Legal Question in Legal Malpractice in New Jersey

Orthodontist Holding Back Information To Get You To Pay More

I was told by the Dr. that I have to pay the balance due out of my pocket,after the insurance payment.He told me that this is how it is done,all the time.I feel that I was duped,under false pretenses,into signing a contract saying that I would make any payments that were not covered.This was the 1st time I was ever to an orthodontist in my life, and I took the Dr. word for it, that I have to pay. Now, I find out from my ins. co.(through another problem I had with payments)that I did not have to pay him anything but my deductible. I already paid him $600.00. Is there anything I can do, or was I just played for a fool?


Asked on 12/07/04, 11:30 am

1 Answer from Attorneys

Re: Orthodontist Holding Back Information To Get You To Pay More

All orthodontists work the same. They have a fee schedule. They evaluate, summarize the work, and draft the contract according to what work/proceedures the patient needs.

Insurance companies usually cover nothing or a fixed amount for ortho. The patient is expected to pay the difference. You must read your contract carefully. What did you agree to?

I believe the insurance company is wrong if they said all you had to do was pay the orthodontist the $600 deductable. I have never seen where an orthodontist is required to accept the insurance company schedule of payments, though that may be possible, but you would have to see the contract between the insurance company and the doctor. If this is correct, the doctor is in violation of his contract with the insurance cpompany, and THEY should contact the doctor and straighten this out, as you are not in a position to do so.

Put your request in wtiting to your insurance company and ask for a written response.

Good luck.

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Answered on 12/07/04, 4:29 pm


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