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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Legal
Satisfied Customers: 118760
Experience:  JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
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We live in Illinois. My husband has dental insurance through

Customer Question

We live in Illinois. My husband has dental insurance through his employer. We had a great dentist we all loved. When we started seeing this dentist she has inquired why I had never had gotten partials and I told her because we could not afford them. She looked at our insurance policy and on my next visit she said that partials are indeed covered with a very small co pay of something I bleieve at that time was around $100.00. I told her mulitple times on that visit and my subsequent visits over the next few weeks that if it, the partial (s), was not covered I DO NOT need or want them because we live paycheck to paycheck and we cannot afford them. She agreed everytime and she said she knew they were and there would be no problems. She proceeded with fittings, etc. Several weeks later I received 3 letters from my insurance carrier denying the claims for the first partial my immediately called them and they explained why and I then immediately called and talked with her receptionist and informed them. They said they also had received one of the three letters and that the dentist was in the process of getting it approved that I should not worry it was taken care of. I went in for my next visit a few days later and I asked her about the letters and she said she had resubmitted the claim and it was covered and if not it would be taken care of. I told her again if it is not covered by insuarance do not order it we cannot afford it, and once again she told me not to worry. She ordered the partial, I had never received a bill on it, had 2 adjustments, and other than for the adjustments it has been sitting in the case never being worn. It has been over 2 years now and is taken me to small claims court and of course does not and says she would not ever would have agreed to an agreement like that. In Illinois do I have a legal leg to stand on. The only witnesses I have have are her employees that I believe under oath would tell the truth but would lose their job and I do not want them to lose job, but she is wanting me to pay almost $800.00 for something I told her multiple times and her agreeing not to have made because I could not afford it.
Submitted: 6 years ago.
Category: Legal
Expert:  Law Educator, Esq. replied 6 years ago.
Unfortunately, under the equitable theory of unjust enrichment and quantum meruit (for the work done), when an insurance company does not pay for work and you did have the work done, legally you owe for that work and unfortunately, even though they said they believed the insurance would pay, if the insurance does not pay you are the ultimate person responsible. This is why the judge is not listening to you, because the legal theories are not in your favor.

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Customer: replied 6 years ago.
EVen though she was told and instrusted before she ever took the impressions that if it was not covered not to make the partials that I did not want them. I instructed her not to and she did so anyway?
Expert:  Law Educator, Esq. replied 6 years ago.
Once you accepted them I am afraid that you became liable for them under the legal theories I mentioned.
Customer: replied 6 years ago.
I did not know I had a choice because when I went in for my appt she said oh by the way your partials are here. I then asked her if the insurance had paid and she said it was all taken care of and to enjoy my knew teeth. I knew something wasn't right and I never wore them. They are still in the case exactly how they were whenever I carried them out of their office, dust layered accross the top of the case and all...she had told me she couldn't send them back to the lab or have them remade for anyone else because they were made for me.
Expert:  Law Educator, Esq. replied 6 years ago.
I am afraid that the problem is they were made and you cannot now refuse to pay. Your oral statements do not matter, since there was an actual hand to hand exchange of the property. Had you refused to take them from the dentist you would have had a much stronger claim since you could have argued you never received what you agreed upon.