A dentist told me he took my Insurance; did the work. Insurance didn't pay. Do I owe the full amount?
California. I had a root canal done by a dentist who said my insurance would cover all but the co-pay of $440 (which I paid). When the insurance declined to pay because he wasn't a preferred provider, he billed me for the full amount ($1340; balance due: $900). I sent him a check for $460 (the amount the Insurance would have paid him if he'd been a PPO). He rejected it and now I have collections coming after me. I signed saying I would pay what my insurance didn't cover--BUT he misrepresented to me prior to that that he was on their plan. I had been sent straight to his office (in pain) by a dentist who was on the PPO list, and I didn't check the second dentist's name to be sure he was listed (which is why I am willing to pay what the Insurance would have paid-my bad). Now I'm being charged the full amount, and my credit has been damaged. I also lost out on money that could have been credited to my closing costs on a re-fi because my score was less than 700. It had been 802 prior to this incident. I would like to take the dentist and collection agency to small claims for adjudication of this debt.
So, the dentist misrepresented his status on my plan, did the work, then billed me the full amount, refused my check, then refused my offer of mediation at my expense and turned me over to collections--I guess my question is: Does he have the right to deceive me into getting the work done, then insist I pay the full amount due based on the signed agreement stating I will pay what the Insurance doesn't cover?
What recourse do I have?
- 9 years agoFavorite Answer
Yes, you do.
It's not up to the DENTIST to figure out how much the insurance pays on your behalf, it's up to YOU.
He has no duty to "represent" what your deal is between you and the insurance company. You're going to lose this in adjudication, or in small claims court, where ever it ends up.
Does he have a right to DECEIVE you? No. Did he deliberately lie? Probably not, and you won't be able to prove it in court, anyway.
Your recourse would be court, but you're going to lose. He did the work, you agreed to pay for whatever the insurance doesn't cover . . .. you need to pay for whatever the insurance didn't cover.
Lesson learned: always call your OWN insurance, every single time, to make sure the provider IS in network, and find out exactly what is covered, to what degree, under what circumstances.
- lucyLv 79 years ago
When you went to this dentist, most likely you signed a standard form that stated, you will be responsible for any payments not paid by insurance. Every doctor/dentist/hospital makes you sign this form just because in many cases insurance does not pay at all or non ppo etc.
When a provider is on a preferred ppo, they have to agree to the "negotiated" rate and many believe too low, so will not be on the ppo list.
You are stuck unfortunately. I guarantee the next time you go to any provider, you will be on the phone with your insurance 1st to verify.
- Tom ZLv 79 years ago
A day doesn't go by that a similar question isn't posted here.
First off, it is your responsibility to be sure that your plan covers the procedure and that the provider is part of the insurer's network. You do that, not by assuming the dental office has the necessary approval, but by personally seeking prior authorization from the insurer.
Second, you say that you "signed agreement stating I will pay what the Insurance doesn't cover". I don't see how you are going to overcome a signed agreement where you explicitly agreed to pay whatever the insurance didn't.
Expensive tuition in the school of hard knocks.Source(s): ...
- rtfmLv 79 years ago
You agreed to pay what the insurance doesn't cover. That would be 100 percent of his bill.
Sorry, I know it sucks -- but it is *always* the responsibility of the insured to make sure whatever they're having done is covered by their plan. Medical offices simply cannot keep track of every policy belonging to every patient that they have. That would be a full-time job for them. That's why they make you sign the type of document that you signed.
(It's also unlikely that one hit for a medical bill could reduce your score from 802 to 700. I suspect there are other reasons as well.)
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- ?Lv 59 years ago
You have no recourse. You did not make sure the dentist was in your network. This is solely your responsibility. He did not deceive you. He might be in network with the insurance company, but under a different plan. It happens all the time. Insurance did not cover any, you are responsible for the full balance.
- debijsLv 79 years ago
~~Unfortunately you will be held responsible for the charges. Providers can tell you anything, but it is up to the subscriber to verify everything with their insurance company before using any provider, lab, hospital, etc. It is just the way it is.
Call and speak to the office manager, explain what you were told and ask for a discount. It's the only hope you have. They will keep after you and turn you into collections, so you will have to pay.~~
- 9 years ago
You went out of network and it affected your credit because you did nothing about it. Items that are taken care of promptly don't go to collections, so your error was ignoring the initial bills...and prior to that checking to make sure he was in network. You could probably add flossing to the list of items you could have done to prevent a small item in becoming a big one.
- AnonymousLv 79 years ago
Yes, you owe the full amount.
He didn't deceive you - he guessed at what your insurance might cover, and he guessed wrong. It's up to you, to get the details of your insurance plan, NOT your dentist.
- David14Lv 79 years ago
Of course you owe the full amount. The work was done and YOU are responsible regardless of who is paying.
Your over entitlement and stubbornness have done nothing but hurt your credit.