Responsibity for Medical Charges Not Covered By Insurance
My question involves insurance law for the state of: NY
Hi all,
Last year I went to the dentist and was informed that I needed to have several cavities filled. Subsequently, a few weeks later I had the cavities filled as suggested. One year later I've now been informed that I need to retroactively pay for the fillings ($1000) since my insurance benefits didn't include fillings. I recognize that I am responsible for knowing the limits of my insurance coverage and should have refused service, nevertheless, do I have any legal recourse to avoid paying the fee? At the time I asked the dentist whether it would be covered by my insurance and they said yes! But before filling my cavities the dentist was fully aware that my insurance would not cover the fee (I have a copy of their records), yet did not advise me of this fact ahead of time. Shouldn't there be an agreement of payment in advance of rendering services or is this covered when initially joining a dental office?
I suspect that I'm liable but figure it's worth a shot to find a way out of the situation. More than anything else, it frustrating to have a $1000 bill pop-up when the dentist knew I would be paying for it.
Thanks!
Re: Responsible for Medical Charges
Sorry, but you are completely responsible for knowing what your insurance will and will not cover. It isn't the dentist's job to keep track of your insurance for you.
BTW, I have worked in Benefits for over 30 years and have yet to see a dental insurance plan that doesn't cover fillings. On the other hand, if you are talking about your medical insurance, I have yet to see a medical plan that would.
Re: Responsible for Medical Charges
Thanks for the insight. I understand that it is typical for some offices to have an "uninsured rate" as distinct from the traditional insured rate. Any truth to this? Perhaps I can negotiate down to this rate?
Re: Responsible for Medical Charges
They're not supposed to have two different rates. I'm sure some do, but they aren't supposed to.
Re: Responsible for Medical Charges
You can "try" for a reduced rate but they don't have to give you one.
Re: Responsibity for Medical Charges
They refer to that as the "cash" rate. You get it for paying cash immediately. It never hurts to ask though.
Re: Responsible for Medical Charges
Hi,
Yes definitely its your fault you should be asking to your medical agent rather asking to your dentist about the medical coverage.
Re: Responsible for Medical Charges
Without knowing if the policy applies a waiting period for non-preventive services or your original effective date, it's impossible to comment as to the details of your post.
For any services over $200, I would strongly recommend you tell your dentist to file a pre-treatment estimate to your carrier so you know up front what your costs will be prior to services being rendered.