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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Legal
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Experience:  JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
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Connecticut: I went to a dentist and provided Aetna Insurance.

Resolved Question:

Connecticut: I went to a dentist and provided Aetna Insurance. "Supposedly" they verified the insurance, and then did $775 worth of dental work. Despite paying my families previous dental claims for many years, Aetna found a reason to not pay this claim.

They also retroactively pulled money back from every dentist we ever visited, saying we never had (or paid for) dental insurance. I spoke with Aetna a year ago, and they just blew me off saying it was not their responsibility. I said that if they didn't pay all these other dental bills, I would not have been in this mess owing Two Thousand to various dentists. Their clerical error cost me a small fortune, and put me into bad graces with local businesses.

We now have 3 dentists looking for money. My wife is paying on one (because she wants to stay in good with doctor), and I reuse to pay on the other two because I feel that a "Clerical Error on the part of Aenta, does not equal debt on my part". Especially when I genuinely thought we had dental coverage (though looking back, we never seemed to have had it, even though they paid). The two bills in question are for $775, and $335.

I have received my first Small Claims for $775. They are not only going after me, but also my wife who had never been to the office, nor ever even spoken to anyone on the phone. Basically, they are just going after my spouse because it seems convenient, even though she had zero to do with the debit.

I now have Two Connecticut Superior Court Centralized Small Claim forms that want an answer of "I Disagree", "I Owe Part", "I Owe, but need more time", and Counterclaim. One for me, one for my wife. What should I say? Am I completely wrong in thinking that this is a Dentist/Aetna dispute? If either of them did their due diligence, this never would have happened.
Submitted: 1 year ago.
Category: Legal
Expert:  Law Educator, Esq. replied 1 year ago.
Thank you for your question. I look forward to working with you to providing you the information you are seeking.

I am afraid that ultimately, the insured is liable for bills when the insurer does not pay, even if the dentist had agreed to verify your insurance. I am sorry to say that the responsibility for knowing coverage under insurance is the insured party's responsibility. Thus, the insured should know whether or not they have a dental plan or not and if Aetna made an error and paid for something you did not have, under the legal theory of unjust enrichment you would still be liable as the insured.

The only possibility you have is if you can prove the dentist did not actually check and lied to you about coverage, then you have a chance at arguing the dentist was liable for causing this debt because you would not have agreed to treatment without insurance. The problem with this argument is that under the legal theory of "quantum meruit" (for the work done) the dentist could still seek to recover for whatever work you actually received from them as you did receive the benefit of their work.



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Law Educator, Esq., Attorney
Category: Legal
Satisfied Customers: 90268
Experience: JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
Law Educator, Esq. and 15 other Legal Specialists are ready to help you
Customer: replied 1 year ago.

As stated, they are also coming after my wife too. Does Connecticut law allow a spouse to get sucked into this? Or can I get her taken off as a Defendant? Other than relation, she had nothing to do with this ie: Not a guardian nor co-signer, or whatever.

Expert:  Law Educator, Esq. replied 1 year ago.
Unfortunately, under CT law, medical expenses are considered marital obligations meaning that they can pursue both husband and wife for medical debts.

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