Who is financially responsible for my dental bill: my insurance company, my dentist, or me?

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Who is financially responsible for my dental bill: my insurance company, my dentist, or me?

I recently obtained dental insurance under a plan that lists my dentist as a provider. I called my dentist to ask if they accepted my insurance. They said yes. I presented my insurance card prior to receiving care. After I received my cleaning, exam, and X-rays, I was informed that the dentist does not accept my insurance after all. The dentist said they have been trying to get removed from my insurance plan’s list of providers. The dentist wants me to pay the full price of the dental care, even though I was led to believe it would be covered by my insurance. What can I do?

Asked on February 13, 2011 under Insurance Law, California

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 10 years ago | Contributor

Normally, the patient is resonsible to the dentist for the cost of the treatment and then has the right to proceed against the health insurance provider if the insurer should have paid under the plan but did not.

In your case, *if* the only reason you either (1) went to this dentist or (2) had this procedure done was done being told by the dentist that they accepted your insurance, you would have a good case that you do not have to pay anything more than your normal copay, etc. for this treatement. (Going forward, they can make you pay the full amount if you're not on a plan they accept.) Because of the dentist's representations to you, which you reasonably relied upon, the dentist would be "estopped" from now trying to charge you the full amount. Of course, if you and the dentist can't work something out, you may end up on litigation if they try to sue you for  the money due...you will have to decide if the risk, cost, and inconvenience of collections and/or litigation is worth fighting this, or if you would be better served paying but complaining about this dentist to the state licensing board while seeking a new dentist. Even if you win, if you and the dentist fight, it could be expensive.


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