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Responsibility for Medical Bills

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  • 10-20-2009, 02:50 PM
    arimpact
    Responsibility for Medical Bills
    Hi, I'm wondering if someone can help me understand if I'm responsible for a dental/medical bill. I had a wisdom tooth pulled in July this year that cost around $800. Prior to the operation, the receptionist at the dental office called my insurance and told me the insurance will cover 85% of the fee, and printed out an estimation of coverage and my due fees. Based on that estimation, I went ahead with the operation, 2 months later i get a bill for that 700$ which apparently was rejected by my insurance company. I called both the insurance and the dental office and from what i can gather, there was a mis-communication when the dental office asked about the coverage. My teeth were impacted and apparently impacted teeth doesn't get covered under dental (where there wouldn't be a deductible) it would be covered under medical(where there will be a deductible) The insurance have no phone log of how the question was specifically asked. I'm wondering if this can be considered a case of detrimental reliance. I have the printed estimation as dispute evidence, does that count for anything?

    Thanks for your help in advance!
  • 10-20-2009, 04:32 PM
    Antigone
    Re: Responsible for the Medical Bill
    Quote:

    Quoting arimpact
    View Post
    Hi, I'm wondering if someone can help me understand if I'm responsible for a dental/medical bill. I had a wisdom tooth pulled in July this year that cost around $800. Prior to the operation, the receptionist at the dental office called my insurance and told me the insurance will cover 85% of the fee, and printed out an estimation of coverage and my due fees. Based on that estimation, I went ahead with the operation, 2 months later i get a bill for that 700$ which apparently was rejected by my insurance company. I called both the insurance and the dental office and from what i can gather, there was a mis-communication when the dental office asked about the coverage. My teeth were impacted and apparently impacted teeth doesn't get covered under dental (where there wouldn't be a deductible) it would be covered under medical(where there will be a deductible) The insurance have no phone log of how the question was specifically asked. I'm wondering if this can be considered a case of detrimental reliance. I have the printed estimation as dispute evidence, does that count for anything?

    Thanks for your help in advance!

    You can certainly avoid paying the bill directly to the dentist and then deal with a collector later. I'd personally rather work with the dental office than a collector any day;)
  • 10-20-2009, 04:55 PM
    cbg
    Re: Responsible for the Medical Bill
    So why don't you simply submit the bill to your medical carrier?
  • 10-20-2009, 08:44 PM
    arimpact
    Re: Responsible for the Medical Bill
    I already talked to the dental office regarding this and they are very defensive about it. Saying I should have checked insurance policy myself and completely ignoring the fact they estimate they give me a printed estimate. Granted, I understand that point of view. But this is the first time I used dental insurance independently and I figure the receptionists who probably does this on a daily basis as part of their job would know better than a novice like me about what's covered and what's not.

    I'd like for this to not go to collection either since they will probably slap on interest, I'm wondering about my leverage to avoid this bill altogether with the given information.

    I've also sent a dispute of the bill to my medical carrier, though since the situation is no fault of the carrier I highly doubt I'll get a favorable answer from them.
  • 10-21-2009, 05:48 AM
    lealea1005
    Re: Responsible for the Medical Bill
    Quote:

    Quoting arimpact
    View Post
    I already talked to the dental office regarding this and they are very defensive about it. Saying I should have checked insurance policy myself and completely ignoring the fact they estimate they give me a printed estimate. Granted, I understand that point of view. But this is the first time I used dental insurance independently and I figure the receptionists who probably does this on a daily basis as part of their job would know better than a novice like me about what's covered and what's not.

    I'd like for this to not go to collection either since they will probably slap on interest, I'm wondering about my leverage to avoid this bill altogether with the given information.

    I've also sent a dispute of the bill to my medical carrier, though since the situation is no fault of the carrier I highly doubt I'll get a favorable answer from them.


    Did you give them your medical insurance card as well as your dental insurance card?

    The receptionist called your dental insurance, verified wisdom teeth extraction was a covered service, and received an estimate of what the dental insurance company would reimburse. The receptionist can only go by the information given to her from the insurance company's representative.
  • 10-21-2009, 06:20 PM
    cbg
    Re: Responsible for the Medical Bill
    Well, it IS your responsibility, not hers, to check on your insurance....
  • 10-21-2009, 06:43 PM
    Betty3
    Re: Responsible for the Medical Bill
    When it comes right down to it, you are ultimately responsible to the dentist for any amt. your ins. does not cover. You received the services.
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