Legal Question in Health Care Law in California

I owe my dental office $700, but don't think it's fair for me to have to pay it. My dentist recommended a replacement for a crown I had. It was going to cost $1300, but I agreed to get it because the office showed me an invoice that said the patient responsibility was only $600. After I got the crown, I got a bill asking me to pay for the rest of the cost too. My insurance apparently only covers 1 crown every 5 years, I had gotten the first in '07. My dental office had only given me some guess of what they thought I had to pay, apparently. They sent an appeal to my insurance company, but it was denied.

After reading my dental insurance info more closely, it said that it is recommended that the dental office send in an approval to the insurance company first for procedures over $300, to see if or what cost would be covered. Was it not the office's responsibility to at least ask if I wanted to do this, especially for an expensive $1300 procedure? Is it not common courtesy, if not required, if they care about keeping their patients and treating them fairly? If they had sent in the request, to which the answer would've been that my insurance wouldn't cover the crown, I would not have gotten it at all. Now I'm responsible for the full $1300 because, I feel, my dental office failed to follow protocol.

I haven't spoken to them about it yet. How can I resolve this?


Asked on 11/05/09, 9:23 pm

1 Answer from Attorneys

Melvin C. Belli The Belli Law Firm

One even if your dentist had followed procedure the claim still would not have been approved.. Are you really sure you didn't want the crown and instead walk around with a missing tooth or part of it.

What I suggest is that you share your concerns with your dentist see if he will cut a little off the bill or allow you to make payments and pay him.

I would think having a good set of teeth is worth the extra $600. George Washington would probably agree too.

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Answered on 11/19/09, 3:04 am


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