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Does your
dentist ever discount fees for you? Your dentist should
know the rules concerning filing claims for discounted
services.
- Your dentist
must indicate any discounts given to you clearly on
the face of the claim form or in the notes field of
the electronic claim.
- The discount
must be applied so that the net fee submitted to us
and the net fee charged to you are both reduced.
- If your
dentist already gave you a discount for a procedure,
your dentist's submitted fee for that procedure should
reflect the discounted amount.
- Your dentist
may offer you discount coupons for services or
procedures. However, all claims submitted must reflect
the discounted fees as well.
Your dentist's
submitted fee must be the lower of the "usual" fee or
the fee actually charged to and intended to be collected
from you. The "usual" fee is the fee your dentist most
frequently charges to and accepts from uninsured
patients as payment in full for particular procedures
(less any discount that is regularly offered to
patients, other than a discount that reasonably reflects
the time value of money).
Failure to
disclose discounts or the use of coupons is one of the
unacceptable billing practices reviewed during the claim
verification process. Dentists who fail to disclose
discounts or coupons may receive overpayments that are
recoverable. If a claim form is intentionally submitted
with undisclosed discounts or coupon use, it can be
considered a fraudulent attempt to gain benefits. |
