Legal Question in Legal Ethics in North Carolina

Being sued by dentist

i has surgery done on my mouth beginning in january 2003 and had my last visit in march of 2003. i took all my insurance information with me at my first visit and asked for an estimate so i could decide whether to have this done or do it over an extended period of time. the estimate was for 2420.90 for my part and the remainder to be paid by my insurance. i paid 1211.00 and was to pay the remainder at the end of july when i had a follow up for a cleaning. beginning of july i received a bill for 7366.00. i thought this was a mistake so i called them and they told me my insurance would only pay up to 1000.00 and the rest is my reponsibility. i understand that estimates are not always correct but a 6156.10 is a ridiculous difference. i feel that they mislead me after checking my credit. i think that when they say how good it was they didn't think i would risk not paying. well i refuse to pay that amount and we go to arbitration next month. is there anything i can do to win this? also they are naming my husband in this case and he has nothing to do with any of this. is there anything i can do to get him off this lawsuit? thanks for your patients with my long post.


Asked on 2/21/04, 5:01 pm

1 Answer from Attorneys

John Kirby Law Offices of John M. Kirby

Re: Being sued by dentist

We need a lot more facts to answer this question. You should probably consult a lawyer to fully discuss this and provide him or her with all the facts, especially with an upcoming arbitration hearing. This inquiry raises a lot of complex questions, involving contracts, dentistry, arbitration, and insurance. We would need to know exactly what was said to you, and exactly what any written contracts and documents say. Assuming that the health care provider's agent said something to the effect of "we believe that your insurance will pay about $6,000 of the $8400 bill," and assuming that you relied on this statement (discussed infra), and assuming that there are no disclaimers in your written documents (e.g. stating that the health care provider makes no representation as to amounts paid by insurance), then you may have some claim, or defense, based on "negligent misrepresentation." The legalities, however, are quite murky here. (Another approach would be that the "contract" between you and the provider as that you would only be charged $2400 for you personally.) It is not clear what the provider's obligations are regarding insurance. (Unfortunately, as this claim involves "professional services," you probably cannot use the "unfair and deceptive" trade practice statutes.) You can attempt to make these arguments yourself, but I would advise you to retain a lawyer to assist you to research the legal issues and to explore the factual issues. Finally, it is not clear whether you "relied" on the estimate. If you would have had the procedure anyway, at the same price, then your case is weakened. As for your spouse, I do not see his exposure. (There is a doctrine called the "necessaries doctrine," which can result in a spouse's liability for the debt of their spouse, but I will not go into that here.)

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Answered on 2/22/04, 7:20 pm


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