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Note: this is a real example, but I don't care nearly enough to fight it; I ask purely out of curiosity.

I was at the dentist and I had a few cavities filled in. My understanding from what was explained to me is that 2 of them were filled with white, and 2 with silver; insurance covers 80% of silver, but 0% of white. The dentist never mentioned that there were options, and never mentioned that the options cost different amounts of money.

For that matter, I never explicitly agreed to pay for anything. What makes a medical fee enforceable?

Edit: I could understand situations where the patient is incapable of communicating/deciding, but nevertheless needs urgent treatment, and how in a situation like that the patient would get the treatment and subsequently be responsible for paying.

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    Which jurisdiction? I'd imagine things like this are at least country specific; in the US, it's probably state specific. For example, some states have signs at car dealerships that you have a right to a quote for any works performed above XXX$. – cnst Aug 31 '15 at 0:44
  • Also, for what it's worth, insurance is usually still supposed to cover white filling if the filling is to be visible when one smiles. E.g., it's only not covered when the patient requires white filling in the back, where silver or white doesn't make much difference for casual appearance. – cnst Aug 31 '15 at 0:46
  • In this case the jurisdiction is NY, but I mean for the question to be more general (if the answer is "it depends", then what's the most common rule?). – Adam Zerner Aug 31 '15 at 0:50
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    Did you sign a patient consent form? Did that form indicate that you were agreeing to treatment? Did the dentist discuss with you what he was doing and ask if it was O.K.? Often dentists will do all of these things which will put you on the hook for paying for the service. It is unlikely the dentist would have known, absent previous experience, what exactly your dental insurance would cover for you in particular. An option, after the dentist has laid out a treatment plan, would be for the patient to wait until after discussing cost with the insurance company. – Dave D Aug 31 '15 at 1:22
  • I hadn't signed any form at the start of my visit, and can't remember signing anything like that in the past. I agreed to have him treat the cavities. I agree that it's unreasonable to expect that he'd know exactly how much my insurance plan would cover, but I would think that the doctor/dentist is responsible for communicating to the patient that there are multiple options and that the different options cost different amounts of money (amongst other costs and benefits). – Adam Zerner Aug 31 '15 at 1:42
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You sat in the chair, you agreed to the treatment. By doing so you implicitly agreed to pay the dentist his fee. Now, the price was not agreed beforehand so the exact amount is subject to negotiation. This negotiation is usually best pursued when you have the fillings in your teeth and the money still in your wallet - this is called "leverage".

The amount that your insurer reimburses you is a matter entirely independent of how much you pay your dentist. However, the difference in your ability to recover the costs are a valid point to raise in your negotiation.

  • You can implicitly agree to pay someone an unspecified amount? Also, I don't see how this is a matter of negotiation. The leverage the dentist has is the force of the law. The leverage I have is that I'm in control of my money. Naturally, I'm only going to pay as much as I'm legally required to pay, so to me this seems like an entirely legal manner. – Adam Zerner Aug 31 '15 at 2:39
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    @Adam In general, yes. It wouldn't cover unreasonable fees, but the idea is that you agreed that you would pay for the services, and if the precise amount was important you would have worked it out in advance. Incidentally, Dale: It's entirely possible there is a contract between your insurance company and the dentist; in that situation, your insurance company's policies do directly affect what the dentist can charge (and you might not be personally responsible for part of that fee). But when there's not, you agreed to be personally responsible for it. – cpast Aug 31 '15 at 2:48
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    "You can implicitly agree to pay someone an unspecified amount?" All the time - a plumber clearing a choke, a mechanic fixing your car - there may be estimates involved (or not) but the price is not agreed when the contract is formed. – Dale M Aug 31 '15 at 2:50
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    @Adam As for leverage, and outside of strict legal matters: Debts are not necessarily set in stone. Lawsuits are long, tedious, and expensive for both sides; if you in fact aren't willing to pay the full amount, people you owe money to are often willing to compromise and accept less in order to get the whole thing behind them. Because you have both the fillings and the money, the dentist needs to go through an expensive process to get the money, as opposed to just not giving you the fillings. – cpast Aug 31 '15 at 2:50
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    @cpast This is known as "The Golden Rule: the person with the gold makes the rules" :) – Dale M Aug 31 '15 at 2:53

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