Advertisement

Archive for Friday, October 7, 2011

Unpaid $57.69 dental bill decided by Kansas appeals court

October 7, 2011

Advertisement

— A panel of the Kansas Court of Appeals on Friday rejected an appeal by a Lawrence dentist who filed a lawsuit to recover $57.69 from a former patient.

But the law firm representing Dr. Thomas Rainbolt said the appeal had nothing to do with trying to recover the money.

Brandy Sutton of Pendleton & Sutton Attorneys at Law said Rainbolt allowed the law firm to appeal the case to try to get clarification on a legal issue that she said comes up frequently in lawsuits involving small amounts of money.

The dispute stemmed from a February 2006 appointment when Amit Guha went to Rainbolt’s dentistry practice for a routine examination and cleaning and instead received a more expensive “periodontal maintenance” exam, the appeals court ruling states.

Guha’s insurance carrier refused to pay for the difference in cost, and in June 2009 Rainbolt filed action to collect the balance.

At a bench trial before District Court Judge Peggy Kittel, Guha represented himself, saying he had always requested services that would be fully covered by his insurance, and that he had not been told he would be getting a more expensive examination.

Kittel ruled that Guha was under no legal obligation to pay the amount the insurance declined to cover.

One of the major issues on appeal was Kittel’s denial of a summary judgment for Rainbolt and allowing Guha to respond to requests for admissions and interrogatories “out of time.” The appeals court panel, however, concluded that Kittel handled the case appropriately.

“Guha indicated he had been confused by communication from counsel for Dr. Rainbolt, and he outlined a defense on the merits. The district court left Dr. Rainbolt ample time to marshal his evidence for trial; it did not set aside admissions the day of trial, thereby discombobulating his ability to present his case. We are convinced the district court is not the only judge who would have handled the issue in this manner,” the panel said.

Rainbolt’s attorneys also said the district court erred in finding for Guha based on the trial evidence.

Guha had signed a “consent for services” requiring him to be responsible for paying for all dental services received even if the insurance provider refused to pay.

But the appeals court said the patient would have to approve those services to be responsible for the payment.

Comments

Tony Kisner 3 years, 2 months ago

Dentist are they worst kind of thieves. Always up selling services of questionable need.

sad_lawrencian 3 years, 2 months ago

I second that. I went to a local dental provider, River Rock Family Dental, in 2010 for a general exam and cleaning, and after spending more than half an hour getting digital photos and x-rays taken of my teeth, I asked the hygienist when the cleaning would begin. She said, "There is no cleaning today." I said, what? She said, "Today is just your pre-screen. You'll have to make another appointment to come back for the cleaning." Then she informed me that the cleaning would not be a standard cleaning, but would be a more advanced procedure called a "scaling".

What a rip off! There used to be a day and time when you would go in, get a fairly quick checkup, some x-rays and then get a cleaning. (And no offense to the people at River Rock, but their practice is so high-tech, the examination rooms looked more like airplane cockpits than a dental practice.) After being informed I had to return for a "scaling", I went to the front counter to talk to the billing person, who told me my insurance would not cover the cost of the scaling. At this point, I'd had about enough. My insurance covered the cost of this appointment and the x-rays/digital photos, with no copay, and I decided I did not want to give any more money to these people. I left and ultimately did not return to this provider.

ljwhirled 3 years, 2 months ago

$57.69 for every 15 min spent thinking about the case.

Sitting on the can thinking about the case? $57.69.

Driving kids to school while thinking about the case? $57.69.

Thinking about the case to try not to "go off" early? $19.23 (A lawyer would only make it 5 min anyway.)

Susan Mangan 3 years, 2 months ago

I am soooo not surprised about this, after finding out who the dentist is. Same reason I quit going to him. I didn't like his bedside manner and didn't trust him. I have a WONDERFUL dentist now, who I can't speak highly enough of. But I had to go to Johnson County to find him.

lawrencejna 3 years, 2 months ago

I also had a bad experience with Dr. Rainbolt. Unfortunately, I paid. I wish I had acted as this gentleman had. He had told me a 3 part procedure was covered by my insurance and two days after my first visit refused to finish the procedure until I was able to cough up 2 grand. It became apparent that my trust had been intentionally violated for his own personal gain.

jafs 3 years, 2 months ago

Except that if the patient went in for a routine cleaning that was covered by their insurance and the office did something more without informing him, that seems wrong to me.

At the very least, the office should have informed him before beginning that they wanted to do a more intensive procedure that might not be covered by his insurance company, and why, and let him decide before proceeding.

I also had a bad experience with a local office that wanted to do several thousand dollars worth of work, including crowns, etc. After taking their suggestions to another dentist I knew, he said "They must have a lot of school loans to pay off", and went down the list explaining why it wasn't necessary. I went to him, he did replace some fillings, saved me a lot of money, and kept more of my teeth intact.

Their communication also wasn't great.

Liberty275 3 years, 2 months ago

"Except that if the patient went in for a routine cleaning that was covered by their insurance and the office did something more without informing him, that seems wrong to me."

No. There is no way a dentist, or a doctor, can know what the insurance will or will not cover until after the final outside arbitration. The patient could even bring in a copy of his actual contract, which he is unlikely to have, and even with what seems like iron-clad words, the dentist nor an attorney would be able to know what might be covered.

Since the defendants case hinges on his statement, he should have to prove it with more than just his word unless the dentist acknowledges the validity. Since the case was about "clarification on a legal issue", that seems unlikely.

Somewhere the dentist must have conceded he agreed to work within the limits of the fellow's insurance, given the outcome of the case. However, that remains invalid because the dentist can't judge what will be covered.

