Insurance Management FAQs

Am I required to collect coinsurance from my patients, or can I simply accept the amount that the insurance carrier pays as payment in full?

According to the ADA Principles of Ethics:

5.B.1. Waiver of Copayment. A dentist who accepts a third party* payment under a copayment plan as payment in full without disclosing to the third party* that the patient’s payment portion will not be collected, is engaged in overbilling. The essence of this ethical impropriety is deception and misrepresentation; an overbilling dentist makes it appear to the third party that the charge to the patient for services rendered is higher than it actually is.

*A third party is any party to a dental prepayment contract that may collect premiums, assume financial risks, pay claims and/or provide administrative services.

Answer is informational only and not intended as legal advice. Answer may contain excerpts from The ADA Practical Guide to Frequently Asked Legal Questions.