Federal No Surprises Act May Affect Dentists

The ADA recently released guidance concerning the new federal rules for the No Surprises Act, which went into effect on Jan. 1. Unlike Michigan’s state-level legislation on the same topic, which excluded dentistry as a result of MDA advocacy, the federal law may have an impact on dentists. The law addresses balance billing, and this provision largely does not apply to private dental offices. However, the law’s requirements regarding transparency of health care costs could apply to private dental offices depending on how the service is being paid for.

For services to uninsured or self-pay patients, patients must be informed that they have a right to request a good faith estimate about the cost of services in advance. If the patient does request it, dentists must provide that estimate within the required timeframe.

An uninsured patient is a patient with no dental benefits. A self-pay patient is defined as an individual who has dental benefits but who does not seek to submit a claim to a dental plan for payment for the service. A non-covered service or any cost that will go above the annual maximum for the patient’s plan is considered “self-pay.”

The rules specify that if the bill for the primary procedure is more than $400 higher than the good faith estimate, the patient can dispute the charges through the dispute resolution process. However, if a self-pay patient submits a claim to their dental plan or insurer for the billed charges, they are no longer considered “self-pay” and will not be allowed to use the process.

The MDA has created two tools for dental offices to use in communicating with patients about this. The first is a Sample Notice that could be given to uninsured or self-pay patients. The second is a sample Microsoft Word form you may use to document good faith estimates for patients who request them. It would be wise to update your office manual to reflect offering the notice to the affected patients, and to keep a copy of the good faith estimates provided in the patient’s record.