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  1. #1

    Default Doctor Recommended an Oral Appliance That Was Not Needed

    My question involves malpractice in the state of: CA

    Hello everyone, my question is about a medical bill. I had seen a specialist for cluster headaches and the doctor asked if I had a night guard and how old it is (for grinding teeth). She told me it was due to be replaced and she could get my medical insurance to pay for it so I agreed.
    My next appointment she did the molds and I signed a paper agreeing to pay what my insurance doesn't.
    I saw my dentist soon after and was told the night guard is fine and does not need replacing. I have since received a bill for the new one for $900 after insurance. I have yet to do the fitting appointment and pick up the new guard.
    I feel upsold and misled, is that at all enough standing to back out of this? I have spoken to the doctor and she is not letting me out. I have never been in this position with a doctor before. What recourse do I have? Thank you

  2. #2
    Join Date
    Jul 2018
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    1,061

    Default Re: Misleading Treatment

    Quote Quoting MIVGTI
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    She told me . . . she could get my medical insurance to pay for it so I agreed.
    My next appointment . . . I signed a paper agreeing to pay what my insurance doesn't.
    Before I read further, I want to emphasize these two sentences. Having you sign an agreement that you would pay whatever your insurance didn't cover clearly implied the possibility that, regardless of what the doctor told you, your insurance would not cover the entire cost.

    It's also worth pointing out that it is always the patient's responsibility to know or find out what his/her insurance will or won't cover.

    Moving on...

    Quote Quoting MIVGTI
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    I saw my dentist soon after and was told the night guard is fine and does not need replacing.
    Ok...so you got conflicting opinions from two different professionals. Presumably, however, your dentist is not an M.D., much less a specialist in the treatment of headaches. Right?

    Quote Quoting MIVGTI
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    is that at all enough standing to back out of this?
    Not sure what you mean by "standing" in this context, but nothing you posted suggests to me that you have any basis for not honoring your agreement to pay for services rendered in excess of your insurance coverage.

    Quote Quoting MIVGTI
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    What recourse do I have?
    Recourse for what? Nothing in your post suggests that anything legally wrongful occurred.

    You apparently are having buyer's remorse and don't want to pay the $900 and are grasping at an opinion rendered by someone with a very different field of expertise. Frankly, that doesn't make any sense.

  3. #3
    Join Date
    Jun 2014
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    2,990

    Default Re: Misleading Treatment

    It does not matter. But did you read every word on the paper before you signed it ?

  4. #4

    Default Re: Misleading Treatment

    Thank you for your reply. I guess you are right, no matter what someone tells you personally, once your signature is on a paper it's over with.
    I have always trusted my doctors, it sounds like it was my bad believing what I was told, that this was necessary and appropriate treatment and that my out of pocket would be minimal.
    I've never had a reason to not have confidence and trust in a doctor, lesson learned.

    Hello, yes I did read it and completely understood what it said. Again, I was told one thing by someone I thought I could trust. I have told several people about this experience and not one of them has thought i was in the wrong, which led me to posting here. Though the above reply is in all reality absolutely correct, I would still welcome other opinions here as well.

  5. #5
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    23,820

    Default Re: Misleading Treatment

    Medicine is not an exact science and two professionals can disagree on the best treatment without either of them being wrong or untrustworthy.

  6. #6
    Join Date
    Jul 2018
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    Default Re: Misleading Treatment

    Quote Quoting MIVGTI
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    I have always trusted my doctors, it sounds like it was my bad believing what I was told, that this was necessary and appropriate treatment and that my out of pocket would be minimal.
    I've never had a reason to not have confidence and trust in a doctor, lesson learned.
    Two things here: as "cbg" said, doctors disagree all the time about an appropriate course of treatment. What I find curious is that you seem to be assuming that what your dentist told you trumps what the medical doctor/specialist told you. I can't understand why you're doing that. It would be a little like taking the opinion of podiatrist about a dental matter over the opinion of a dentist.

    Second, doctors know virtually nothing about insurance. Their staff members tend to be better informed, but they are not insurance experts. For any sort of non-routine treatment, it is imperative that the patient confirm with the insurance carrier the extent to which coverage exists.

  7. #7

    Default Re: Misleading Treatment

    Absolutely, I agree with what you are saying. It's just when a doctor says "I can get your insurance to pay for this", and "your current night guard is old enough to need replacing", it's a hard pill to swallow later when you find neither is true. It is like a doctor saying your walking cane is worn out when it really isn't. Keep in mind that I have not had this night guard fitted or picked it up, so I'm not expecting anything for free. I don't even mind paying for part of it and never getting it, which is what i may propose. I also never had intention of suing or anything of the like. In a perfect world I would pay for my last office visit and be done with it, I was more curious if that would be a possibility.

  8. #8
    Join Date
    Oct 2006
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    15,112

    Default Re: Misleading Treatment

    Quote Quoting MIVGTI
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    Absolutely, I agree with what you are saying. It's just when a doctor says "I can get your insurance to pay for this", and "your current night guard is old enough to need replacing", it's a hard pill to swallow later when you find neither is true. It is like a doctor saying your walking cane is worn out when it really isn't. Keep in mind that I have not had this night guard fitted or picked it up, so I'm not expecting anything for free. I don't even mind paying for part of it and never getting it, which is what i may propose. I also never had intention of suing or anything of the like. In a perfect world I would pay for my last office visit and be done with it, I was more curious if that would be a possibility.
    The problem is that the night guard was custom made for you, from molds taken from you. It cannot be fitted to or sold to anyone else. The Dr. did not make the night guard, another company did and they will not take it back. You signed a contract for it, and you will be held to that contract. Your best case scenario is that you accept that and get your new night guard and pay for it. Your worst case scenario is that you refuse, and you end up in collections and pay even more in the long term, with no new night guard.

  9. #9
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    23,820

    Default Re: Misleading Treatment

    Quote Quoting MIVGTI
    View Post
    Absolutely, I agree with what you are saying. It's just when a doctor says "I can get your insurance to pay for this", and "your current night guard is old enough to need replacing", it's a hard pill to swallow later when you find neither is true.
    So why are you so intent on believing that the dentist is 100% right and the doctor is 100% wrong?

    It is not up to the doctor whether or not the insurance will cover it. Why didn't you check? It was, after all, your responsibility and not his.

  10. #10

    Default Re: Misleading Treatment

    You're right cbg, I should have checked and not taken the doctors word as gospel. For that I will pay.

    llworking, I suppose I trust the dentist more for a few reasons. He's one of the best in town and I've known him since I was a child, and as far as night guards go his training is probably comparable to the md. The thing that bugs me is that from one night guard to another there isn't a whole lot of difference, it's a molded plastic bit to keep your teeth apart. I wouldn't be asking my dentists opinion on a broken foot or a kidney transplant.

    It sounds like there's no doubt I should go ahead and pay for it, so I probably will. Thank you again for your input.

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