typical given your policy. It is your obligation to verify what is covered and how much they will pay towards any particular treatment.