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Dental Billing and Insurance Issue
SOme background:
In 2004 I cracked a tooth and had a crown put on it. At the time I didn't have insurance and I paid cash for it. In 2009 I chipped the crown. I had moved 1500 miles so was unable to go back to the original dentist. I find a dentist, go in, give them my insurance information, they call to get approval, comes back that the replacement is covered 50%. I pay the balance, get the work done and move on with my life. Now 2 years later I get a bill for the other 50%. As it turns out, my insurance will not cover a replacement crown if it is less than 10 years old. Apparently it doesn't matter if they didn't pay for it in the first place. I spoke with the billing department for the dentist who admitted that they never actually got approval for the specific procedure and never mentioned to the insurance company at time of approval that they were replacing an existing crown because "the insurance company had no record of a crown already existing" Now, the crown didn't need replacing. The doctor said so. It could have been fixed (which would have been covered) but she thought that replacing it was a better choice because it would be solid. As the price was pretty close I opted to go with the new one based on the fact that I was told that replacement was covered. Now my question: do you think I owe the balance or is it their fault that the insurance wouldn't cover it? The way I am feeling is that I was lied to in order to get a more expensive, unnecessary procedure. |
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I think you owe the balance UNLESS you have a "final bill" or something that indicates insurance will/would pay the other half. You can dispute the bill but my feeling is if you get sued the argument will be that you GOT the product/service and, therefore, you owe. I have no idea why it took so long for the insurance carrier to get back to the Dentist to get back to you. I'm not saying it's fair - I'm saying I think that's how a decision would come down. The other argument is, "You only agreed to this because insurance would pay for it? If they did not pay you would not have had the work done? So you knew the work wasn't necessary?" Know how I know that? It actually happened to me - same thing. Dental insurance. |
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