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Questionable billing practices

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Two months ago, I visited an endodontist to repair an abscessed tooth. During my initial visit I was in alot of pain and my face was badly swollen. While I was in that
condition, the endodontist informed me that a second tooth was probably going to
cause me the same problems so she strongly suggested I have it repaired,

Before making the appts. to have both teeth fixed, I asked her receptionist if my insurance would cover the repairs. She said yes. I was never informed of the cost of the services or in any way advised that my insurance would not cover the entire expense.

My insurance covers 100% of most dental treatments with an annual limit of $1500. In the 12 years that I've had the insurance, I have never once even approached the limit. The dentist I'd used for 10 years always pre-approved large expenses through my insurance company before suggesting treatment. The endodontist did not do the same.

After I had all the work done, I learned the problem the endodontist diagnosed in the second tooth probably would not have caused me any trouble. It may have only been a small shadow on the x-ray. In other
words, its questionable if there was any problem at all.

The endodontist billed my insurance company for over $2000. The endodontist then sent me a $700 bill, which is the amount over my insurance limit. Again, the endodontist and her staff never advised me of the cost before doing the work and lead me to believe my insurance would cover the entire expense.

Am I required to pay the $700 since I was not advised of the cost in advance? Also, the treatment for the second tooth was probably not necessary in the first place. Do I have any recourse in this matter?





You have to pay it. She did the work & deserves to be paid. Unless you can show that the endodontist should have known that the second tooth didn't need any work, you'll have to pay the entire bill. You should have asked what the total bill would be. Work out a payment plan & get it in writing.

This is not legal advice and you are not my client. Double check everything with your own attorney and your state's laws.

[This message has been edited by Tracey (edited July 28, 2000).]


Thank you Tracey but I disagree with your opinion. If you enter a store, hair salon, etc., the prices are clearly posted. I find it hard to believe that dentists are somehow immune from advising a person of the cost before rendering a service and, aside from this endodontist, I have never known one who didn't.

Her receptionist told me the insurance WOULD cover the costs. Had they advised my that the insurance would not cover $700 of the bill, I would not have had the work done.

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR>Originally posted by Tracey:
You have to pay it. She did the work & deserves to be paid. Unless you can show that the endodontist should have known that the second tooth didn't need any work, you'll have to pay the entire bill. You should have asked what the total bill would be. Work out a payment plan & get it in writing.



Senior Member
Reprinted by IAAL

New Member posted June 16, 2000 12:02 PM
I recently had to have a dental crown re-done- Now the dentist is telling me that neither one of my insurances (2 of them!) is going to pay for this work because the original crown was less than 4 years old. This amounts to $355.80 of which he is "willing to take" $177.90, and wants me to "come by the office to sign a financial agreement". I feel that I should have been notified before the work was done that the insurance was not going to pay for this. I also feel like that if it had been done correctly in the first place, I would not have had to have it redone.

IP: Logged

Member posted June 16, 2000 12:18 PM

My response:

Oh, you're not going to like this, and I don't expect you to believe me - - for all I know, you may just be venting on this Board and will do as you believe no matter what is said here - - but, here goes anyway:

1. Your dentist is just that, a dentist. He's not your insurance agent, and he, nor his office is required by any law, to memorize your insurance policy. That's your responsibility. The dentist and his staff deal with innumerable insurance companies, and it's not up to him to "dispute" coverage decisions - - that's your job. If there's coverage, great. If not, the dentist, as a business person, looks to you, his patient, for payment of services rendered. He doesn't have to wait until your insurance problem is resolved. You are imbued, by law, to know the terms, conditions and all other perameters of your own insurance coverage. If you don't, that's not the dentist's fault or problem. He's a dentist, not an insurance agent.

2. With regard to the fact that your crown needed replacing, unless you can show malpractice with another dentist saying that what your dentist did was "below the standard of care in your community", there's nothing you can do. Dentistry is not an exact science, and everyone's dental make up is different, along with bodily chemical make up; indeed, what may work for you, may not work for me. What may last in your mouth, may not last in mine, and vice-versa.

So, if your crown work didn't last as long as it was estimated to last, it may very well be within your own mouth, and your own chemical make up that is causing the problem. Also, from your post, it would seem that if your insurance had covered the latest round of dental work, you wouldn't be complaining.

I would suggest that you sign the agreement for payment, before he sends your account to collections.

That's my take on this issue.


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[This message has been edited by I AM ALWAYS LIABLE (edited July 29, 2000).]

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