I suggested to my manager that offering both our in-office discount plan and dental insurance could really help our patients. She replied that it would be insurance fraud. I tried searching online, but I can’t find a clear answer. However, the new Google AI mentioned it’s fine as long as we disclose the discount to the insurance.
Does anyone here know if this is true or if it’s against the rules? Would love to understand the reasoning either way.
Thanks a ton!
When you’re credentialed with an insurance carrier, you’re generally only supposed to charge the patient the contracted rate you’ve agreed to with them. Are you discounting the rate you negotiated with the carrier, or are you using the usual customary rate (UCR) for what insurance doesn’t cover and then discounting that? One might not be great for business, and the other could actually be illegal.
@Vail
We’re actually out of network with all insurances, so we’re not tied to any UCR. Would that change things?
So, in this case, it would be our office fee, with a discount applied, that gets billed to the insurance.
In-office plans should ideally only go to patients without dental insurance. If someone gets insurance during the plan period, you could prorate the remaining time and refund them.
Tracking both discounts and insurance rates is a headache and could lead to unintentional issues with fraud. Honestly, it’s probably not worth the hassle in terms of overhead hours.
Also, don’t rely on AI for legal or medical advice; I’ve seen it suggest things like glue as a food ingredient. 
@Addison
Haha, I wasn’t planning on taking the AI’s advice! I just found it odd that it mentioned it wasn’t fraud, and my own Google search didn’t clear things up.
You’re probably right—it’s not worth the trouble. I just thought maybe there was a specific reason it could or couldn’t work. Thanks for taking the time to answer my question!