Wisdom teeth out for braces...Is this a possible lawsuit?

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#1 Post by **SideKick3QT** » Wed Jul 09, 2008 5:23 am

I had my wisdom teeth removed at a University medical center in March 08. I had a consultation back in October 07. After the consultation I was given an estimate of 347.50 included with my insurance deduction so I set up an appt to have the procedure done. I called numerous times between that time to verify the price and was told every time that it was the correct price I would have to pay.
They also told me that full amount of 347.50 would have to be paid prior to having the surgery done. So the surgery date comes and 30 minutes before I go to the office I call them to verify the price one more time and they said it was correct.
A week later I have issues with the surgery site so I go in to get checked. While on the phone they tell me they gave me the wrong price and I owe $1,095.
They claim the $347.50 was the amt my insurance would pay not the amt I was to pay out of pocket. How do you make that mistake OVER & OVER again?
Can I sue them?

#2 Post by **TumbleDryLow** » Wed Jul 09, 2008 9:59 am

Unfortunately, humans make mistakes. But what's really unfortunate is when they make the same one over, and over, and over again.

I'm not a lawyer, but I would suspect that unless you have it in writing what the final price was going to be, you would have a hard time taking legal action. Even if you did have something in writing, if it says "estimate" or "quote" that gives leeway for a potential higher price.

What I would do in this case is speak to someone as high up on the chain as possible and explain the situation. If they don't budge on the price say you need to be put on a payment plan--which is the least they can do.

Good luck.

#3 Post by **artroxu** » Wed Jul 09, 2008 11:45 am

Just curious, I have training as a medical assistant and am familiar with this stuff. When you called each time did you speak with the same person? Did you get verbal quotes from the office or your ins. carrier or both? Ask the office if they keep records of phone calls made and the subject of the call. As Tumble said, look for writen documentation stating the price. Also, are you the responsible party on the insurance or are you covered through someone else? Look through your ins. procedures booklet if you have one and try and find out whether it is your responsibility to verify coverage through your ins or if the responsibility lies with your doctor. Look at your insurance info. It looks like you have what is called "coinsurance" which means you have to pay a percentage of the procedure cost out of pocket instead of a fixed amount. Most plans are 70/30 insurance/patient or 80/20 respectively. If you are 20 or 30% give a copy of this info to your doctors office, it could be as simple as a data entry error. Also talk to the doctor, provide as much evidence and explanation as possible. If he doesn't budge I would contact your insurance and see how the claim was filed from your doctor. If you know your coinsurance is a certain percentage and you are told that is something else and they are trying to collect on you, go to a legal professional. That should be a last resort.

Oh and if you're doctor is "out of network" you may be stuck with paying the balance. However you may be able to haggle on the final price because of the circumstances and being repeatedly misinformed, however this would still count on who's responsibility it is to verify coverage, you or your dr. office.

#4 Post by **purpleteeth** » Wed Jul 09, 2008 1:47 pm

I have done medical billing before and to be honest, no total cost can be accurately given until after the procedure is done -- as insurance does not always pay, despite making promises to pay. You are responsible for the full cost despite insurance and when insurance doesn't pay, that then is totally up to you how you pay for it.

#5 Post by **ArchAngle** » Wed Jul 09, 2008 3:23 pm

347.50 would have to be paid prior to having the surgery done

What does the receipt for this say? Paid in full for services, Payment for services? There must be a receipt after you paid 347.50 up front before having the service. What's it say?

Though your multiple phone calls and checking and rechecking the price may suggest even you might have throught the price was too good to be true. Even so, check the receipt for the paid up front amount.

#6 Post by **chef** » Thu Jul 10, 2008 7:07 am

Can you sue them? Of course. Will you win a settlement? No, not without written documentation.

#7 Post by **SideKick3QT** » Sun Jul 13, 2008 6:23 am

Just to update everybody, after getting the run around with the company I got in contact with the office manager and she pulled my chart to do some investigating. She ended up waiving the $1,095 I was charged for the procedure since it was the clerks mistake for quoting me the wrong price.

Such a weight off my shoulders!!!!

I think im going to send her a fruit basket or something. Its the least I could do for the ONE person who actually tried to help me after 4 months!

#8 Post by **kirjax** » Sun Jul 13, 2008 8:47 am

that is unfortunate but yes it does happen and unless you do have something written from them in documentation you have no case. Even if you tried you'd spend more money putting out to the courts then it would even be worth!! You'd end up losing money then actually winning much of it back.

This is just one of those

things in life!!

#9 Post by **SideKick3QT** » Mon Jul 14, 2008 10:04 pm

Well I did not have any documentation that was given to me and the lady took care of it and I dont have to pay a dime!!!! goes to show ya!