Q: Dental Insurance - Are there any remedies for work done before the waiting period?
Husband had dental work done prior to his 6 month waiting period. No one at the office had told him that he had this waiting period (understandably, we have the duty to read all fine print). However, I went to my own dentist and they notified me immediately of my waiting period and wouldnt schedule anything until my wait was up. No one told my husband. Kind of feel like the DDS office was just trying to get money out of us knowing we had a wait period. Orr are we justtt Effd?
A: From your facts is appears that your dental insurance company provided adequate notice to you and applicable dentists, so you likely do not have a claim against the insurance company. Turning to your husband's dentist, your situation is not a clear-cut case. Unless the dental agreement states otherwise, the DDS' office is generally not required to notify you of potential billing problems (a contact law claim); however, most insurance companies require that doctor's offices pre-authorize treatment (except for emergencies) and prevent the doctor's office from charging you if the doctor's office made an error (lack of coverage is an error). Check you dental insurance (and probably give them a call too). If this provision exists (and there is a good chance it does), inform the insurance company and they will contact the doctor. I have handled claims like this in the past, so here is what you can expect: (1) expect to call the insurance company daily until the matter is resolved; (2) the doctor's office will either immediate waive the charge (unlikely) or dig-in-their heals; (3) you may need to file an appeal with the insurance company; (4) you will probably want to send a written request for explanation to the doctor's office (you can do yourself or have an attorney contact the doctor with law firm letterhead); and (5) if you are in the right, keep pounding at it (but NEVER loose your temper). From experience, this is an unpleasant and time-consuming process. You may want to contact a lawyer (but you do not need to). Advice aside, you are justified in feeling cheated and I wish you the best of luck in the process.
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