Q: Is it legal for dentist office to do this... to say there is no coverage so they can charge cash price, it was COVERED!
Told daughter needed braces; but not covered. offered choice of braces & Invisalign. Had planned on braces, couldn’t afford invisalign, they said NO price difference $5,495 braces OR $5,495 Invisalign.
Ex’s coworker got braces & it WAS COVERED. Called dentist office, said wasn’t covered. Called insurance company, IT WAS! Called dentist agreed to submit claim. Weeks passed, office sends email showing claim denied. called insurance, they forgot X-rays! Went back & forth 8 mths.
Finally approved. We have flat $1,800 copay. Already paid $2,930, they say still owe $1,820, bk invisalign cost more. Insurance sent $745. They took insurance check & credited account.
I understand invisalign cost more than braces; which is why I asked price difference. Had they been honest & not claimed to have called my insurance to check for benefits (by the way, I found out they never did actually call my insurance, Blue Shield keeps a record of all calls and THEY NEVER CALLED.) So, again, they lied.
A: Fraud includes concealment of information that a person is legally obligated to disclose. You could have both Negligent misrepresentation and concealment in the facts that you describe. No one can predict what the outcome would be in Court. You can go to a local attorney for an evaluation of your case and/or file in Small claims for a refund of money beyond what the insurance would pay, and for other damages.
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