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)?
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)?