Full question:
My daughter had her braces put on July of 08 when she was 17 yrs old. She had 15 monthly visits to the orthodontist before she turned 19 in Sept 09. Our dental benefits state there is a $1500 life time benefit that terms at age 19. She is due to have her braces off in Jan 2010 so i can understand being responsible for any money owed after Sept. 09 but because the dental ins. co. divides the $1500 into 5 payments paying $300 every 6 mos. they are holding me responsible for $600 when i already fulfilled my financial obligation of over $1800. So my question is, is it legal to bill me for services she received prior to being 19 just because our dental ins. co. wants to pay every 6 mos. Shouldn't they have to make a partial payment for the months she was seen prior to turning 19. Please help, Thank You.
- Category: Contracts
- Subcategory: Breach of Contract
- Date:
- State: Pennsylvania
Answer:
The answer to your question depends on the terms of your contract with the insurance company. You should carefully review the contract to understand your rights and obligations, as well as those of the insurer. It’s possible that the contract specifies that the $1500 lifetime benefit is contingent upon receiving payments of $300 every six months. If you decide to pursue legal action, keep in mind the following general principles of contract law:
Contracts are legally enforceable agreements that create obligations for the parties involved. A breach of contract occurs when one party fails to perform their duties as outlined in the contract, resulting in economic damage or other measurable harm to the other party. Remedies for breach of contract typically aim to restore the injured party to the position they would have been in had the breach not occurred. Common remedies include money damages, restitution, rescission, reformation, and specific performance.
Restitution aims to return the injured party to their original position before the contract was formed, while rescission cancels the contract, and reformation modifies the contract to correct inequities. Specific performance compels a party to fulfill their contractual duties when monetary damages are insufficient.
In this situation, if your insurance company is billing you for services rendered before your daughter turned 19, it’s crucial to review the contract terms to determine if they are legally justified in doing so. If you believe they are not, you may want to consult with a legal professional for further assistance.
This content is for informational purposes only and is not legal advice. Legal statutes mentioned reflect the law at the time the content was written and may no longer be current. Always verify the latest version of the law before relying on it.