Chicago, IL asked in Arbitration / Mediation Law and Health Care Law for Illinois

Q: I received a surprise invoice from a pathologist after a procedure at the dentist. Is there any way I can dispute?

I had a procedure done at the dentist. I asked several times what the full amount of costs would be ($900 all in!). They wanted my health insurance ID. I asked why, they said it's for the pathologist but it will be covered by insurance: no problems there. I confirmed this twice since I have an HMO and wanted to know whether I needed a referral. I was ensured that I didn't. Now - after the procedure - I receive a $540 invoice from the pathologist (which I never ever had contact with, nor did I provide them with my info). I contacted the dentist and they say they can't do anything about it. I am not willing to pay the invoice since I wasn't give a choice (to send tissue to the pathologist or to postpone the procedure) or a price beforehand. The procedure already costs me $900 out of pocket (which I was aware of beforehand) and $540 was just added without me knowing. Can you advice? Thank you.

1 Lawyer Answer
Tim Akpinar
Tim Akpinar
  • Arbitration & Mediation Lawyer
  • Little Neck, NY

A: An Illinois attorney would need to advise, since insurance practices are governed by state law. But your post remains open for three weeks. One option, before seeking meaningful input from a local attorney in the Chicago area could be to explore what the carrier could do. With surprise invoices, carrier examiners see them with more regularity nowadays, and sometimes they are able to advise or review the claim. There's no guarantees there - it could depend on the carrier, the policy, the services, the basis for the surprise invoice, and experience of the claim examiner. Good luck

Tim Akpinar

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