Non-Medicaid Dental Providers Can Now Collect Co-Pays

Dentist in a dental officeIn exciting news for non-Medicaid dental providers, you may now collect copays for patients with dual coverage. In the past, state law has contained two conflicting sections when it came to whether the copay of a deductible amount from a dually covered dental patient’s primary insurance provider was able to be collected from Medicaid dental patients.

These two conflicting sections were:

  1. If the dentist did not collect the required private plan’s copay, he or she could possibly be subject to penalties related to insurance fraud.
  2. If the dentist did collect the private plan copay, he or she could be fined under a section of the state law that prohibited dental providers from collecting any fee from Medicaid patients for a covered dental service.

Because of these conflicting sections of state law and the potential penalties the dentists could face, many dental practices became hesitant to treat patients who were dually covered under a private plan and Medicaid.

Change In Policy

In this legislative session, the Colorado Dental Association successfully improved the legal environment for these dually covered patients and for the dentists who treat them. The state Medicaid program issued a bulletin that states clearly that a non-Medicaid dental provider is allowed to collect a required deductible or copay from a patient who has dual coverage, both by Medicaid and a private insurance plan.

This policy is applied to those dentists who are not currently enrolled as Medicaid providers.

This new policy doesn’t address the issue of copay and deductible collections by dentists who do participate in Medicaid, however this issue will be addressed in the coming months.

For more information on this change in policy, please don’t hesitate to contact CTC Associates. We’ve assisted dentists all over the country in improving their dental practices and profitability.

Posted on Nov 8, 2017

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