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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Business Law
Satisfied Customers: 118777
Experience:  All corporate law, including non-profits and charitable fraternal organizations.
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I have been to a dentist for a regular cleaning, but did not

Customer Question

I have been to a dentist for a regular cleaning, but did not like how my case was handled. As a procedure in the first visit, the dental hygienist took the x-rays and concluded that I needed a deep clean or "scaling". I would end up paying out-of-pocket for this procedure and he also gave me a estimate for a second treatment which was way more expensive. Because of that, I decided to go to another dentist and get a second opinion. At the same day, I had a panoramic x-ray and it was concluded that I only needed a regular cleaning. They also gave a estimate for a treatment, but in this case, the pricing was more reasonable.
In sum, my insurance paid for the dentist who I received the dental cleaning and did not pay the first dentist whom just gave a consult. Now, the clinic and the insurance company claim that I am responsible for the bill of $175.00 for a diagnosis that did not make sense to me. Plus, the clinic stated in the bill that I did the same procedure in the other dentist.
My question is about my right of getting a second opinion. Does a patient have a right to get a second opinion as part of his or her coverage?
Submitted: 1 year ago.
Category: Business Law
Expert:  Law Educator, Esq. replied 1 year ago.
Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.
Not all insurance plans provide payment for a second opinion, so you have to actually read you insurance plan description. The plans that do pay for second opinions mostly require prior approval from the insurer to get a second opinion, but again that varies from plan to plan and you need to read your plan description to find out if second opinions are covered.
Whether or not second opinions are covered, ultimately when an insurer does not pay a doctor's bill, the patient is legally liable. If the first doctor misdiagnosed you or improperly diagnosed you then you could seek to dispute the bill on that basis. If the doctor does not agree to waive the bill for their improper diagnosis, then it is possible for you to sue in small claims court for breach of contract and failure to provide proper care and diagnosis as malpractice (you will need your second dentist to testify how the diagnosis was improper or incorrect).