Can I waive patient copays ?

If you are contracted with a dental plan to be part of its network of providers, the contract will dictate your copayment collection obligation. Dental plans maintain that the patient's copayment is important to the overall economics of providing coverage, as it is factored in when determining the premium payment. Moreover, an insurance carrier may conclude that you are misrepresenting your fee to them when you fail to collect copayments, as the fee charged to the insurance carrier is more than the fee actually charged (because the actual fee does not include the copayment). Additionally, dental insurance plans believe that patients’ utilization of dental services will increase if they have no financial obligation for treatment.

California law does not prohibit the waiver of copayments. The California attorney general issued an opinion in 1981 stating that routine waiver of copayments is permissible. However, that opinion has been contested. In one case, a trial court ruled that a dentist who waived a patient’s copayment without reflecting it on the claim to the dental plan violated statutory provisions prohibiting insurance fraud and unfair competition. Federal law prohibits waiver of copayments for Medicare or Medicaid patients except in limited cases such as a patient's extreme financial hardship.

In summary, if you are a contracted provider with a dental plan, and the provider contract is silent on the question of waiving a copayment, such waiver would be permissible, but it should be disclosed on the claim form to the plan. Regardless, it is best to check with a patient's dental benefits carrier before waiving the patient's copayment responsibility.

The practice of waiving copayments, even if allowed by a dental plan, may adversely affect the value of your dental practice at the time it is sold. When disclosed to a prospective buyer, the waiver of copayments may result in that buyer refusing to purchase the practice or may decrease its value.

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 ?

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