An insurance carrier will not pay for a particular service that I performed, but if I submit a slightly different code, it will be covered. Should I submit the code for the service that would be covered so that my patient can be reimbursed?
The American Dental Association and the Pennsylvania Dental Association urge dentists to accurately report the service that is provided. To do otherwise may be considered a fraudulent act. If the service is covered, it will be paid. If the service is not covered, it will be rejected. Non-covered services are the responsibility of the patient.
Answer is informational only and not intended as legal advice. Answer may contain excerpts from The ADA Practical Guide to Frequently Asked Legal Questions.