June 20, 2019

Dentistry and The Law: Q & A with Health Care Attorney Daniel Schulte

Answer 1:  The answer to this question depends on the requirements of each insurer or dental plan that you contract with.  In most, if not all, cases, identifying the dentist that provided the service is required when submitting a claim to the insurer or dental plan for payment.  The ADA Dental Claim Form is required to be signed by the treating dentist.  The treating dentist is required to provide his/her NPI and license number as well.

 This is required by the insurer or dental plan for many reasons.  They need to know if the treating dentist participates with them because this usually effects the amount of the benefits available and whether the dentist will be paid directly by the insurer or dental plan.  In addition, the identity of the dentist may determine the amount of the fee that the insurer or dental plan pays.  Some dental networks vary the fees paid to participating dentists based on when they joined the network, where they practice (you may have offices in different locations) and other factors.

Billing for the services provided by a hygienist or an assistant is a different matter.  Generally, they provide their services only to a dentist’s patient of record and only following delegation from and with the supervision of a dentist.  As a result of these legal restrictions the services provided by hygienists and assistants billed by the dentist who delegated and supervised the service.

Answer 2:  Bills have been introduced both at the federal and state levels that are aimed at protecting patients from being “surprised” with personal liability for a medical bill in an amount greater than what was expected when receiving services from a nonparticipating provider.  Presumably, dentists would be included with all of Michigan’s other providers of health care services, and would therefor be subject to these requirements if these bills become law.

The article can be viewed in the Journal of the Michigan Dental Association, on page 22.


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