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I just moved from Florida to California. I went to my new dentist for a dental cleaning. I have dental insurance. I asked him, if he would tell me in advance the price, if I have to pay something. He answered, "Of course." I also asked him, if he was in-network with my dental insurance company. He answered, "Yes."

He billed $118 to the insurance company for a liquid that I thought it was mouth wash. The dental insurance paid $43, and I got a letter from the dentist that I have to pay the difference, $75.

As he never told me the price in advance, should I have to pay? If not, what would I need to do?

At this time, my plan is to pay, and look for a different dentist.

The only reason that I am thinking to do that is because I think that if I do not pay my credit score would be damaged. Also, hiring a lawyer would be more expensive.

However, I feel that he broke our contract not telling me the price in advance. I do not think that is reasonable $118 for a liquid that I thought was mouth wash. What can you tell me?

I found a question, that even though is not the exact case, gave me a lot of information.

Can a dentist charge for a treatment without written paperwork?

Additionally to the fluoride, that is the name of the liquid, he charged for X rays and the cleaning what was covered by the dental insurance. My previous dentist uses 45 minutes for the cleaning. This dentist used only 15 minutes.

My previous dentists never charged me for this "treatment." I think that what this dentist is doing is illegal, but is it illegal?

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As he never told me the price in advance, should I have to pay?

Apparently yes. The fact that the dentist answered that he would tell you in advance the price, and yet you allowed him to do the job without him doing so reflects that you knowingly waived the opportunity to timely get that information. In terms of the Restatement (Second) of Contracts at § 154(b), that is called *Bear[ing] the Risk of a Mistake.

I do not think that is reasonable $118 for a liquid that I thought was mouth wash. What can you tell me?

One prima facie element of fraud is the plaintiff's reasonable reliance on the defendant's misrepresentations. The question is what made you think you were acquiring mouth wash when it appears that (1) there was little to no communication between you and the dentist, and (2) you made no actual attempt to inquire of him so as to make an informed decision. These circumstances weaken your ability to prove that you reasonably relied on whatever [mis-]representations (if any) the dentist might have made to you.

In a context of omission or concealment of information by the dentist, you would have to prove that the dentist failed his duty to make the pertinent disclosure(s). This is known as silent fraud. However, it is unclear from your description whether or not the matter amounts to some dentist's duty in this regard.

It might help to argue position from the standpoint of dentist's unfair and deceptive practice(s), a matter which is legislated in pretty much every state in the U.S. But you need to be mindful of the aforementioned obstacles, and persuade that the dentist de facto misled you.

Also, hiring a lawyer would be more expensive.

For sure. But the amount at issue would have to be litigated in Small Claims court, where attorneys are generally not allowed.

My previous dentist uses 45 minutes for the cleaning. This dentist used only 15 minutes.

This comparison in and of itself is irrelevant because one goes to the dentist for a service to be performed, not for a requisite minimum of dentist's time.

The relevance of time spent on you lies mostly in proving that the dentist was negligent, careless, etc., and resulted in a service that was detrimental to you[r health].

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    Thank you so much for your help! I appreciate the time that you invested helping me and other people who have the same doubt. – Beginner Aug 19 at 4:08
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What did the dentist say when you raised the issue?

What’s going on right now is a customer satisfaction problem, not a legal problem. The dentist failed to meet your expectations and you should talk to them in order to work out a mutually acceptable resolution.

Legally, this issue is not straightforward as, while the dentist may have breached the contract by not informing you, we don’t know that, if you had been informed, if a reasonable person in your position would have accepted the cost for whatever the procedure was. If they would have, then no damage followed the breach. Notwithstanding, the value is not worth litigation for either party.

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  • Thank you so much for your help! I appreciate the time that you invested helping me and other people who have the same doubt. – Beginner Aug 19 at 4:08
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In the usual case, there are three contracts, involving you, the dentist, and the insurance company. Your contract with insurance guarantees a certain level of coverage, depending on whether a dentist is in-network or out. Your contract with the dentist basically says "I will pay", and the dentist's contract with insurance with insurance says "I will not charge customer for non-covered amounts". But you don't really know what is in the dentist's contract with insurance.

You are not 100% clear in the sequence of words used by you and the dentist (nobody ever remembers exact words), and the exact words matter. The first question is what the contract says, especially does the contract have an "entire agreement" clause, which is designed to exclude verbal comments from the scope of the contract. The second question is whether you asked explicitly whether you would be held responsible for amounts billed but not paid by insurance. It sounds like he did tell you the price in advance, the amount that he would bill insurance, and he made no representation about the level of your insurance coverage. Alternatively, did he (or his paperwork assistant) indicate "insurance usually covers this", which may be true "usually" but not with your insurance. If you said "Would you please verify my insurance coverage" and they reply "We have verified that this is 100% covered", then the matter is more in your favor, but still you have a mystery: was their verification a problem (their fault) or did the insurance company err (the insurance company's fault)?

Your first step should be to scrutinize your contract with the dentist. The language of these contracts is usually pretty specific about the fact that they deal with insurance companies as a courtesy to you and that you are utterly and absolutely responsible for the billed amount. Since you asked whether they would tell you if the charge increases, that would mean that they would have to tell you if they increased the charge from $118, which they apparently did not do. What you wanted to know but probably did not ask is, what happens if the insurance company does not pay the entire amount.

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    Even if the insurance "covers it", it doesn't mean that he would not end up owing the full amount. Even "will the insurance cover this in full?", if answered in the affirmative, will not mean that. If it comes out of the "deductible", then he may have to pay the full amount. However, simply asking "will the insurance cover this?" would have to be answered "yes" in the OP's case. His insurance did cover it (just not in full). It maybe a separate question, but I actually haven't figured out how to ask the real question of whether it is definitively clear that you'll owe nothing. – grovkin Aug 16 at 23:58
  • Thank you so much for your help! I appreciate the time that you invested helping me and other people who have the same doubt. – Beginner Aug 19 at 4:09

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