Denver, CO asked in Consumer Law, Insurance Bad Faith and Small Claims for Colorado

Q: Hi! This is a dental billing issue. I am thinking to go to small claims court re it, but not sure it's worth it

I have received a quote from a dental company for implant, abutment and crown for 4 535$. This is with the consideration that my dental insurance will cover 50% of the first and second part of all work and my out of pocket will be 2212$. I thought that this quote means this info is checked with my insurance company and is guaranteed. I asked verbally and received a "yes" but didn't think i'll need a written proof as it is my first time doing an implant and i haven't had billing issues with dental companies before. FYI, i immigrated to US about 4 years ago and currently a green card holder. After the first part of work was done and I paid 1239$ I received an extra bill of approx 600$ where it was mentioned insurance declined coverage for "missing tooth clause". Researching now, I do see that 90% of all dental insurances have this clause, it is very common yet I had no idea when I received their quote I have to know about "missing tooth clause" as my tooth was missing, I told my medical

1 Lawyer Answer
Tim Akpinar
Tim Akpinar
  • Insurance Claims Lawyer
  • Little Neck, NY

A: A Colorado attorney could advise best, but your post remains open for three weeks. In terms of reimbursement efforts, they could depend on whether that how the clause was worded and the dental company's agreement. One option could be to consult with a Colorado attorney who handles medical/dental billing claims to review the clause and the agreement more closely to determine whether there might be any options that could enable coverage. Good luck

Tim Akpinar

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