Dental Scam: Was I Ripped Off for Crown?

Here's my situation: I had a crown put in the middle of May and an adjustment on the crown in June. Throughout this process, I received two statements from the Dentist saying that they expected my insurance to cover half the costs, and I would have to pay a total of $486 out of pocket - which I did. At my last adjustment, the receptionist told me they possibly calculated the costs wrong and that I still would need to pay an additional $50. I received the bill for this mid June stating I needed to pay $50 more - fine by me. Now at the beginning of THIS month, I received a second bill stating that I needed to pay an additional $480 because my insurance didn't cover the crown as expected. I call my insurance provider up to ask what the deal is. They tell me that on APRIL 14 (a whole month before my procedure began), they told the dental receptionist who called to confirm my benefits that the Insurance WOULD NOT COVER ANY of the procedure (they have this on their records staying they told her this specifically). Again, this was on April 15th. Yet the dentist and his financial assistant never said a word to me about this. Instead, as explained above, throughout the months of May and June they led me to believe that the insurance was approved, and I only had to pay half out of pocket. My questions: Was I ripped off by the dentist? Are they trying to scam me? And what should I do: Refuse to pay since it is their fault they got the bill wrong (and I NEVER would have agreed to the procedure if I had known it would have cost me so much out of pocket) or set up some sort of a payment plan? Do I have a case? Please help soon!
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Unfortunately for you, you don't have a case. The dentist performed the treatment and you are responsible for payment. From a practice management point of view, someone screwed up. Insurance requests a pre-estimate for crowns, bridges and dentures, but even if a pre-estimate is returned with benefits, the fine print has all kinds of disclaimers about possible changes in benefits depending upon a variety of possibilities. Your dentist should be doing a better job of determining what benefits you are entitled to. No dentist wants an angry patient. Frankly, I doubt that any insurance company keeps records of conversations with dental offices. We often call repeatedly regarding coverage problems and get different answers each time. What the dentist SHOULD do is explain why the insurance company denied benefits. It is possible that crowns are not a covered service. There are many possible reasons that a claim will be rejected, and--not infrequently it's an error--either in billing or in claims processing. Your dentist should go to bat for you if you are eligible for benefits, but he/she is not liable for a failure to get an insurance benefit (unless a billing error has occurred). It's helpful to everyone to understand what is covered and what is not, but unless the dentist is a closed panel contract dentist for the insurance company questions of benefits are between you and your insurance company. Sorry, Steve Bornfeld, DDS
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