Waiving a patient’s financial dues could be a practice booster to attract new patients. Typically, this means a violation of the contract when not collecting the co-payment and could be illegal based on federal and state laws. However, the Question which often comes to mind is that : what if a neighboring dental office provides dental treatment without collecting deductible or co-payment? What if the patient is a staff or relative, friend of a dentist, or a low-income patient needing treatment. Unfortunately, writing-off co-payment can put the dentist on shaky ground and even put the license of the practice in danger. If a dental plan issues an invoice to the patient for the cost of rendered treatment, then the collection is a must.
According to the ADA’s Code of Ethics, dentists who waive copayments from a patient and accept payment by the insurer in full without revealing to the insurer that the patient’s portion of the cost is not being collected are overbilling or committing insurance fraud. This is a breach of the contractual agreement.
Why do dental plans need co-payments?
It is important to note here that the dental plan premium depends upon the cost of the treatments. If the plan integrates some form of copay and the practitioner never intends to collect, then it changes the entire fee structure of the dental benefit plan. Initially, the dental plan will ask the practitioner to collect co-payment from enrollee’s patients. However, deception and misrepresentation of not collecting co-payments could result in unwanted audits and financial stress.
Is forgiving co-payment a fraud?
The issue here is not a matter of being sympathetic or kind to the patient’s plight. Some would argue long-time loyal patients deserve a discount, and even if you wish to provide, apply discounts both to the plan’s portion and the patient’s copayment to avoid getting ripped off.
For instance, if the provider’s charge for a particular service is $400, with $200 paid by the insurer and the other $200 is the patient’s co-payment: and you have decided to waive off copayment as a regular business practice, then you should offer a discount to both the parties . The non disclosure of such unlawful practice to the insurer risks possible allegations.
Here are the following options concerning discounting co-payments without question:
Reasonable efforts to avoid overbilling and collecting co-payments