Waiving a Patient Copayment? You Must Let Us Know

Dentists must legibly and conspicuously disclose their intention to waive a patient’s copayment responsibility on the face of each paper claim form or in the notes/remarks sections of electronic claims submitted to a third-party payer. 

If dentists do not indicate on the face of the claim form, or in the notes field of the electronic claim, their intention to waive all or part of their patients’ copayment, they are inaccurately reporting their actual fee. 

Submitting a higher fee to Delta Dental of New Jersey (or any insurance company) than is charged to and intended to be collected from the patient is not permissible; it incorrectly states the dentist’s actual fee. The dentist signature box of a dental claim form states in part,

“…the fees submitted are the actual fees I have charged and intend to collect for those procedures.” 

Additionally, courts have concluded that failure to disclose waiver of copayment is fraudulent. New Jersey and Connecticut law requires the disclosure of an intention to waive a patient’s copayment responsibility. 

Undisclosed waiver of the patient’s copayment responsibility is one of the unacceptable billing practices reviewed during the claim verification process. Undisclosed waiver can result in overpayments that are recoverable by Delta Dental. 

For more information, please refer to:

• New Jersey State Board of Dentistry, Administrative Code [NJAC 13:30-8.10].
• General Statutes of Connecticut [Volume 7, Title 20, Chapter 379 Sec. 20-114].
• Delta Dental of New Jersey Participation Agreement.
• Delta Dental of New Jersey Dentist Handbook for Participating Dentists, Chapter 11, Claim Verifications (Common Claim Discrepancies #2).