Changes In Policy Now Allows Non-Medicaid Dental Providers To Collect Copays

Arm holding Jenga PieceIf you are a non-Medicaid dental provider, you can now collect copays for your dental patients who have dual coverage. Up until now, state law has provided two conflicting statements in regards to whether the copay of a deductible amount from a patient with dual insurance coverage could be collected from the primary insurance provider when the other provider was Medicaid.

These conflicting statements were:

  1. If the dentist collected the copay from the private insurance plan, he or she could be fined under a section of state law that prohibits dental providers from collecting ay fee from patients with Medicaid for a dental service that was covered.
  2. If the dentist did not collect the private plan’s copay, he or she could face penalties related to insurance fraud.

Because these two statements were confusing, conflicting, and could carry penalties, many dentists became hesitant to treat patients who were dually covered under Medicaid and a private insurance plan.

New Changes In Policy

The Colorado Dental Association has successfully improved the situation for Medicaid patients with dual coverage and for the dental practices that treat them. The Medicaid program has issued a statement that plainly states that any non-Medicaid dental provider can now collect any required copay or deductible from dually covered patients. This policy is provided to those dentists who are not enrolled as current Medicaid providers.

If you have any questions or concerns regarding this policy change, or for any of your dental consulting needs, please contact CTC National.  

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