Stack of bills to pay3/16/2023 ![]() ![]() For future reference, you either need to get a clear written statement from the service provider that they will accept whatever the insurance company allows you (i.e. It is highly unlikely that the dentist actually lied to you about the cost, especially it is unlikely that he said anything that could be construed as a promise that the insurance company would provide a particular level of coverage. Your obligation to the dentist arises from the service provided plus the rarely-read clause in the financial agreement document that you signed at some point which says something like "We will submit claims to your insurance company, but you are ultimately responsible for any unpaid charges". ![]() The insurance company statement "You should not be billed for this service" has no legal force, but it does weakly suggest that they blame the dentist somewhat (the alternative is to simply say "This service is not covered"). If a service provider egregiously breaks the terms of an agreement with the insurance company, the provider could be sued or at least dropped from the in-network list. The insurance company has some (minor) leverage over the dentist, if the dentist has breached his contract with the company. You can call the insurance company in advance of the procedure and get a definite decision as to whether the service in question is covered, and if they say "Yes", then you are covered, otherwise you will know you are not, and can plan accordingly. However, the chances are virtually non-existent that they are actually obligated to pay the dentist. The brute force approach would be to sue the insurance company for failing to cover something that they are (ostensibly) obligated to pay on your behalf, under the terms of your insurance contract. Your recourse is to object to the insurance company, since they are the ones who have an obligation to you. ![]() You have an obligation to pay the dentist (in exchange for services) the insurance company has an obligation to cover certain expenses of yours (in exchange for money) the dentist has an obligation to the insurance company to accept certain terms specified by the insurance company (in exchange for being listed as 'in-network'). It is legal for a dentist to bill you for services rendered. Since my insurance says " You should not be billed for this service.", does that mean he is not allowed to bill me as an "in-network" dentist? I would have never done this procedure if my insurance didn't cover it but since they made me believe it was part of the process I thought they had experience with this sort of thing before. Is this legal, can he send me a bill when he's an "in-network" dentist and my insurance denied his claim? Today I get a bill in the mail from my dentist at $594 and the receptionist stated that my insurance did not allow any benefits for this procedure so the dentist gave me a ($150) discount so the bill is for $444. The amount billed on my insurance claim shows $500, the member rate shows $319, and if this claim got approved I would have just owed $95. ![]() You should not be billed for this service. Well my insurance didn't approve it because of the following reason:īased on the diagnostic materials provided by your dentist, this service does not meet this requirement for coverage. My dentist's office assured me that this is part of the process and they would have to send it paperwork so they can approve. I then got a notice from my insurance stating that they need additional information from the dentist before they can approve this claim. A couple months ago I went to the dentist for a crown, he noticed my jaw clicking and he said that I would need a " occlusal adjustment" to help fix this.īased on what I was told, I was under the impression that my insurance would cover this. ![]()
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