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.

Dental CPT Code Lookup.

About Us | Contact | Privacy

Copyright 2021 - ©