Do I have to pay for a crown if I ended up having the tooth pulled?

I had a root canal on tooth 30 and had a crown made for that tooth 10 months ago. My insurance paid 60% and I paid 40% in advance of receiving the crown. However, the root canal failed and I was referred to an endo who re-did the root canal and it failed again. After all this treatment I had to take money out of my pocket because I ran out of benefits. On the endo’s advice, I waited several months and into this calendar year to see if the tooth would resolve on its on, which it never did. Now I will have to have the tooth pulled. Do I have to pay for the crown that I never received? I want to get an implant but the insurance won’t cover it because they think I have a crown on that tooth.

Asked on September 2, 2012 under Bankruptcy Law, Texas

Answers:

B.H.F., Member, Texas State Bar / FreeAdvice Contributing Attorney

Answered 8 years ago | Contributor

Generally speaking, you should never have to pay for something that you did not recieve.  However, part of the answer to your question will depend on whether your dentist/endo did any "prep" work for the crown.  If your endo did do some work, then you should receive a refund of the amount not earned.  Another factor which could affect your answer is whether you signed any written agreements regarding the crown.  If you signed an agreement which does not authorize refunds when any work has been performed, then you may have some difficulty getting as much of your refund.

So to answer your question, based on the facts as you describe them without the other variables above, you should be able to get a refund or a credit towards your next procedure.  If your endo refuses, then you need to contact your insurance company and file a complaint regarding fraudulent billing since it appears they billed your insurance prematurely for a service they never rendered. 


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