The ADA is asking for examples from members if they have experienced a dental benefit carrier reducing payments as the result of an overpayment made to another dentist. In New York State, this practice is against NYS Insurance Law and should be reported to the NYS Department of Financial Services at https://www.dfs.ny.gov/complaint. In addition, members may contact Jacquie Donnelly at NYSDA at jdonnelly@nysdental.org.

Learn more about the ADA’s efforts and share your experience:

Carriers have reduced payments to recoup overpayments made to other dentists

The American Dental Association is aware of dental benefit carriers reducing, or “offsetting,” payments owed to dentists to recoup overpayments made to other dentists.

This has occurred when the dentists separately provided care to the same patient or different family members covered under the same policy. In one known instance, the dentists were not affiliated with the same practice. The ADA Council on Dental Benefit Programs has called on the carrier in that instance to justify its actions.

As the council challenges these recoupment practices, it seeks input from ADA members to help strengthen the Association’s policy surrounding this issue.

“We want to hear from our members about recoupment practices,” council Chair Mark A. Moats, D.M.D., said. “Together, we can build toward a future that prioritizes fairness in payment policies. By sharing your experiences, you can make a meaningful difference in the lives of patients and the future of dentistry.”

Member dentists can email dentalbenefits@ada.org to share their experiences for policy-planning purposes using the subject line “CDBP — Benefits and Policy Issues.” Those who use the subject line will not receive a direct response to their email, so anyone requiring personalized assistance should instead contact the ADA Third Party Payer Concierge between 8:30 a.m. and 5 p.m. CT Monday through Friday at 1-800-621-8099 or the same email address.

The ADA asks members who reach out about recoupment practices to include context and supporting documentation to explain what they have experienced, such as communications received from carriers. However, what they send must not include any information that identifies or could be used to identify a patient or a patient’s relative, employer or household member. Any protected health information must be de-identified in compliance with the Health Insurance Portability and Accountability Act.

For resources from the ADA related to dental benefits, visit ADA.org/dentalinsurance.