As the Attorney General’s position addressed in-network providers only, CSDA President Dr. Tam Le and staff have since met with the AG and his staff to seek clarification on the out-of-network issues. We received a follow-up letter (click here to access the letter) on October 2, 2020 with the following guidance:
Out-of-network providers are not limited to what they can charge patients by contract fee schedules and, as a result additional PPE charges are likewise not limited. Additionally, dentists providing services to patients who do not have insurance would not be limited in what they could charge patients, including PPE charges.
What does this mean? We continue to advise you to check your provider contracts and review the terms of your participation agreements before charging for PPE. We also recommend that you inform patients of any additional charges prior to their appointment (click here to access a poster). Please note: It is unethical to only charge uninsured patients or only seek reimbursement for insured patients to address the costs of PPE.
For further guidance please review the ADA’s COVID-19 Coding and Billing Interim Guidance on PPE. This document provides information on billing for PPE as well as a listing of the dental plans currently providing financial assistance during this time. Should you decide to re-negotiate your fee schedules, the ADA has also developed a guide on Handling Contract Negotiations.