Thursday Troubleshooter: Primary vs. secondary dental insurance write-offs

QUESTION: This question is regarding primary vs. secondary write-offs. I was trained (years ago) that we had to honor the largest write off between the two insurances when there was dual insurance. Otherwise, we would be in breach of our PPO contract with the insurance company, regardless of whether the primary or secondary had the lowest allowable.

Can you please clarify which write-off has to be honored? Does it vary by state? Can you also tell me where I may find written documentation that I can take to the doctor/ practice administrator?

ANSWER FROM BRIDGET FAY, consultant with Odyssey Management, Inc.
This is a tricky question with a tricky answer, but you are on the right track. The best practice in this case is to honor the allowance of the primary insurance. Keep in mind that you cannot collect more than your fee, and don't over adjust if you don't need to. You don't want to end up with patient credit balances. Usually any extra collected above the PPO fee belongs to the doctor, but always be safe and check the contract language for the insurance companies involved.

I like to wait until I've received both payments and then make the write-offs. Just make sure you keep your remittance/EOB handy or make a note in the account.

As far as obtaining written documentation, check your contracts with the insurance companies first. If that doesn't clear it up, head to this page — http://www.ada.org/news/2164.aspx. The ADA has collectively gathered information from several resources, including the National Association of Dental Plans.

Good luck!

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