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  1. #1

    Default 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!

  2. #2
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default 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.

  3. #3

    Default 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?

  4. #4
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default 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.

  5. #5
    Join Date
    Apr 2007
    Location
    Il.(near StL,Mo.)
    Posts
    5,252

    Default Re: Responsible for Medical Charges

    You can "try" for a reduced rate but they don't have to give you one.

  6. #6

    Default 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.

  7. #7
    Join Date
    Sep 2011
    Location
    OH10
    Posts
    17,019

    Default 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.

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