The dentist should appeal, reducing the amount to $1 so he doesn't punish the patient, but then he might get an opinion that serves his long-term interest better.

Liberty275 3 years, 2 months ago

One way they might know what will be paid is in a written answer from the insurance company affirming they will pay for certain procedures.

Liberty275 3 years, 2 months ago

I only know this because I recently had emergency services out of state, and got a $10,000 (annual out of network, out of pocket limit) bill from a doctor because the insurance company wasn't specifically informed of the emergency nature of the claim. I called and cleared it up and the $10,000 liability turned into a $50 liability. The doctors had no way of knowing because I didn't sign a HIPAA authorization for them to request any information from the insurance company about my health care. All they can do is submit requests and hope they get a check. If they don't get a check from the insurance company, they will send the bill to the insured.

Nobody but you has or can grant access to any information related to your health.

jafs 3 years, 2 months ago

And, the patient, if well informed, knows what his insurance covers - our dental coverage includes full coverage for 2x/annual cleanings, and 1x/annual x-rays.

Medical care is more complicated, and you often can't find out how much you owe for quite a while, which is a problem, and should be corrected. We should be able to know exactly how much we'll have to pay out of pocket before having any medical treatment.

I've tried to find that out a couple of times from insurance companies, and it's virtually impossible, which is absurd.

Liberty275 3 years, 2 months ago

Contact the KS insurance commissioner.

anonymous12345 3 years, 2 months ago

I agree with Felixiscariot's post. Dental professionals treat the patient, not the insurance companies. Every insurance has different coverage depending on the plan and there is no way to know what will and will not be covered since it varies. Some companies would have covered all of the service while some cover none. Specialized cleanings are recommended for people in some stage of periodontal disease. These cleanings are to help control the disease and routine maintenance appointments are to help prevent relapse of infection. Periodontal disease is known as a, "Silent Disease" because you can have it and not even know it. If you are unsure about recommendations, get a second opinion and call your insurance company if you want to know about coverage before having the procedure and follow up cleanings, exams, etc... completed. Usually professionals are trying to help people, not scam them.

jafs 3 years, 2 months ago

See my above response.

If he went in for a routine cleaning that he knew was covered, and they did more than that without informing him of it beforehand, I think they were wrong.

They should have informed him that they thought he needed a more intensive cleaning, and why, and let him decide before proceeding.

sickofdummies 3 years, 2 months ago

The key word is IF they didn't inform him. Lots of people who are anti-Rainbolt, but I know plenty of people who will never do business with Guha's again, either.

Eride 3 years, 2 months ago

Exactly.

Kudos to Mr. Guha for not allowing himself to be extorted. A dentist shouldn't be allowed to furnish other services without telling the patient and then try to charge the patient for them. In fact, a dentist shouldn't even be providing any care without informing the patient of what the care is. Isn't that one of the professional duties owed to the patient in that profession?

Liberty275 3 years, 2 months ago

You might note the dealer cannot exceed 115% (or something like that) of the estimate if you request one, whether it is initially signed by you or amended with strict detail noted if the amendment was approved by phone. Look at the piece of paper the guy hands you before he changes your oil next time. Look for the little words, right above your signature.

verity 3 years, 2 months ago

My dentist always tells me exactly what will be covered by my insurance and what won't. If it's something like replacing a filling or crown, they request the amount from the insurance company. If they want to do something extra that they feel is appropriate, they always ask and tell me exactly how much it will cost.

Good for Mr. Guha---sounds like it was the principle of the thing and not the money---in the end it may have cost him more, but that dentist may think twice before pulling that again. At least other people are now aware of what the dentist did. Don't think this was good for business.

Kat Christian 3 years, 2 months ago

People you must remember when you see a Doctor or a Dentist YOU are paying their salary therefore you are the one in charge - they provide a service to you that you pay dearly for. So it is not required to have an x-ray everytime you go to the Dentist. I get a cleaning every 6 months and x-rayed every 5 or so years. It is not necessary or healthy to get x-rayed every year. Say NO - if they don't like it find another Dentist. Same with a Doctor if they perscribe a drug for you and cannot explain the side affects or don't know exactly how it will help you - that means they are not keeping up with the latest findings. Tell them NO on the drug or if you did your research and found a better drug that may help you then tell them that is what you think is best for you. Remember they may have medical schooling, but they are still only people and make mistakes, get lazy in their profession or can become incompetent. There is a lot of information on the computer or at the library to research about your illness. Best to be informed before you seek medical help. If a doctor states you have an illness make them prove it. Sorry I don't have much faith in our medical professionals anymore.

countrygal07 3 years, 2 months ago

I took my daughter to this dentist for braces. Paid almost 5 grand . Toward the end of the treatment my insurance changed so took her to a different dentist to find out the braces were outdated and werent doing what they should have been doing. There goes another 5 grand and her teeth look so nice now. i would never go back to Rainbolt.

sweetiepie 3 years, 2 months ago

I've had lots of contact with dentists and the one I go to now never gives me the right quote as to how much my insurance will pay and how much I will have to pay because he never really knows what he's going to do. He submits the work up to the insurance company, and then without fail has to do all these other things that weren't in the original plan and that he has to refer me to other people (one hand washes the other so to speak) to have done. It's kind of hard to say no when you're in the middle of some complicated treatment, because the dentist will just stop and say I can't go any further until you have all this other work done.
Unfortunately, he also tries to charge you for things that are just ordinary parts of treatment by billing them as extra.
Yes, I'd go to someone else, but I'm right in the middle of one of those complicated treatments. It sure doesn't give you much confidence in the dentist though.

Commenting has been disabled for this item.