Can I sue my kids' dentist for overcharging based on the estimate I was given?

Question

An estimate was prepared when I scheduled their appointment. I was told the office staff would verify this estimate with my insurance company to receive a confirmation of what services would be covered and if there was any problem, they would let me know. I agreed to this estimate and scheduled the next appointment. AFTER (not before) the completion of all services at the end of the next appointment, I was told they were not able to contact my insurance company to verify any coverage information. I paid the estimated amount and instructed the woman to file the claim with the insurance company and I would wait to hear the result. The next call I got was from a collections company saying the ins co didn't pay. At that point I talked with ins co and they said there was no coverage since dentist was not in network. Now I am faced with huge bill I never would have agreed to if I would have known up front ins wouldn't pay. Has anyone sued for this before? What was the result?

An estimate was prepared when I scheduled their appointment. I was told the office staff would verify this estimate with my insurance company to receive a confirmation of what services would be covered and if there was any problem, they would let me know. I agreed to this estimate and scheduled the next appointment. In reviewing the info from my dental coverage, it said a % would be covered as long as the specialist was referred by our network dentist. AFTER (not before) all was done at the end of the next appointment, they told me they were not able to contact my insurance company to verify any coverage information. I am in a small town where people are generally honest and trust one another so I trusted them. I paid the estimated amount and later the ins co said I was mis-reading their benefit info and they would not pay. Now I am faced with huge bill I never would have agreed to if I would have known up front ins wouldn't pay. Has anyone sued for this before? What happened?

Sorry - never done this before. Didn't realize I was duplicating information - just trying to clarify the ins co info appeared to cover part of the dental work even though the dentist was not in their network since the in-network dentist referred me to them. My other big issue is how the office staff didn't follow through as they promised they would and how everything is found out after the work is done - no way to "return" if costs are not as agreed upon. I would be fine if it was slightly more for unforeseen expenses in the process, but this is four times the expected bill. There must be some way to hold medical professionals responsible for what they tell us. I know I should have checked into things further and agree I'm partly responsible but not 100% as it appears from their communications.

Answer 1

It would be very difficult to sue because you don't have any damages. Legally, damages means something they did cost you money.

If you pay the bill, then you can sue the dentist for breach of contract. (Your damages are the amount you paid over the cost of the estimate) Depending on the contract, you may have a chance of winning.

At this point, your best bet is to contest the charges and notify the collection agency that you did not agree to the charges and do not owe the money. Also notify all of the credit agencies (IN WRITING) that you do not agree with the charges and that you did not authorize the charges.

You can hope that they sue you (not likely) and present your case to the judge who may agree with you.

Or you can offer to make small payments if they will reduce the fee to half. (More likely) This option may improve your credit record. Remember though, if you negotiate and agree to pay any part of the remaining balance, it will make it nearly impossible to dispute the charge later because the negotiations reaffirm the debt.

If this goes on your credit record, it may affect your intrest rates on unrelated credit cards and loans. It may impare your abolity to borrow money in the future.

It will make it impossible to get a mortgage. If you ever plan on buying a house, handle this well in advance.

Answer 2

You want to sue a dentist because YOU did not investigate beforehand whether or not this dentist was a participating dentist with your insurance company? Sorry dear---YOUR FAULT....it is YOUR responsibility to check to see if the dentist or ANY provider you choose participates with your insurance company... it is NOT the responsibility of the dentist to tell you IF YOU DON'T ASK. Plus the fact that what you were given before the work was done was called an ESTIMATE.... look that word up in the dictionary... it is NOT an EXACT... it is a reasonable GUESS as to what something will cost... but, like in MOST cases, (try dealing with any contractor who issued an ESTIMATE)----costs are USUALLY higher then the initial estimate due to rising costs of equipment or materials used or more serious improvements needed or whatever...... suck up the costs yourself and LEARN from your BIG MISTAKE... that of not asking the dentist if all costs would be covered by your insurance company PRIOR to him starting the work.

Answer 3

You can try and sue, but you have two big problems. One is that an estimate isn't an exact figure, it's just that an estimate, it could be more or it could be less.

As for the dentist not being in your network, it seems that your ins company should have said something when you picked the dentist, you may be able to win on that issue. Best of luck.

Answer 4

An estimate is just that an estimate. It is not the fault of the dentist that your insurance wont pay. It is your responsibility to know the dentists and doctors in your network. File an appeal with the insurance company. Some of them partially cover out of network.

Answer 5

Iffy. You might end up having to pay on this one. You could file a grievance with your insurance company, and they may end up covering part of the cost, which would be better than nothing.

As for getting a civil judgement against the dentist, if the dentist can provide records showing he wasnt insanely price gowging you (i.e. everything has a reasonable profit margin) I don't think any judge would find him in the wrong.

Probably not the answer you wanted, but probably the correct one, good luck.

Answer 6

Normally you are given a list of doctors in your network by your insurance - its our duty to check and see f they are in it.