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MShore
MShore, Attorney
Category: Legal
Satisfied Customers: 25285
Experience:  Negotiate, Draft, and Review many complex commercial agreements each year.
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Hello, My daughter had dental implants installed and was told

Resolved Question:

Hello, My daughter had dental implants installed and was told by the dental provider that they had got approval from my dental insurance that they would cover 20%. I have an invoice that shows what I was to pay, $4950.00 and what my dental insurance was covering approx $2000.00. I paid my designated portion in full. Proceedure was performed and approx 4-6 weeks later the dental implant office called and said that my insurance was not going to pay and that I was responsible for the $2000.00 balance. After contacting my dental insurance provider I found out that the dental implant office only got a preliminary "verbal" approval of the $2000.00 (20%) coverage, not the required written approval that was nessesary according to my dental insurance provider, Which notified me that upon formal review of the claim submitted by the dental implant center the insurance claim was rejected.

I feel as though I was tricked into giving my business to this dental office before they completed their due diligence concerning any insurance coverage that would be paid by my dental insurance. Was this a form of bait and switch was performed just to get my business? I would have used my normal dentist which told me this would not be covered under my dental insurance plan, but when I shared this with the office that I was assured that they could get 20% approved cor coverage by my Insurance, hence my decision to use this provider. So, am I responsible for the $2000.00 unpaid balance?

Any input is highly appreciated.

Many Thanks in advance,

John Risvold
Submitted: 1 year ago.
Category: Legal
Expert:  MShore replied 1 year ago.
Thank you for the post john, I am happy to assist you by answering your questions. Did the dental office submit a request for written approval before the procedure was performed?
Customer: replied 1 year ago.

No they did not. they called the Insurance co. while my wife was sitting in the office, they came back in the room and said they just got off the phone and got $2000.00 approval. (I just verified this with wife right now)

Expert:  MShore replied 1 year ago.
Thank you John, and your insurance company does not dispute that it offered a preliminary approval, is this correct?
Customer: replied 1 year ago.

No they say they never offered any verbal approval as the proceedure performed is not covered.

Expert:  MShore replied 1 year ago.
Thank you John, then you would not be liable for any additional sum as you paid all that you are obligated to pay, the sum claimed as owing is owed by virtue of the misrepresentation that your insurance authorized the procedure, which is not true. You should obtain a written statement from your insurance company detailing the facts and expressly stating that it never authorized the procedure. This letter would later servea s evidence should the dental office sue you or seek to engage a collection agency to pursue the matter. Please let me know if this does not answer your questions or if you have any follow up questions. If I have answered your questions, please positively rate my answers.
MShore, Attorney
Category: Legal
Satisfied Customers: 25285
Experience: Negotiate, Draft, and Review many complex commercial agreements each year.
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