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Misled About Insurance Coverage by a Dentist

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  • 01-05-2017, 10:57 AM
    briggs0013
    Misled About Insurance Coverage by a Dentist
    My question involves insurance law for the state of: Kentucky

    October 17th, I went in for a standard cleaning and a deep cleaning was recommended. The dentist provided me the pricing with insurance. October 18th, I see where the dentist requested an official estimate to my insurance company and the estimate was rejected, nothing covered. My dentist knew this would not be covered and still mislead me that it would be when I had the actual treatment for the deep cleaning performed on November 9th and November 23rd. They still provided me the covered pricing as if insurance would be paying.

    Is this my mistake? Or is my dentist in the wrong for this situation?
  • 01-05-2017, 01:10 PM
    hr for me
    Re: Misled About Insurance Coverage by a Dentist
    what documentation did you sign regarding what happens if the insurance doesn't pay? I suspect there should be language on the estimate given to you with the pricing on 10/17 and then probably something at time of service.

    Did you followup with either the dental office or your insurance prior to 11/9 to make sure it was covered? How did they mislead on 11/9 and the 23rd? Did you specifically ask or did they just not inform you? Both sides probably have ownership in the mistake depending on what was asked/said/not said by both parties.

    I have learned to be very very careful about what is going to be covered prior to any work being done because there are so many different plans/coverages and dental pricing that there is no way the dentist office can know them all. That said, have you discussed your concerns with the dentist's office?
  • 01-05-2017, 03:54 PM
    adjusterjack
    Re: Misled About Insurance Coverage by a Dentist
    Quote:

    Quoting briggs0013
    View Post
    Is this my mistake? Or is my dentist in the wrong for this situation?

    Your mistake.

    The dentist has no obligation to know the insurance details of hundreds of patients.

    He may have estimated something based on general information about dental insurance but it was entirely up to you to verify your coverage.
  • 01-05-2017, 05:41 PM
    budwad
    Re: Misled About Insurance Coverage by a Dentist
    I think you are misunderstanding. The dentist still gave her the price as though insurance was covering the balance even though he/she knew it wasn't.

    Perhaps the dentist is settling for what you will pay him.
    Quote:

    Quoting briggs0013
    View Post
    My dentist knew this would not be covered and still mislead me that it would be when I had the actual treatment for the deep cleaning performed on November 9th and November 23rd. They still provided me the covered pricing as if insurance would be paying.Is this my mistake?

  • 01-05-2017, 05:47 PM
    jk
    Re: Misled About Insurance Coverage by a Dentist
    Quote:

    Quoting briggs0013
    View Post
    My question involves insurance law for the state of: Kentucky

    October 17th, I went in for a standard cleaning and a deep cleaning was recommended. The dentist provided me the pricing with insurance. October 18th, I see where the dentist requested an official estimate to my insurance company and the estimate was rejected, nothing covered. My dentist knew this would not be covered and still mislead me that it would be when I had the actual treatment for the deep cleaning performed on November 9th and November 23rd. They still provided me the covered pricing as if insurance would be paying.

    Is this my mistake? Or is my dentist in the wrong for this situation?

    ok. So far you have not said the dentist tried to collect from you what the insurance company would have paid, if they approved the coverage so...

    what's the problem?
  • 01-05-2017, 07:24 PM
    briggs0013
    Re: Misled About Insurance Coverage by a Dentist
    The documentation the dentist had me sign did say the part the insurance pays was only estimate. But my issue is, my dentist contacted my insurance company for an official estimate of what will be covered. My insurance company has record of where this was requested and stated that these official estimates are mailed to me and my dentist. At the time, i was unaware that anything like this was being mailed to me so I never opened it.

    Today, I went and spoke with my dentist and they stated they never received this estimate. I'm not sure why they would request it and not get it nor follow up with them after not receiving it.

