Dental insurance pay-out is based on a contract between a patient and an insurance company. Unless a dentist signs into a related contract with that insurance company and essentially agrees to work for it, he/she legally is not obligated to work at a reduced fee for that company. An “out-of-network” dentist works for the patient and not for a dental insurance company. Learn more about in network vs. out of network, here.
Dentists have an ethical obligation to provide the best quality of care possible for each individual patient’s needs. Fees are established based on the costs involved in providing that care. It is illegal for dental practice owners to collaborate for the purpose of “fixing” fees. Therefore, dental fees vary from one office to another.
It is illegal for an out-of-network dentist to “write-off” balances not paid by insurance companies without disclosing his/her intention to do so at the time of submission. The rationale for this is to prevent intentional over billing to receive higher dental insurance reimbursement. When a dentist establishes a fee, it should be based on the actual cost of rendering the treatment provided, regardless of insurance involvement.