Collecting co-payments and deductibles
Dentists in Ontario can decide what fee will be charged for any given procedure, and the dentist must treat the payment of fees entirely as the responsibility of the patient.
Dentists can accept payment for services directly from a patient’s insurance company. By signing or authorizing a dental insurance claim to be submitted, the dentist is declaring that the claim is accurate and that the amount claimed is the total fee they intend and expect to collect. Coverage for dental care varies, and many insurers may pay an amount less than the full fee as submitted on an insurance claim form.
The outstanding balance owing always remains the responsibility of the patient to pay and the responsibility of the dentist to collect. A dentist must make genuine efforts to collect the co-payment and deductible directly from the patient for these reasons:
- A dentist is legally and ethically responsible for the accuracy of a patient’s financial records
- A dentist is legally and ethically responsible to ensure the insurer is not misled by his/her conduct
- Failure to collect the co-payment and deductible is considered an act of professional misconduct.
A dentist cannot submit a dental insurance claim for a customary (higher) fee and then simply write off the co-payment or deductible as a means of providing a discount.
A patient’s financial records must provide a complete and accurate statement of the account, and include:
- the date and amount of all fees charged
- the date and amount of all payments received from the patient and from the dental insurance provider
- a record of all attempts made to collect co-payments and deductibles from the patient
In some cases, a dentist may charge a reduced fee to a particular patient for a specific service; for example, many dentists charge reduced fees to friends, relatives, staff or patients with financial limitations. Nevertheless, the dental insurance claim in these cases still must accurately reflect the discounted fee, which is the total amount that the dentist expects to collect for the service.
If the third party coverage is based on an older fee guide than the one currently being used by the dentist, there is no obligation to collect that difference; however, any co-payment on that plan must still be collected.
Dentists who continue to provide professional care for patients with large account balances, consisting mainly of co-payments and deductibles, may be seen by the College as not taking their responsibilities seriously.
Not making an earnest attempt to collect co-payments and deductibles may be viewed by a panel of the Inquiries, Complaints and Reports Committee as professional misconduct. In such cases, specified allegations may be referred to the Discipline Committee.
Please call Practice Advisory if you have any questions or concerns regarding collecting co-payments.