Are there legal problems in giving discounts to family, staff or colleagues ?

Such discounts usually fall under your ability to set your own fees. This may not be true for certain insurance plans, which preclude charging some patients in their plan less than the agreed rate. You might run into problems granting discounts for family members if it is contrary to insurance plan rules. Some insurance companies have included provisions in their contract with policyholders that limit or prohibit reimbursement to providers who treat relatives. Dental plans or insurance policies may specifically exclude treatment of immediate family, such as children or a spouse. The rationale is that professional objectivity might be compromised when the patient is an immediate family member. There are also concerns, generally, about patients’ willingness to be completely open and honest with a health care provider who is a family member and to question or refuse treatment suggestions from a family member. Medicare (which doesn’t pay for dental care but often sets the standard for payment policies for health care in general) does not reimburse for services when the patient is an immediate relative of the provider or a member of the provider’s household. Medicare defines “immediate relative” as a spouse; a natural or adoptive child, parent or sibling; a step-parent, step-child, step-brother or step-sister; a father- or mother-in-law, son- or daughter-in-law, brother- or sister-in-law; grandparent or grandchild; and a spouse of a grandparent or grandchild. Again, lacking any specific law addressing this scenario, the patient’s benefit contract with the plan or insurance company will control.

Discounts to dentists who refer patients to the practice should be avoided, as they may be found to violate California provisions prohibiting payment of benefits for referral of patients.

Dentist Problems In Billing Forms With Patients

Common questions & answers with patients insurance collections and dental benefits plans.

What can I do if a patient refuses to pay for what insurance won't cover ?
When the parents are divorced, who should pay for a child's treatment ?
Is it reasonable to check my patient's credit history before I start treatment ?
Can I charge interest for late payments ? If I do so, am I required to notify patients before I start charging interest ?
What notices am I legally required to provide patients to whom I offer third-party financing ?
What if the patient doesn't return for completion of the treatment and the dental plan has already paid for it ?
Can I offer a discount to my patients who pay in full prior to treatment ?
Are there legal problems in giving discounts to family, staff or colleagues ?
If a patient is behind on payments, can I withhold records or stop treatment ?
How do I collect an unpaid balance if the patient is in bankruptcy ?
A patient is owed a refund from overpayment, but I cannot locate the patient to send the refund. What do I do with the funds ?
What do I need to know about working with a collection agency ?
What are the federal and state laws that apply to my collection efforts ?
Is there a statute of limitations for collecting debt ?
Is small claims court an option for collecting unpaid bills ?
What should I do if a patient isn’t satisfied with the quality of treatment and wants a refund ?
Should I use the fee allowed by the plan for each procedure or my own usual, customary and reasonable (UCR) fee ?
Can I waive patient copays ?
Can I establish a discount program in my practice for patients, and what are the legal requirements ?
How soon must I submit a claim in order for it to be considered valid ?
How soon must a dental plan or insurer pay submitted claims ?
What options do I have if I disagree with the insurance plan's payment decision ?
A dental plan is auditing my practice - what does this mean ?
Does an auditor have the authority to access patient records ?
How can a dental office prepare for an announced audit ?
What if the office fails the dental audit?
Are plans required to pay for in-hospital dental treatment ?
Does obtaining a prior authorization from a patient's plan obligate the plan to pay for that treatment ?
Can lab costs be charged on a claim separately from a procedure ?
Must refund demands from dental plans always be paid ?
What should I be aware of when considering contracting with a plan to join its provider network ?
Can I balance bill a Denti-Cal beneficiary for the portion of my bill that wasn't paid by Denti-Cal ?
May I charge a Denti-Cal patient for an alternative procedure that is not a covered benefit of Denti-Cal ?
Must an associate dentist in my office be separately enrolled as a Denti-Cal provider if I am enrolled as a provider ?
What is the best way to obtain information about the treatment, provider participation and payment policies of the Denti-Cal program ?
How and when your practice verifies patient insurance coverage ?
What medical plans will pay for in dental operations ?

Dental CPT Code Lookup.

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