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Dental office ripoff

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pdovy

Junior Member
What is the name of your state (only U.S. law)? Illinois

I recently started seeing a new dentist, as I had moved from another city. On my first visit they found several cavities which needed to be addressed, and they presented me with a treatment plan that detailed the costs, and what portion would be covered by my dental insurance. The total cost to me and the insurer was in excess of $1500, so I asked that before I receive treatment, they submit a preauthorization request to my insurer.

To my knowledge, this is a standard practice for dental offices. Generally they estimate what you will have to pay based on your insurance, and if they estimate incorrectly you may owe more or be entitled to a refund when they actually submit the insurance claim on your behalf. The preauthorization is essentially submitting the claim in advance, and the insurance company responds in writing to the dentist with exact details of what amount will be covered for each portion of the treatment, thus avoiding any discrepancies.

I got a call a few days later from the business assistant at the dental office, and I came down to the office in person to pick up the new treatment plan with the revised numbers. According to the new plan, my insurance had said they would cover a larger percentage of the cost than the dental office originally thought, which I thought was fantastic since I then owed less out of pocket. I didn't think to ask to see anything with my insurers letterhead on it, nor did I call my insurer to verify what the dental office was telling me - I (stupidly) took it on good faith that they did indeed submit the preauthorization request as I had asked, and these new numbers were the result of that request. I went ahead with the treatment and paid the full amount due on the day I received the treatment.

Now nearly a month later I receive a new bill from the dental office informing me that they overestimated my coverage and I now owe them an additional $280 for services rendered. I then called my insurance company, who informed me that they never received any preauthorization request, and if they had they would have given the dental office the correct figures.

I have been told by other people I've related this to that it is possible that by accepting their services on the condition that they first submit the preauthorization request, they entered into a verbal contract with me which they broke by failing to submit the request. I have prepared a letter which I am going to send by certified mail to the dental office which details what I wrote above (although I do not mention the contract part, instead I simply lay my case out and ask that they send me a new invoice showing $0 balance due).

Am I in the right legally? If so, how can I proceed to handle this so I get a favorable outcome? I am concerned that they will hand me over to a collections agency, ding my credit report, and I'll never hear the end of it - but I don't believe I should owe them any additional money.What is the name of your state (only U.S. law)?
 


pdovy

Junior Member
You owe the $280
Could you elaborate on that? Your comment by itself isn't particularly useful.

In my mind what they are doing is akin to if you asked me to paint your house upon the agreement it would cost X dollars, I agreed and performed the work, and then told you in fact it would cost more.

Had the dentist told me the correct pricing information I would not have agreed to have the services performed (I could have gone back to my home dentist and gotten a different filling type which my insurance covers a larger percentage of).
 

seniorjudge

Senior Member
Could you elaborate on that? Your comment by itself isn't particularly useful.

In my mind what they are doing is akin to if you asked me to paint your house upon the agreement it would cost X dollars, I agreed and performed the work, and then told you in fact it would cost more.

Had the dentist told me the correct pricing information I would not have agreed to have the services performed (I could have gone back to my home dentist and gotten a different filling type which my insurance covers a larger percentage of).
You owe the $280
Elaboration: ...because you got the service you asked for.
 

pdovy

Junior Member
Elaboration: ...because you got the service you asked for.
Yes, I did get the service I asked for, but not at the price I agreed to pay.

I told them that the condition on my receiving their services was to submit the request I asked, which would lock in the price I would be asked to pay. They claimed to have done so when they had not. Had they done so, they would not have received my patronage.

I realize it's possible that they are either sloppy or unscrupulous or both, and that that may not resolve my obligation to pay. Nonetheless I would appreciate it if you could give me more than an nine word answer so that I can understand why.
 

seniorjudge

Senior Member
Okay, here is a 59 word answer why you are liable:

I didn't think to ask to see anything with my insurers letterhead on it, nor did I call my insurer to verify what the dental office was telling me - I (stupidly) took it on good faith that they did indeed submit the preauthorization request as I had asked, and these new numbers were the result of that request.
 

Zigner

Senior Member, Non-Attorney
When you agreed to have the work done, you agreed to be responsible for any amounts the dental insurance didn't pay. Your beef is with the ins. co., NOT the dental office.
 

pdovy

Junior Member
SeniorJudge: I'm not really sure why you are so adversarial, but I hear what you are saying. In the future I'll be more careful about what I'm agreeing to, and for the moment I'll probably just pay rather than ruin an otherwise perfect credit score. That said, I won't be going back to that particular dentist.
 

moburkes

Senior Member
The dentist didn't screw up. YOU have a copy of YOUR insurance policy and it tells YOU what portion you are responsible for. No dentist can tell you, without filing a CLAIM (not a preauthorization), how much your insurance company is going to pay. Your dentist doesn't know if you've met your deductible, paid your premiums on time, etc. But, you have an 800# on the back of your insurance card that you could have called. You CHOSE not to. Since every insurance company has thousands of plans, and even dental insurance providers have hundreds, there is just no way for your dentist to know what you're expecting them to know. Period.

Now, go back and ask to read a copy of the paperwork you signed (and you will sign similar paperwork at the next dentist's office), and report back on what it said, that you signed, about who is ultimately responsible for the costs, regardless of insurance.
 

seniorjudge

Senior Member
SeniorJudge: I'm not really sure why you are so adversarial, but I hear what you are saying. In the future I'll be more careful about what I'm agreeing to, and for the moment I'll probably just pay rather than ruin an otherwise perfect credit score. That said, I won't be going back to that particular dentist.
The word is "informative" not "adversarial".
 

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