My dentist is charging me for work they told me my insurance company would cover.?

Ok, so I had some dental work done about 2 months ago. I had something like 7 fillings done which amounted up to about 1200 dollars. I aprooved the procedure and signed paper work saying that my insurance company would cover the other half. So I paid 600 bucks and got the procedure done. I then get a letter in the mail 3 weeks later saying I still owe 600 dollars, so I called the dentist office back and said “I paid my portion, my insurance is suppost to cover the rest.” The lady frorn the dentist office says that my insurance doesn’t cover white resin fillings so I need to pay the other half. I told her that the dentist office (infact I was her) told me that MY insurance would cover the other half, I said I wouldn’t have gotten it done if they weren’t going to cover the other half. So she says that they don’t guarantee that my insurance is going to cover my half. So I said but your the one who told me they would cover it, the paper I signed said they would pay the other half. So I call my insurance and they say they don’t cover white resin fillings, they said that its my responsibility to cover it.


What the @$@# #%#@$%! How can they do this? Should I contact the better business bereu? Should I write them a letter? Get a lawyer? I called another dentist office and they said that’s the secretaries fault for not researching it properly, then I called another office and they said “well u got the work done, you gatta pay”


Please someone help me with some words of advice….

My dentist is charging me for work they told me my insurance company would cover.?
With the dentist, I'm afraid you're going to have to consider it "lesson learned." The dentist's scretary is not an agent of the Insurer and thus cannot make peomises on their behalf. In the future, don't get anything done without a pretreatment estimate from your dentist and insurance company - in writing.


I doubt that you can sue them (except perhaps in Small Claims Court), because no lawyer will take your case (they can't make any money on it).


If you want to go the Small Claims route, it is possible that in the mediation phase (if that's they way Small Claims works in your jurisdiction) you may be able to get them to forgive part of the amount as a good will gesture. It would be a long shot, but perhaps worth trying.





Now, as to your insurance company - you always have a right of appeal, so use it. The worst that can happen is that they will say "no." Unless, of course, your insurer is allowed to keep you out of court and use binding arbitration to resolve disputes. That isn't worth the risk, because if you lose in binding arbitration, you have to pay their lawyers.


So read your policy/contract and make sure you meet any deadlines. You may also consult your state's Department of Insurance, if there is one.
Reply:get some legal advice
Reply:I advise you to pay it. Dentist's offices, just like doctor's offices file paperwork with insurance companies. Either the insurance pays or it doesn't. The patient is responsible for paying any balance remaining. You should have called your insurance company prior to having services done to see if they cover it. Your grown, it is your responsibility, no one else's. That is why you sign a form saying you will pay what the insurance doesn't.


Unfortunately this is an expensive lesson for you on responsibility. In the future you will know to take the time and read your benefits package or call the insurance company first.
Reply:This is the racket between insurance and doctors in America. No one want's to pay and no one wants to take responsibility.


They stick you for outrageous insurance premiums then they don't pay.





Find out who regulates the insurance industry in your state and file a complaint. You can do it on line in most states.





Then find out what govt agency regulates dental providers and file a complaint with them.


You may still have to pay it, but you can cause them some heat-burn which is always gratifying.





Remember too that you don't have to pay it all at once. If you end up having to pay send them whatever you can afford each month even if it's only 20 bucks. They'll just have to live with it. They may threaten you but so what.
Reply:Unfortunately you will probably have to pay the amount. Check the paperwork you signed. It likely syas something like they bill your insurance as a courtesy but you are ultimately responsible for the bill if the insurance company does not pay. I would push the issue with the dentist if you were told the insurance company would cover the rest - telling them the rep at the dentist office told you the resin fillings were covered. They will likely give you a cash discount, but you still may be screwed.
Reply:Contact the insurance company and request that they provide reasoning for their denial of benefits.





It's possible that the reason the denied the benefit is that the fillings were not in a conspicuous location like one of the front teeth.
Reply:In the end you are responsible for the charge. It is BS sometimes that Doctors and Dentist have that right, but we have to pay. You can file a civil suit against the office, the secretary, and maybe get her to confess that it would be covered, but in the end...it's YOUR bill. I hope you find the right answer and get things resolved...sometimes they will cover some of it to NOT go to court!
Reply:Sorry, but it's your job to be aware of your own coverage. The office can verify coverage, but mistakes are made, often. It can be false info. from the insurance company or the person verifying it might get it wrong.





Your only hope is to calmly talk to the doctor who owns the practice and ask for mercy. For the sake of good business and upholding a good reputation, he may waive the fee or reduce it. Otherwise, you do have to pay. It's wrong, but it's the way it is.





Even your insurance company won't guarantee what they tell you on the phone. Ypou need to always consult your summary plan document and have the procedure pre-approved if you can.
Reply:That happened to me to. The dentist gave me an estimate on how much I would have to pay so I had the procedure done. Then later after I paid I got an extra bill for 100$. She said the insurance didnt cover it. I will save the money by skipping a year of dental insurance. If they aint gonna pay why have it? I just keep my teeth as clean as possible on my own.
Reply:Whenever getting any kind of dental work done, always contact the insurance company before allowing the dentist to touch you. Have a copy of the treatment plan ready to read over the phone to them, and ask questions, like, what will you cover, and so on. Because if you dont, then you do end up with the bill. Sorry.
Reply:With all honesty the best route in this case would probably be to pay the remaining balance, but if you are like me, fighting the bill is the more likely option because it is morally wrong. The problem is that insurance and medical don't always agree with the moral side because it costs them money.





If you decide to fight it you should first gather information. Starting with paperwork. Insurance policies, documents from the dentist, and bills. Finding a witness to substantiate that the receptionist told you that your insurance would cover the half in question might also prove benificial.





As for your insurance, you are responsible for knowing and understanding your policy so unless you find a loop hole there is nothing you can do with the insurance.





Here is where it gets questionable. The receptionist presumably does not have a J.D. in other words is not a lawyer. Therefore is prohibited from giving legal advice, i.e. interpreting a contract in the form of a insurance policy. You might be able to come back on that in court and prove that she gave unsound legal advice pertaining to the billing. You might recieve a judgement in your favor, but it is very unlikely.





Your best bet would be to work with the dental office to set up payments for the remainder of the bill, to insure that it is not placed on your credit record. Regrettably you chances of winning this dispute are minimal and possibly could end up costing more then the amount of the bill itself. Good Luck.

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