Is it legal for &quot;in-network&quot; dentist to send me a bill when insurance company denied claim? A couple months ago I went to the dentist for a crown, he noticed my jaw clicking and he said that I would need a "occlusal adjustment" to help fix this. Based on what I was told, I was under the impression that my insurance would cover this. I then got a notice from my insurance stating that they need additional information from the dentist before they can approve this claim. My dentist's office assured me that this is part of the process and they would have to send it paperwork so they can approve. Well my insurance didn't approve it because of the following reason: Based on the diagnostic materials provided by your dentist, this service does not meet this requirement for coverage. You should not be billed for this service. The amount billed on my insurance claim shows $500, the member rate shows $319, and if this claim got approved I would have just owed $95. Today I get a bill in the mail from my dentist at $594 and the receptionist stated that my insurance did not allow any benefits for this procedure so the dentist gave me a ($150) discount so the bill is for $444. Is this legal, can he send me a bill when he's an "in-network" dentist and my insurance denied his claim? I would have never done this procedure if my insurance didn't cover it but since they made me believe it was part of the process I thought they had experience with this sort of thing before. Since my insurance says "You should not be billed for this service.", does that mean he is not allowed to bill me as an "in-network" dentist?
It is legal for a dentist to bill you for services rendered. You have an obligation to pay the dentist (in exchange for services); the insurance company has an obligation to cover certain expenses of yours (in exchange for money); the dentist has an obligation to the insurance company to accept certain terms specified by the insurance company (in exchange for being listed as 'in-network'). Your recourse is to object to the insurance company, since they are the ones who have an obligation to you. The brute force approach would be to sue the insurance company for failing to cover something that they are (ostensibly) obligated to pay on your behalf, under the terms of your insurance contract. However, the chances are virtually non-existent that they are actually obligated to pay the dentist. You can call the insurance company in advance of the procedure and get a definite decision as to whether the service in question is covered, and if they say "Yes", then you are covered, otherwise you will know you are not, and can plan accordingly. The insurance company has some (minor) leverage over the dentist, if the dentist has breached his contract with the company. If a service provider egregiously breaks the terms of an agreement with the insurance company, the provider could be sued or at least dropped from the in-network list. This is, however, fairly theoretical. The insurance company statement "You should not be billed for this service" has no legal force, but it does weakly suggest that they blame the dentist somewhat (the alternative is to simply say "This service is not covered"). Your obligation to the dentist arises from the service provided plus the rarely-read clause in the financial agreement document that you signed at some point which says something like "We will submit claims to your insurance company, but you are ultimately responsible for any unpaid charges". It is highly unlikely that the dentist actually lied to you about the cost, especially it is unlikely that he said anything that could be construed as a promise that the insurance company would provide a particular level of coverage. For future reference, you either need to get a clear written statement from the service provider that they will accept whatever the insurance company allows you (i.e. their seat of the pants estimates are legally binding), or you need to get a clear written statement from the insurance company regarding what is and is not covered.
If you paid by a credit card, the proper procedure is to simply do a chargeback. If the hotel doesn't back down, then the credit card network will hold arbitration. I wouldn't expect them to win, since they don't have anything but their word for it. The hotel does have the option of suing you, but it's unlikely that they will do so for £200, and again they don't have much of a case. Their third option is to just report it to credit reporting agencies as a unpaid debt. For this, there's not much you can do other than have the fact that you dispute it included in your file. Theoretically, you could sue them for defamation, but that would be impractical.
No While you can be bound to terms you had the opportunity to read and didn’t, you cannot be bound to terms that you did not have the opportunity to read. That doesn’t mean that you don’t have a contract but it will be on different conditions to those in the undisclosed terms. For a contract to be valid, the parties must agree on the essential terms, for a phone contract, what service the phone company is giving and how much the consumer pays. Incidental terms can be left undefined and they will, if needed, be filled in by a court with reasonable terms. However, this only happens to the extent necessary to give effect to the primary purpose of the contract. For example, late fees or termination fees are not strictly necessary (common law principles of damages for breach of contract work just fine) so, if the undisclosed terms include them, they will be unenforceable. Notwithstanding, it’s quite likely that refusing to disclose in the advance violates state or Federal consumer protection laws against misleading or deceptive conduct.
If you do not get anything from this "contract", and all it says is that you will pay someone a sum of money "on demand", it does not meet the basic requirements to form a contract, and in particular, there is no consideration being received by you. It would therefore not be a contract and would have zero legal force. If you do receive consideration, demonstrating that you signed the contract under duress will require specific legal advice, and you need a practicing lawyer in your jurisdiction.
Usually, a clause like this is used in contracts of full time managerial or professional employees of a business who are employed on a salaried or commissioned, as opposed to an hourly basis, in positions that are exempt from overtime requirements. It basically prohibits moonlighting with a second job while employed at your current job. A non-competition clause, in contrast, would typically prohibit working for a competitor for some period of time after ceasing to work at your current employer. This is concerned about spreading your time and efforts too thin, rather than competition. You could violate it even if your moonlighting job has no direct impact (other than loss of some of your full time services) on the firm that employs you in your primary job. It does not prohibit you from having a personal life (e.g. going to the dentist, visiting family, watching a movie, etc.). Normally, this is used as a backstop against gross abuses, with performance based evaluation as the primary means by which the employee is evaluated. The line between personal investment activity and moonlighting or an intensive hobby can be vague and it is usually only enforced in extreme cases.
No, this is not an acknowledgement of guilt or liability. It offers a &quot;discount&quot; some sort of reduction in price. This could be an offer of settlement without admission of liability, or even just advertising for repeat business (unlikely as that may seem). Without the rest of the communication, there is no way to tell. Unless there are specific admissions, this statement alone is not likely to have much significance in such a case. Edit: There is still not enough context to tell exactly what the sender of this communication wanted to accomplish with the offer of the discount, but since the OP now says &quot;the party does not take the responsibility&quot; this is not an admission of guilt, whatever else it is. It sounds like some sort of backdoor form of settlement offer without admission, but that is far from clear to me. My original answer is not significantly hanged here.
Your problem is not just that you don't have a working stopcock, but that you now know that you don't have one. Of course it's not illegal by itself, the problem is what is going to happen if you have an insurance case. Your home insurance most likely has to pay for accidental damage. But any damage that would be caused by not being able to close the stopcock, when you knew it wasn't working, they could claim that this is due to gross negligence. Whether they would succeed with that claim or not, I don't know, but fixing the stopcock seems to be a much, much cheaper solution. PS. Seems I made a wrong assumption here - that it was your home, owned by you. The same reasons that would have made it a good idea for you to fix the stopcock obviously make it a good idea for the landlord as well. So I would make sure that you tell the landlord as soon as possible. If something goes wrong, and the insurance doesn't pay, your landlord would be responsible for the damage. Whether it's legal to not fix the stopcock - that's a different matter. I thought you were the owner. You would have endangered yourself and your property. Nothing illegal with that. But with the landlord it's different; he wouldn't be endangering himself but someone else's property.
Such a right would only exist if the legislature has created it by some act. Insurance is excluded under the class of covered contracts under The Consumer Protection (Distance Selling) Regulations 2000 (see schedule 2), and The Consumer Contracts (Information, Cancellation and Additional Charges) Regulations 2013. The only restriction on automatical renewal clauses under Consumer Rights Act 2015 is that the deadline for objecting to renewal cannot be unreasonably early (schedule 2, unfair terms); and in general, the terms may not be vague. Since there is no law restricting a contract from requiring written notice, or telephone notice, or whatever they demand, then it comes down to what the contract says. If it says &quot;you must call&quot;, then you must call.