D
dent
Guest
In April 2000, my wife's dental insurance changed from a PPO to an HMO. She called the Dentist's office to inform them that the insurance had changed.
In July 2000 she went in for her annual cleanings and presented her new insurance card (HMO) at that time. On this visit, they spoke to her regarding a procedure for her teeth, and asked her to come in for a consultation.
At the consultation, she was informed that her insurance would cover the entire cost of the procedure. ON THIS ADVICE, she agreed to have the procedure done.
Last Month (May 2001), we received a bill from the dentist's office for the entire $800+ cost of the procedure.
The insurance company informs us that NO inquiries were made regarding whether this procedure was covered by our plan (it is not). In addition, they inform us that if an inquiry had been made to the previous plan (PPO) that the inquiry would have been forwarded to the HMO department.
I feel that this is at best, a clerical error on the part of the dentists office, and at worst, blatant/ fraudulent misrepresentation on the part of the dental office. In either case, I don't feel we should be held responsible. I will take this to court if necessary, but I wanted to check if we have proper legal grounds/ precedent.
I read a FAQ the other day that this type of case (Donning?) often ends up in small claims, but there was no mention of typical outcomes.
This all took place in South Florida, and we currently live in Central Florida.
I apologize for being verbose, but I think all the information is relevant.
Thank You.
In July 2000 she went in for her annual cleanings and presented her new insurance card (HMO) at that time. On this visit, they spoke to her regarding a procedure for her teeth, and asked her to come in for a consultation.
At the consultation, she was informed that her insurance would cover the entire cost of the procedure. ON THIS ADVICE, she agreed to have the procedure done.
Last Month (May 2001), we received a bill from the dentist's office for the entire $800+ cost of the procedure.
The insurance company informs us that NO inquiries were made regarding whether this procedure was covered by our plan (it is not). In addition, they inform us that if an inquiry had been made to the previous plan (PPO) that the inquiry would have been forwarded to the HMO department.
I feel that this is at best, a clerical error on the part of the dentists office, and at worst, blatant/ fraudulent misrepresentation on the part of the dental office. In either case, I don't feel we should be held responsible. I will take this to court if necessary, but I wanted to check if we have proper legal grounds/ precedent.
I read a FAQ the other day that this type of case (Donning?) often ends up in small claims, but there was no mention of typical outcomes.
This all took place in South Florida, and we currently live in Central Florida.
I apologize for being verbose, but I think all the information is relevant.
Thank You.