What if the patient doesn't return for completion of the treatment and the dental plan has already paid for it ?
If a claim was submitted for work already completed and the patient's insurance carrier paid it, there should be no problem. However, if you filed a claim before treatment was completed, acceptance of payment without refunding a portion of it may constitute insurance fraud. An example would be a patient who needs a cast, post and core to support a crown. If you do only the preparatory treatment but submit a claim for the placement of a crown and the patient does not return for the crown, strongly consider repaying the insurance carrier for a portion of the crown reimbursement. Many dental plans bundle the fees for cast, post and core with reimbursement for the full crown, but if only the foundation work is completed and the crown is not placed, plans will allow partial payment on the crown procedure. Other plans that bundle preparatory care with the fee for crown placement don't pay until the final crown seat date. If the patient never returns for placement of the permanent crown, the claim won't be paid, no matter how much prep work was done. If you are contracted with a dental benefit plan, you must comply with the plan's policy on payment for partial work. Many plans do not pay for preparatory work but consider all procedures leading up to, for example, a crown placement, to be inclusive in one fee allowance for the crown itself.
Dentist Problems In Billing Forms With Patients
Common questions & answers with patients insurance collections and dental benefits plans.