Thursday Troubleshooter: Primary vs. secondary dental insurance write-offs
Dental insurance can be a confusing subject for front office employees
QUESTION: This question is regarding primary vs. secondary write-offs. I was trained (years ago) that we had to honor the largest write off between the two insurances when there was dual insurance. Otherwise, we would be in breach of our PPO contract with the insurance company, regardless of whether the primary or secondary had the lowest allowable.
Can you please clarify which write-off has to be honored? Does it vary by state? Can you also tell me where I may find written documentation that I can take to the doctor/ practice administrator?
ANSWER FROM BRIDGET FAY, consultant with Odyssey Management, Inc.
This is a tricky question with a tricky answer, but you are on the right track. The best practice in this case is to honor the allowance of the primary insurance. Keep in mind that you cannot collect more than your fee, and don't over adjust if you don't need to. You don't want to end up with patient credit balances. Usually any extra collected above the PPO fee belongs to the doctor, but always be safe and check the contract language for the insurance companies involved.
I like to wait until I've received both payments and then make the write-offs. Just make sure you keep your remittance/EOB handy or make a note in the account.
As far as obtaining written documentation, check your contracts with the insurance companies first. If that doesn't clear it up, head to this page — http://www.ada.org/news/2164.aspx. The ADA has collectively gathered information from several resources, including the National Association of Dental Plans.
PAST THURSDAY TROUBLESHOOTERS:
Email and HIPAA, when is the line crossed?
Team is frustrated dentist contacts them after hours
Is 'one big happy family' on the dental team a good thing?
Do YOU have a tough issue in your dental office that you would like addressed?
Send your questions for the experts to answer. Responses will come from various consultants associated with Speaking Consulting Network, Academy of Dental Management Consultants, or Dental Consultant Connection. Their members will take turns fielding your questions on DentistryIQ, because they are very familiar with addressing the tough issues. Hey, it's their job.
Send your questions to email@example.com. All inquiries will be answered anonymously every Thursday here on DIQ.