Non-Covered Dental Procedures Are Not Write-Offs
New legislation regarding non-covered dental services prohibits insurance companies from controlling what a dentist may charge for those procedures. As these laws begin taking effect in various states across the country, many dental insurance companies in the effected states are amending their provider contracts to reflect the new language and law.
It only seems fair that if a procedure is not a covered benefit of the policy, the insurance company can say, “I don’t want to participate in the cost of this service.” The contracted dentist would then charge the patient the standard fee schedule (cash patient). But it hasn’t always been this way for many insurance policies.
In the past, insurance policies dictated that if a procedure (for instance: an occlusal guard) was not covered by the patient’s insurance policy, but was found on the list of covered procedures issued by the policy, then the patient paid the in-network fee (if the practice was a network provider), even though it was not covered by the policy. This isn’t fair because the insurance company is dictating what the dentist can charge, even though they are not participating in the coverage.
Thirty-five states have passed new legislation that no longer allows insurers to require dental providers to give discounts for services not covered under an insured dental plan. Listed below are the states that have passed this legislation. You can find the document source HERE.
1. Alabama. Effective date: September 1, 2015
Many practices are wondering how to discuss the new legislation with patients, especially when it becomes apparent that their out-of-pocket expenses will increase due to the loss of discounts or write-off adjustments for certain dental procedures. Employers may experience more complaints due to employee dissatisfaction at increased costs for non-covered services. Patients may opt not to have the service performed if there isn’t a required discount or their insurance company declines to participate in the cost of services that their dental provider recommends.
Here is some scripting for this situation.
Patient: Why doesn’t my insurance cover this procedure?
Office: The purchaser or your employer has chosen this policy coverage to give you basic care with the interest of keeping the group dental premium more affordable for all employees. This procedure is not considered basic care under your policy. Basic care is cleanings, examinations, x-rays and fillings.
Patient: Why can’t you give me a discount or write-off what the insurance won’t pay?
Office: I understand how you feel. We are contracted with your insurance company to accept their discounted fee schedule. You are receiving substantial discounts with this plan. Part of that contract states that we have to collect your deductibles and coinsurance to comply with the contract.
For in-network or contracted dentists, the challenge of selling the benefits of dental care after the per-calendar year maximum has been met is another subject. Even with insurance covering some of the costs, it can be a challenge to get patients to accept treatment due to out-of-pocket costs. In the past, after the patient’s maximum was met they could still receive discounted benefits on further treatment even if not covered by the policy. This is subject to interpretation by the state, but if it is not covered by the policy it can be charged at the standard fee.
This legislature, although fair to the dentists, will not necessarily increase production and collections. Those are skills based on the providers and their dental team’s ability to sell the benefits of good dental health and motivate the patients to accept health.
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