Do I have a claim against insurance company if they did not disclose that if I stopped my coverage with them that I would also lose my dental insurance?

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Do I have a claim against insurance company if they did not disclose that if I stopped my coverage with them that I would also lose my dental insurance?

I turned to the insurance company for help in applying for health and dental insurance 4 months ago. They applied me to health insurance and dental insurance with a separate company, so they are 2 different organizations. Also, I paid them the money for their service. Last month I asked them to cancel my health but not my dental insurance, Then, 2 weeks ago, I had a dentist visit and dental insurance covered 75% of my visit, 15% I paid at the end of my visit. Everything seemed fine. However, yesterday I received an e-mail from the dental office that my dental insurance was canceled and I have to pay $2420. I emailed to the insurance agency that I didn’t ask them to cancel my dental coverage, I asked to cancel only health coverage. So they told me that the dental insurance can’t work without health insurance. And in case of health cancellation, dental coverage will be canceled as well. I didn’t know about that. When I was in their office 4 months ago, nobody in their office told me how health and dental coverage work together, and nobody provided me with paperwork and handbooks, where it is written that dental plan is a part of health plan and dental plan can’t work separately. Also, they did not provide me with full information about the insurance plan and, even more, information about the cancellation. What will be your suggestion?

Asked on March 21, 2019 under Insurance Law, Pennsylvania

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 2 years ago | Contributor

If before cancelling, you specifically asked them if the dental insurance would stay in place and they told you that it would, then they have to stand by what they said and provide the dental coverage; if they don't, you could sue them on several grounds, such as fraud (lying or misrepresenting), breach of contract (violating the agreement), and/or promissory estoppel (intentionally promising you something which they logically must have known you would rely on and act on to your detriment).
But if you did not ask, you have no grounds to take legal action. They are not responsible for knowing your intentions (i.e. if you meant to cancel both or not), or state of your knowledge (if you knew that you could not have dental on its own or not), and do not have an affirmative duty to volunteer this information to you. You are responsible for managing your own insurance needs and obtaining the information you need to make decisions. So while they had to answer any questions honestly and accurately, they don't have to go out of their way to make sure you understand the consequences of what you are doing. So unless you asked them, they would not be liable.


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