Wednesday, June 7, 2017

Dental insurance issues

Dental Insurance issues that a dentist cares about

Collection of dental insurance issues I have seen come up and see asked again and again.

Is it legal to waive co-pays?

Well that depends. Never for government programs like Medicaid. My opinion is that it legal as long as you follow some of the rules. Here is a great dentaltown thread on the exact same question.

In network

You can waive the co-pay but you need to notify the carrier. Delta considers, emphasis on Delta considers, it fraud if do not notify the carrier that you do not attempt to collect co-pay. However, if you are in network it is likely against your contract so there would probably be some contractual issue. If the contract is silent on the issue then a waiver is permissible according to CDA.

Out of network

Do not advertise that you waive co-pays. Jason Wood’s opinion seems to be that OON can do what they want. Probably best practice to just put it in the remarks section.


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