QUESTION
If it turns out that I was asked to sign up for a dental procedure under false pretenses regarding my insurance coverage, can I get the money back?
Asked on Dec 07th, 2011 on Consumer Law - New York
More details to this question:
Recently I was asked to sign up for a dental procedure that I "needed." When I asked if my insurance covered it, the office said that it didn''t. I then had the procedure done. Later I investigated and learned that my insurance did in fact cover this procedure, but it has to approve it first, based on X Rays sent to it by this office to help decide whether it''s medically necessary or not. I confronted the office about this and it changed its story from "Your insurance doesn''t cover this procedure at all" to "90% of the time when we ask for authorization from your insurance, it gets rejected, so it''s just lying to you when it says it covers the procedure." I then asked this office to send an authorization to my insurance, to see if it could still pay for the procedure after I had it done. The insurance rejected the request, saying it wasn''t necessary. It''s now obvious that this office had me sign up for this procedure under false pretenses. Am I entitled to my money back?
1 ANSWER
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Ouch. Insurance. What a hassle. I hate to say this, but it was YOUR job to be sure that the procedure was covered before you had it. I'm sure there is a claims dispute procedure, and I suggest that you proceed with it along with the help of your dental office. They'll likely need to help you support that coverage is warranted.
I have had a case where the medical professional said everything was covered by insurance and no amounts were due and then a year later sent a bill to the patient for $1800. They backed off on that, and perhaps you can cut a deal with the dentist if the insurance claim doesn't pan out. Oftentimes insurance companies pay far less than private individuals, and I suggest you negotiate a reduced rate for the procedure. It's not clear how much is due or if you're able to pay, and those factors will play into what the dentist is willing to do.
Hopefully you'll be able to work out something fair to everyone. Be sure that next time you have any type of medical or dental procedure that you first confirm coverage with your insurer.
Answered on Dec 16th, 2011 at 12:19 PM