“My Old Dentist Didn’t Make Me Pay the Co-Pay. Why Won’t You?”
Even if you see a dentist that’s out of your network, Delta Dental will still help pay for covered procedures, although you'll enjoy less savings than at a Delta Dental dentist. DHMO-type plans have fixed prices for procedures, known as copays. As an example, during 2019, Delta Dental of Washington offered dental insurance on the private market starting at a monthly cost of around $26 for an individual and $122 for a family of four. After you pay your deductible and/or your copay, your dental insurance coverage kicks in. But there are still out-of-pocket costs to consider. Delta Dental PPO is underwritten by Delta Dental Insurance Company in AL, DC, FL, GA, LA, MS, MT, NV and UT and by not-for-profit dental service companies in these states: CA — Delta Dental of California; PA, MD — Delta Dental of Pennsylvania; NY — Delta Dental of New York, Inc.; DE — Delta Dental of Delaware, Inc.; WV — Delta Dental.
Fortunately, this is not a question I hear very often, but from colleagues around the country, I know that more and more patients are asking that their co-pays be waived, and more and more dentists are doing it. Heck, some dentists are even ADVERTISING it! But there’s something VERY important that every dentist and every patient should know:
Waiving Dental Insurance Co-Pays is ILLEGAL
Did you know that, if your dentist waives the co-pay for your dental treatment, s/he is actually committing insurance fraud? And that you are a participant in it? Kind of scary, but around the US, a number of dentists have actually been prosecuted and sent to jail for such insurance fraud. This is a very serious matter! Read what Delta Dental has to say on the issue:
Beware of offers to waive coinsurance/copayment amounts
Delta Dental Insurance Prices
Your dentist has just offered to give you a discount. She is going to accept your insurance as payment in full and not collect your coinsurance/copayment amount from you. This may sound like a great deal, but it’s not. Here are a few reasons why:
- Accepting your insurance as payment in full and disregarding your coinsurance, copayment or deductible results in overbilling the insurance company. It’s against the law in many states and is viewed by the dental profession as unethical. It’s also a violation of the dentist’s contract with Delta Dental.
- Dentists are not reducing their fee when they do not collect patient payments. Instead, these dentists are charging inflated fees to the insurance carrier to make up for the money they lose from waiving the coinsurance/copayment amounts.
- Enrollees who knowingly agree to the dentist’s scheme are participating in this deception.
No matter how irresistible the offer of “free” dentistry seems, the care you receive really isn’t free. As a result, it increases costs and your present dental plan may become too expensive for your employer to offer.
Delta Dental Insurance Plans
Delta Dental takes overbilling very seriously, and we use a variety of methods to fight it. However, all our anti-fraud methods are not enough without your cooperation. If your dentist is waiving your coinsurance/copayment amounts, or if you have any other suspicions that your dentist might be overbilling, please report it to Delta Dental’s Fraud Hotline at 800-526-1852. Or, complete and submit our online Fraud Report Form. You may remain anonymous.