An article from the American Dental Association explains that patients who are provided with a premium tax credit and fail to pay their premium will enter a 90-day grace period to repay their debt. The 3rd party payer will have to pay the first months bills while the patient remains responsible for the second and third months. The concern is whether or not dentists will have to take further action if they do not receive their money within the 90-day period.
"There remain a number of uncertainties," Dr. Andrew Vorrasi, chair of the ADA Council on Dental Benefit Programs said. "We are unsure how many patients will have the tax credit apply to dental after satisfying their medical premium. We are also not clear on how embedded plans with a pediatric benefit will handle this issue."
The ADA Practice Institute provides the following tips on how to handle this sort of situation effectively:
- Always check and document a patient's benefit eligibility status before they come into the office, especially patients who purchased dental benefits through the ACA Marketplace.
- Watch for communications regarding the grace period. The ACA requires plans to notify dentists that there's a possibility the claims may be denied when a patient is in the grace period. But regulations do not specify when and how this should be done. The general expectation is that the payer would send a notification to the dentist as soon as practical when an enrollee enters the grace period. It could be through fax, mail, email or through a notification on the website or a standard electronic transaction.
- Find out how the plan will handle grace period issues. For example, a payer could pend claims during the second or third month of the grace period and deny those claims if the patient's coverage is terminated retroactively because the premiums were not paid by the end of the grace period.
- Be prepared to discuss grace periods with your patients along with alternate financial arrangements.
- Check for state law protections to guard against the third-party payer seeking refunds, especially if the payer fails to provide accurate information.
- Ensure a collection policy exists for the practice and is sufficient to address potential grace period issues.
- Document everything.