Coinsurance is Not a “Discount” to be Written Off

I can’t believe offices are still writing off coinsurance to make patients happy.  Sure, everyone likes to feel like they are getting a bargain by not having to pay money for products and services that normally should be paid for but when it comes to a contractual relationship with an insurance company the professional provider needs to think twice.

Per Delta Dental Insurance companies, one of the largest in the nation the following statements are taken very seriously:

  • Accepting your insurance as payment in full and disregarding your coinsurance, copayment or deductible results in overbilling the insurance company. It’s against the law in many states and is viewed by the dental profession as unethical. It’s also a violation of the dentist’s contract with Delta Dental.
  • Dentists are not reducing their fee when they do not collect patient payments. Instead, these dentists are charging inflated fees to the insurance carrier to make up for the money they lose from waiving the coinsurance/copayment amounts.
  • Enrollees who knowingly agree to the dentist’s scheme are participating in this deception.

    The rule to remember is:  Do not charge the insurance company more than you charge the patient.  The insurance company is paying a contractual percentage based on the agreed upon total fee charged to the patient.  When you write it off and don’t collect from the patient you are committing fraud and the insurance company can ask for an audit.

Dental Billing