It is common for dentists, who want to help certain patients, to provide dental treatment for just what the insurance pays. No co-payment or deductible is collected. It is also common for dentists to provide treatment to staff or their relatives, who are covered by insurance, for just what the insurance pays.
Unfortunately, by waiving the deductible or co-payment, dentists put themselves on shaky ground.
According to the American Dental Association’s (ADA) Code of Ethics, dentists who waive co-payments and accept what insurance pays as payment in full, without fully disclosing to the insurance company that the co-payment was waived, are engaged in overbilling. It does not matter if the dentist is waiving the deductible or co-payment for a staff member, family member, or unrelated patient.
Even thought the ADA’s Code of Ethics provides flexibility if the practice fully discloses the waiver of co-payments to insurance companies, many states are not so flexible. Oregon and Washington law require the collection of co-payments. Period.
In addition to running afoul of professional ethics and state laws, dentists may also violate PPO contracts by failing to collect co-payments. And if that wasn’t enough, waiving co-payments for Medicare is against federal law.
It is not uncommon for this to come as a surprise to dentists and their teams. Unfortunately, the law does not provide a free pass for getting out of trouble when you are unsure of the regulations. Please look closely at the policies you have in your dental practice and contact your state dental board to learn more.
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