Irvine, CA asked in Civil Litigation, Contracts, Insurance Bad Faith and Insurance Defense for California

Q: My dentist refuses to abide to the insurance in-network contract and has charged me more than the allowance for braces.

The insurance has already called them more than once to inform them that there is an allowance but still they are overcharging me. A financial agreement was signed and the dentists stated on the agreement that those were the allowed insurance and treatment charges but it was all a lie and fraud. My insurance company doesn't seem to be doing anything about it and the dentist is not correcting the charges. Can/should I sue my dentist or the insurance company for fraud/false statement and advertisement or not protecting their clients of fraudulent statement/charges of their in-network providers?

1 Lawyer Answer
Maurice Mandel II
Maurice Mandel II
  • Newport Beach, CA
  • Licensed in California

A: You could file such a lawsuit, but IMO what you really have is a run of the mill breach of contract suit against the dentist. This really is not something to be excited about, and it is not going to go to the Supreme Court. You should write a calm and polite letter to the dentist with a copy of the contract and the Insurance letters, that says, basically: "This is what we contracted for. This is what the insurance allows and this is all that you are entitled to bill me for." You can say that you have consulted with an attorney and that you will take all appropriate legal action to preserve your legal rights. If he continues, sue him in small claims court, possibly for a violation of the Fair Debt Collection Practices act- pursuing the collection of a debt that he knows is not owed.

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