Do I have to pay dental expenses that my insurance didn’t cover because the provider didn’t tell me that they doesn’t work with my insurance coverage?

UPDATED: Sep 30, 2022

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Do I have to pay dental expenses that my insurance didn’t cover because the provider didn’t tell me that they doesn’t work with my insurance coverage?

I saw a dentist for the first time back in July 2016. I called the and they said that they accept my insurance ‘Solstice’. I had an annual check up, x-rays, and cleaning. They called me in December telling me that I owed them for the work done because my insurance is an HMO and they don’t work with it. I told them that they should have told me that before doing the work. They told me that it was my responsibility to verify that information with my insurance. I’ve never had to do that before. If I knew that they didn’t work with my insurance I would have gone to another dentist. This is clearly a mistake on their part. She told me that if I didn’t pay they are going to send my account to collections because I signed a paper saying that I would pay any services not covered by my insurance.

Asked on January 5, 2017 under Insurance Law, Florida


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 5 years ago | Contributor

Unfortunately, fair or not, they are legally right. 
1) The legal responsibility is on the insured--that is, *you*--to make sure you are covered. You are not allowed to rely on what the doctor tells you in this regard, but rather, you have to check with your insurer to make sure that they will pay for these procedures.
2) And by signing something saying that you would pay for anything not covered by insurance, you contractually confirmed your obligation to pay--i.e. you signed a contract that you would pay for all uncovered amounts, whatever they are.
So you are responsible for the cost, and could be sued for not paying.

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