Am I liable for mistakes on Insurance Website and Dentist Office.

I went to find a preferred provider on my insurance website since this policy only pays services performed by in-network provider. I went to this dentist listed as preferred provider and the dental office confirmed our coverage. After performing thousands of dollars of work, the dental office told me that I am not covered. They had called the wrong division of Humana to confirm coverage. I call insurance company and they said that their database shows my dentist as a non-PPO while the insurance website still shows her name as PPO. Both insurance company and dentist contributed to this error which is now leaving me with thousands dollars of bill. How and who should I pursue to relief this bill? What are my chances of winning?
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Answers (1)

James Charles Haigh

James Charles Haigh

Contributor Level 4
First thing I would do is print out the web site page where the insurer lists the selected dentist as a preferred provider - you need to memorialize that before insurer changes the page. Be sure your printer is set so that it will include the print date on the page as it is printed (to document the date you print it out).

Next, I would send a detailed letter to your insurer laying out the facts - give them another chance to rectify this by paying your claim. If they again refuse, then you need to locate an attorney experienced in "bad faith" insurance law - the insurer has an obligation to pay covered claims. You did everything you were supposed to do - you checked the web site to confirm the DDS you selected was a preferred provider, and you then had the DDS call the insurer to confirm coverage before the treatment. The insurer mislead you into believing the DDS was a preferred provider; clearly you would not have selected him/her if had been aware the insurer was not going to honor the claim. You may also try calling the Dept of Insurance and complaining to them about what happened. Your insurer needs to be more careful about listing preferred providers on their web site.

I would also notify your dentist that you are pursuing the insurance company. Although the dentist also mislead you into having the treatment done, at least the dentist performed services for which she should be compensated. My guess is that the dental office will agree to carry your balance pending your claim against the insurer.

Do not delay in calling an attorney - you need to act on this ASAP. There are statutes of limitation in California which operate to bar claims for damages if you delay too long in filing suit. A local attorney can explain this to you in detail and advise you as to your rights. Good luck to you!
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