    To reiterate, my problem is that the dentist the day of service presented me paper work with my out of pocket and an estimate of what insurance pays, which is roughly 50%. However, prior to this, my dentist should have received paperwork stating none would be covered by insurance.
  • 01-05-2017, 07:40 PM
    jk
    Re: Misled About Insurance Coverage by a Dentist
    I'm still missing your point. If he has not asked for the money the insurance company would pay if they approved the claim, just what is the problem?

    but let's say he does bill you that amount;

    you had already had notice the insurance denied the prospective claim (even though you failed to open the mail) and you still showed up for the procedure. The dentist can presume you knew you had to pay for the entire procedure and still showed up and said nothing so...

    what is the problem here?
  • 01-05-2017, 08:26 PM
    briggs0013
    Re: Misled About Insurance Coverage by a Dentist
    The problem to me is that the dentist told me a particular procedure is covered, and provided me an estimated amount to be covered after they should have received paperwork saying insurance would not cover it.

    And actually, the above paragraph contains a series of events that sat with me the wrong way. I feel that it is unethical behavior so I am posting here to ask someone with more experience if there is any type of legal issue here. I felt like I was lied to so that my dentist could make easy money.

    And yes, I have to pay for the full procedure. Sorry, I assumed that this was implied.
  • 01-05-2017, 08:34 PM
    jk
    Re: Misled About Insurance Coverage by a Dentist
    The dentist said he had not recieved the denial. Do have proof otherwise?

    im not seeing how you see this as easy money for himself. He makes the same whether you pay for it or you and the insurance comply each pay 1/2 of the bill.

    Since you were given notice of the denial prior to the procedure, the only person at fault here is you for not taking the denial into consideration in your decision to proceed.

    Whats that you say; you didn't open the mail that held the denial? Whose fault is that?
  • 01-05-2017, 08:41 PM
    geek
    Re: Misled About Insurance Coverage by a Dentist
    You said there was an envelope with pertinent documents that you didn't open. How is that the dentist's fault?

    I just went through a number of cleanings and other work. You need to contact your insurance co and work with your dentist. There may have been a coding error.

    If not, then you are liable for the balance. Most dentists will work with you regarding payment.
  • 01-05-2017, 08:57 PM
    briggs0013
    Re: Misled About Insurance Coverage by a Dentist
    The documents were requested by my dentist. The insurance company sends them to both parties. I was unaware of the request. If my dentist had no interest in these documents, why would they request them.

    I understand that all of this could have been avoided had I gotten the procedure preapproved by my insurance. Live and learn, this is all new to me.

    I am focused on one thing. Deception. Telling me one thing while knowing something else to be true. I.E. Your procedure IS covered but we can only estimate the amount. But they received a document requested by them weeks before saying based on provided evidence, this procedure will NOT be covered.
  • 01-05-2017, 09:05 PM
    jk
    Re: Misled About Insurance Coverage by a Dentist
    You say they recieved it. They say they didn't. We KNOW you recieved yours and ignored it. I don't see any deception. I see somebody not wanting to accept blame when it is clearly theirs.


    Their request to YOUR insurance provider was as a courtesy to you. It is your obligation to verify your coverage.
  • 01-05-2017, 09:08 PM
    geek
    Re: Misled About Insurance Coverage by a Dentist
    Well, you probably signed something that said your bill was an estimate based on anticipated reimbursement. You will owe them for any balance not covered. If the work was done, the dentist should be paid- whether by the insurance co. or you. I think your beef is with the insurance company. Call them. Ask them why you were denied.

    Accusing your dentist of deception is a little premature, since you haven't all the facts in hand.
  • 01-06-2017, 07:58 AM
    hr for me
    Re: Misled About Insurance Coverage by a Dentist
    you didn't do your due diligence either with pre-approval yourself or opening the non-approval letter? But expect them to know more about your personal insurance than you do? This one is on you.

    I would hope the dental office would work with you if you go in nicely and not with guns blazing about their mistake and your anger over the situation. Maybe if you admit some fault, they will work better with you. If you try to totally blame them 100%, you should not expect for them to work nicely with you to resolve the issue.
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