Dentist Suing me in Small Claims

[needhelp17]

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

Hello,

I am being sued in small claims court by a dentist due to an outstanding balance. There is some dispute as to whether the procedure was appropriate, and to whether the service is complete. A couple points to note are:
1. The dentist states that there was little tooth structure remaining while the insurance company states (after multiple reviews) that there was plenty of tooth structure.
2. Because the dentist was in-network, I would expect that part of the service was filing a complete and valid claim. That is, sending an incomplete claim (one missing data) or an invalid claim (one with incorrect information and codes) would constitute incomplete service.

Both the insurance company and I have been attempting to work with the dentist but they are not working with us to get the appropriate information to the insurance company. I even had a conference call where the dentist office refused to fax the information to the supervisor while we were all on the phone.

My planned defense is that the dentist's service is not complete and is withholding the information necessary to get insurance approval.

Do I have a reasonable defense?

I have never been a plaintiff or defendant in small claims court. Are there any good books or other resources for understanding the process and my rights?

I was planning to counterclaim for my time. Is that reasonable? Is there anything else for which I should counterclaim?

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

 

[JETX]

1. The dentist states that there was little tooth structure remaining while the insurance company states (after multiple reviews) that there was plenty of tooth structure.

Did an insurance adjuster actually come over and do an examination of your mouth before the treatment??

2. Because the dentist was in-network, I would expect that part of the service was filing a complete and valid claim. That is, sending an incomplete claim (one missing data) or an invalid claim (one with incorrect information and codes) would constitute incomplete service.

Not correct. The service 'completeness' has NOTHING to do with billing accuracy.

My planned defense is that the dentist's service is not complete and is withholding the information necessary to get insurance approval.

Sounds like a planned failure.

Do I have a reasonable defense?

Not as stated here.

I was planning to counterclaim for my time. Is that reasonable?

No.

Is there anything else for which I should counterclaim?

Post your entire dental history and billing records to the internet and we will take a look.

 

[needhelp17]

Jetx, thank you for your quick and honest response.

Did an insurance adjuster actually come over and do an examination of your mouth before the treatment??

No. Because the dentist did the examination, the insurance company has requested the dentist to provide a narrative of the situation, which the dentist is now refusing to provide, even though he claims to have already written the narrative.

Not correct. The service 'completeness' has NOTHING to do with billing accuracy.

Ok. I suppose that is reasonable. But it doesn't seem reasonable that an in-network dentist (who is responsible for filing the insurance claim) can file an incomplete/incorrect claim, and then bill me for their mistake.

At the same time, I understand that what is reasonable doesn't always fly in court.

Sounds like a planned failure.

Ok. But it seems like a clear case where the dentist is not fulfilling their responsibility or reasonable expectations for an in-network dentist. Is it the case that you disagree with this statement, or that you agree but this logic is not a sufficient defense?

> I was planning to counterclaim for my time. Is that reasonable?
No.
Post your entire dental history and billing records to the internet and we will take a look.

I'd like to prepare for the scenario that the dentist's claim is found to be invalid and the court finds for me. What could I counterclaim or what do others typically counterclaim? I don't believe there is anything else in my dental history or records to support a counterclaim. This is more an issue that I think this claim is frivolous and is wasting my time.

I am very open to doing my own research but I haven't found appropriate resources, possibly because I am searching for the wrong terms. If you know of any resources, please send the links.

Thanks!