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Is it illegal to offer a 25% off coupon on copay or

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deductible in the state of...
Is it illegal to offer a 25% off coupon on copay or deductible in the state of Nevada for dental services?
Submitted: 5 months ago.Category: Legal
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11/21/2017
Lawyer: legalgems, Lawyer replied 5 months ago
legalgems
legalgems, Lawyer
Category: Legal
Satisfied Customers: 12,570
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Hello! I will be reviewing your question and posting a response momentarily; if you have any follow up questions please respond here. Thanks!

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Lawyer: legalgems, Lawyer replied 5 months ago

Still researching-thanks!

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Lawyer: legalgems, Lawyer replied 5 months ago

Thank you for your patience; only a handful of states issue guidance on this topic and NV is not one of them. The participation agreement between the insurance company and the dentist may be considered breached if the contract states the dentist will receive a copay/deductible for certain services. Furthermore if the dentist routinely waives these fees, the insurance company can argue the dentist is acting fraudulently (tort: fraud) due to misstating the true charge-so if a dentist on paper charges $500 for procedure #1, but routinely waives a $250 deductible or copay, the insurer can argue that the true cost of the procedure is $250.

Federal law prohibits such waivers for government subsidy programs such as medicare/medicaid under the Federal False Claims Act but this does not apply to private insurance.

A dentist may submit the following to get an advisory opinion from the board:

http://dental.nv.gov/uploadedFiles/dental.nv.gov/content/Contact/Petition%20Form.pdf

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Lawyer: legalgems, Lawyer replied 4 months ago

Hello again; just checking in to see how things worked out;

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