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My dentist told me my treatment was pre-approved by insurance. Now they've sent the debt to a collection agency.
Anonymous2 views3 answers
At the time of treatment I made it very clear I wouldn't go ahead unless it was covered. She assured me it would be and I was told by her staff it was pre-approved by my insurance company. When the insurance company then rejected the claim, she assured me once again that she would sort it out and I wouldn't have to pay.
I heard nothing further from her for seven months when her office called me in a threatening way claiming I owed the $1800. She had never been in touch with the insurance company again. I reminded her of her commitment to do this and she then sent a letter to the insurance company which again rejected the claim.
A few months later I received the standard (on the line of abusive, harassing etc) calls from a collection agency.
Do I have to pay? I don't believe I owe her.
While you may be responsible for the debt, because of the agreement you signed, the dentist may have violated the Consumers Legal Remedies Act ("CLRA"), which is at Cal. Civil Code sec. 1770, subdivision (a), paragraphs 5, 14, and 17, perhaps other paragraphs. The dentist or his/her staff has misrepresented to you that the insurance was covered. Otherwise, you would not have agreed to the procedures by this dentist, and you would not have done it had you known it would not be so covered. I don't know how your insurance policy works, which may impact your claim, as it may be that you were supposed to get some form of pre-approval. Since I don't know that, I cannot address those concerns.
If you believe that the dentist violated the CLRA, you should send that dentist a letter by certified mail, return receipt requested and keep a copy of the letter, of course. Below is a link to my web site for some sample dispute letters. If you modify letter #2.1 for your situation and add the reference to the CLRA and use the word "misrepresentation" I think that should suffice.
If you were harassed, please be sure to send the debt collector a letter describing the harassing conduct and advising them of your dispute with the dentist, by enclosing a copy of your CLRA dispute letter. Of course, send that by certified mail, return receipt requested. Send letter #1.1. A debt collector is also required to send you an initial letter advising you of your right to dispute a debt and all communications must state they are a debt collector and the purpose of the call is to collect a debt.
Well, if there was a paper (called a written contract) you signed when you registered with the practice stating you knew you were liable for all charges, then you have answered your own question. That contract is enforceable. It likely allows for the debt to be sent out for collection after a specified time that you agreed upon if you refuse to make the account good.
Dig out the contract you signed and read it. Take it to a local lawyer for a review. Without it, no observation is very meaningful, right?
Apparently you agreed with your dentist's office that you would remain ultimately liable for any charge, which isn't unreasonable or unusual, because your dentist's office isn't your insurer, they're your dental provider.
That agreement probably says that they make no representations about your coverage, and that nothing said by anyone varies the terms of the agreement you signed - also typical and not unreasonable. The dental office staff has lots of experience dealing with insurance companies, and it's normal and part of their job to help process your claims, but they're not the ones who need to enforce your insurance policy, since you're obligated to make good on any liabilities, you're the one that needs to get the coverage.
So rather than focusing on the dentist's office staff and their apparent inability to get your treatment covered, or their heavy-handed collection tactics, why don't you focus on YOU getting YOUR insurance company to pay for this treatment? Do you know the details of this underlying issue, like why did the staff assure you that it was covered, and why did the carrier reject your claim? What exactly does your policy say about coverage for this treatment? Did you exhaust you appeal rights with the insurer once the claim was rejected?
Disclaimer: Please note that this answer does not constitute legal advice, and should not be relied on, since each state has different laws, each situation is fact specific, and it is impossible to evaluate a legal problem without a comprehensive consultation and review of all the facts and documents at issue. This answer does not create an attorney-client relationship.
