In dealing with Insurance companies in the dental offices we serve, there is a cycle, if you would. The last blog went into depth about the Dental Patient Revenue Cycle, if you haven't gotten the chance to read that head on over.
Your front office person gets in the middle of the mucky water, asking the Doc what to do. Often times, the Doc quickly says, just write it off.
For all of you reading this right now, this may sound awkwardly bold; You can not legally excuse a balance when dealing with insurance IF you discount the patient portion after the insurance has paid. The patient balance is fully theirs to pay. Key here – fully. If adjustments or write offs are done after insurance, this is insurance fraud.
If this sounds harsh or makes you feel uncomfortable, allow us to be clear. It may be the adage of “everybody does this” and it could be true. We are here to share the rules of the trade. Our intent is for you to understand the responsibility the Doctor has taken to be credentialed to an insurance and to obey by the governing rules.
So, what do we do? What is right? The reality of this issue is if you are going to offer a discount to patients attached to insurance, you must do this prior to insurance submission and you must collect the patient portion. You do not have the right to write balances off.
One way to get around this is to do a service pro bono. This way, there is no insurance involved. Again, to be clear, you can provide free care. You cannot discount patient portions when insurance is involved.
In numeric terms, discounting insurance can work if done this way. Say the $1000 crown is discounted by you for Suzie before Insurance to $800. Submitted at $800 instead of $1000, the insurance payment of 50% would be $400 not $500 and the same discount to the patient. If this is done prior to filing insurance, this is legal. You must discount the insurance end as well.
Avoid stripes at all costs! Ask one of our AMP Coaches about this for more information.