Page 1 of 2 1 2 LastLast
Results 1 to 10 of 14
  1. #1
    Join Date
    Jan 2017
    Posts
    4

    Default 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?

  2. #2
    Join Date
    Feb 2008
    Posts
    1,179

    Default 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?

  3. #3
    Join Date
    Mar 2013
    Posts
    18,340

    Default 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.

  4. #4
    Join Date
    Nov 2013
    Posts
    7,056

    Default 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?

  5. #5
    Join Date
    Jan 2006
    Posts
    38,867

    Default 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?

  6. #6
    Join Date
    Jan 2017
    Posts
    4

    Default 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.

  7. #7
    Join Date
    Jan 2006
    Posts
    38,867

    Default 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?

  8. #8
    Join Date
    Jan 2017
    Posts
    4

    Default 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.

  9. #9
    Join Date
    Jan 2006
    Posts
    38,867

    Default 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?

  10. #10
    Join Date
    Nov 2013
    Location
    in alto mare
    Posts
    1,123

    Default 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.

    1. Sponsored Links
       

Page 1 of 2 1 2 LastLast

Similar Threads

  1. Other Insurance: Insurance Coverage Per Occurance vs. Aggregate Annual Coverage
    By Tamaraabel in forum Insurance Law
    Replies: 11
    Last Post: 10-11-2015, 11:45 PM
  2. Sales Agreements: Dealership Misled Car Buyer About Having 24 Hours to Obtain Full Coverage for New Car
    By DanM in forum Cars and Dealerships
    Replies: 4
    Last Post: 06-05-2015, 07:48 AM
  3. Service Providers: Insurance Fraud by Dentist
    By Rita Hoeffner in forum Consumer Law
    Replies: 2
    Last Post: 01-12-2013, 11:38 AM
  4. Health Insurance: Dentist Said My Insurance Was Covered - but Wasn't
    By LotsOfNoodles in forum Insurance Law
    Replies: 1
    Last Post: 12-15-2009, 04:00 AM
  5. Debt Collectors: Dentist/Insurance Billing Malpractice
    By laurabdora in forum Debts and Collections
    Replies: 1
    Last Post: 05-09-2009, 09:20 PM
 
 
Sponsored Links

Legal Help, Information and Resources