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## Situation Overview

The initial estimate for the dental procedure using material A was $40 out of pocket. However, without my knowledge, the material used was switched to Material B, which is not covered by my insurance, resulting in an additional cost of over $200 out of pocket.

## The Dilemma

I am now facing a substantial unexpected expense and am unsure of my options. I am questioning how the good faith and no surprise acts may apply in this situation, considering that I am insured and did receive an estimate that I believe to be inaccurate and potentially in bad faith.

## How AI Legalese Decoder Can Help

The AI Legalese Decoder can assist in understanding the legal implications of this scenario by analyzing the terms of your insurance policy, relevant laws, and regulations. It can provide insights on your rights and potential actions you can take to address the discrepancy in the estimate and unexpected costs incurred. By utilizing AI technology, you can gain clarity on your legal standing and make informed decisions on how to proceed with resolving this issue.

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View Reference


  • sketchymidnight

    If you have that estimate in writing and they didn’t disclose the change before proceeding you have enough to get them to honor the original pricing. They should eat the cost difference.

  • Aleyla

    If they gave you a quote with a list of materials and you agreed and then they used a different set of materials without discussing it with you then I don’t see how this is your problem. This is their problem. I would pay the original price and no more.

  • Blue_foot

    If they are in-network, this material charge violates their contract with the insurance company.

    Some providers try and get away with this.

    Check your EOB on your insurance company website and it should say what you owe.

  • NothinButFett

    Unfortunately an estimate is just that: an estimate. Sometimes fillings require composite over amalgam due to the extensive decay. The depths of the decay might not be known until the tooth is opened up. Some insurances will only cover amalgam which is an old school type of material that is good, but not the best for every type of filling. (Even if these are not the exact materials, the concept still applies.)

    A good dentist will always try to give you the most conservative treatment first which is why he or she might have thought that the tooth could be saved with amalgam. However, things can change quickly once they open up the tooth and they have to use the correct material to fill it. Would you rather have an inadequate filling that will need to be redone over and over?

  • Irtahd

    What did you have done? Typically materials don’t factor into dental estimates unless you’re getting crowns or surgical stuff.

    If it’s just a filling your insurance probably downgraded and paid less because the doctor used resin (the standard) instead of amalgam (an antiquated material few places use anymore)

  • ChacoTacoDunk

    Did you sign anything acknowledging that states you agreed to any upgraded materials and costs associated with them? If not, I would contact your insurance company and let them know you’re being uncharged for services you didn’t agree on. Even with you agreeing to pay, they are breaking an agreement to accept payment in full for services rendered.

    Most insurance companies that have policies which states the cost of services paid by them includes total cost of the services, materials included. This is why you get a pretreatment estimate, in order to see what you have to pay out of pocket. If the insurance company downgraded the material, or if the office doesn’t use those materials, they need to provide services for the allowed cost. It’s something that appears on the dentist contract which a lot of dentists or administrators don’t actually read.

    I worked in CS as a supervisor and we had this come up several times a day. I would have a staff member contact the dental office and set them straight. If they didn’t comply, we’d help the member file a grievance. Good luck!!

  • bros402

    Think of dental insurance like a discount plan.

    Sometimes it doesn’t given your dentist the discount expected.

  • Rourke2013

    I work in dental and you’d have to be a lot more specific to get any insight from anyone who actually knows what they’re talking about. Anyone giving you advice without more context is just guessing at what’s relevant to your specific situation, IE I wouldn’t trust it.

  • Realityhrts

    Dental estimates are never to be taken seriously it seems. Probably just have to eat it and realize it could happen.

  • S7EFEN

    estimate from who? your dentist? thats not how insurance works, you need to ask your insurance what they cover not your dentist.

    fwiw if this is related to fillings the composite fillings are worth paying for if your insurance only covers the lowest bare minimum kind.

  • Arzemna

    Does this fall under surprise billing?

  • rpc56

    The dentist that I’m currently using and my former dentist always gave me a dental treatment plan prior to treatment that showed the costs. Did you receive this?

  • OkBox6131

    Ask them to remove it and give you the cheaper inferior product?

  • nomadschomad

    There’s nothing you can do. If your dentist is quoted you, that’s crappy. The insurance system is still stuck on silver fillings. In real life, most dentists won’t do them, and you don’t want a mouthful of silver anyway. We all pay the difference for white fillings.

  • banshee8d8

    pay the original amount and move on.

  • Strict_Pace8656

    actualmente soy dueño de varios negocios de odontologia, el problema se presenta muchas veces, puede que la carie es mas profunda despues de aperturar y requiera de mas material, o el tipo de resina que se debe aplicar se cambia por la condicion del diente, saludos

  • WorseBlitzNA

    Fillings are typically covered, was it not processed by insurance correctly?