The Unpaid Bill
Robert B. Stevenson
The Ohio State University
College of Dentistry,
Columbus, Ohio - USA
COMMENTARY 1 (according to Belgian law)
In the case of a dental treatment, even in case of an accident, a valid contract is concluded. That also includes the payment of the dentist’s fee (here $3000). In Belgium it will be the patient who will normally pay the bill and get the reimbursement of the insurance company. In some cases (injuries at work) the dentist must send his bill directly to the insurance company, but he can legally do so in all cases where liability insurance is present. The dentist has a direct claim towards the insurance company in these cases, if the other party is held liable.
Dr L. refused the “generous” offer and he would have no problem at all in Belgium to get his fee from the patient. If it can be proven that the patient got the money from the insurance company and did not pay the bill of the dentist, the dentist will have no problem at all to win that case in court. (unless the work was not properly done). It is obvious that this is fraud both from the dentist and the patient if they should agree that the patient should make a profit of $1000. The dentist would be considered to be a fool because he will have to pay taxes on his $3000 bill, receiving only $2000. I cannot imagine that a Belgian dentist will do such a thing.
It can be accepted, in theory, that the dentist should accept only 65% if the patient should refund the insurance company 35%. But why should they do so? Is that a kind of charity? That makes no sense.
I can also see no reason why the patient should go to an attorney if he has no complaints about the work done by the dentist. In some cases a patient comes with a complaint about the treatment on the exact moment that the dentist starts a procedure to claim his unpaid fee. Most of the time a dental expert will then have a look at the case and give is opinion.
In a Belgian court, when a patient refuses to pay the fee of the dentist (and where no fault in treatment was found), the judge will conclude that the patient has no reason to complain about the treatment and that it was rather a question of not willing to pay. He will lose the case and because it was done in a provoking and reckless way he may be condemned to pay all the costs of the procedure, including the fees of the attorney of the dentist and all the costs of the dentist, including the time that he had to spend on the case.
If the attorney can be held liable
depends on the reason why he started a procedure. If it was based on the
complaints of the patient that the work was not properly done he will go free
because he is not expected to know anything about dentistry and he has to rely
on what the patient tells him. The courts will refuse to hear the case if there
is not a beginning of proof based on a report of a dentist.
COMMENTARY 2 (according to US law)
Given the scenario as presented, in the U.S. the Courts and State Boards would generally hold that:
In cases of accidental injury where the dentist has no contract with the insurance company and no assignment of benefits executed by the patient, which appears to be the case here, the patient is reimbursed directly. The dentist would have no recourse against the insurance company, and must look to the patient for payment of the fee. Since the patient has no issues with quality or standard of care, the case is over a year old, and the dentist has made valid attempts to collect the full fee without success, the dentist is well within ethical and legal parameters to collect all or part of the fee charged.
After receiving the complaint and the case records, the state dental board would most likely dismiss the complaint without a hearing or declare the case a fee dispute in which the board has no jurisdiction. In either case, the finding would be in favor of the dentist.
The municipal court will find for the dentist as long as there are no quality of care issues and the fee charged was within the “usual and customary” range. The court will order the patient to pay the full fee along with court costs, and depending on the jurisdiction, award the dentist’s attorney fees as well.
Answers to Questions:
(1) There appears to be no issue of fraud (which involves intent) on the part of the dentist. The dentist in this case had no obligation to the insurance company other than to submit the claim for the fee actually charged. Making valid attempts to collect a full fee and accepting less is quite distinguishable from forgiving co-pay. Charging the full fee and not demanding that the patient pay the co-pay does involve intent and fraudulent activity and may implicate the patient as well as the dentist.
(2) The dentist could accept 65% of the fee on the condition that the patient reimburses 35% back to the insurance company, but this does not appear to be likely in this case. Since the dentist has fulfilled the obligation to the insurance company, there is no ethical or legal reason to do so.
(3) The patient has every right to engage an attorney. The attorney in this case should have determined that the case was without merit and should have strongly advised the patient against pursuing the case through the state dental board or the court. Following a court ruling against the patient, and assuming that frivolous pursuit charges against the patient were plead by the dentist and upheld by the court, the dentist would be awarded attorney fees and the patient’s attorney could be facing sanctions from the court as well.
Contact
addresses:
Robert B. Stevenson
3600 Olentangy River Road, #D3
Columbus OH 43214-3437
USA
Tel: +1 (614) 451-2767
Fax: +1
(614) 451-2988
Email:
Stevenson.113@osu.edu
LesGoBucks@aol.com
Robert Anderson
1909 Walnut Plaza
Carrollton TX 75006
USA
Tel: +1 (972) 416-5251
Fax +1 (972) 418-8772
Email: andertonr@msn.com