A dentist in Columbus, Ohio, has noticed that dental insurance companies have begun to carefully review insurance claims for a second time, months after the initial benefit check has been sent. Sometimes, overpayments are discovered, so the insurance company sends a letter to dentists informing them of the overpayment -- usually a nominal amount -- and requests repayment within 30 days.
The amounts are normally too small to dispute, and specific details are not given, only the amount requested," the Columbus dentist writes.
But when he or other dentists refund the money, they face a tough choice -- "either eat the loss or re-bill their patients, who think they already paid in full."
It strikes the Columbus dentist as unlikely that the insurance companies would never encounter any claims where the dentist was underpaid, but he's yet to hear of a dentist receiving an underpayment check. "If the company is sloppy enough to make so many overpayments, it probably makes occasional underpayments," he writes.
He believes the right thing would be for insurance companies to look for underpayments as well as overpayments, and reimburse the dentists (or patients) the difference.
Recently, he received a letter requesting $23.55 for a claim that was processed and settled last fall. He sent a check, including the group number and claim number, but, he writes that he "also gave them a taste of their own medicine. I made the amount for $25.53. If or when the check clears, I will inform the insurance company that records show they were overpaid by $1.98, and give them 30 days to repay me."
He indicates that he's a little bit uncomfortable having pulled this tactic since it will result in further paperwork and wasted time for the insurance company.
"Is it wrong to alter my ethics to the level practiced by this particular insurance company?" he asks. "Is there a better way to respond? I know many dentists in the same boat."
In the phrasing of the Columbus dentist's question, he may have his answer. By "altering" his ethics, he's implying that he finds the insurance company's after-the-fact selective re-billing to make up for a previous error ethically questionable. If he then sees himself doing something that he holds to be equally ethically questionable just to make life troublesome for the insurance company, then he's likely going against his own values to do so.
While he might take some joy in seeing a company that frustrates him suffer just a little bit in return, more paperwork and more time on the part of the insurance company might only result in those costs being passed onto him and his fellow dentists and patients.
The best thing would be for the insurance companies to try to get the billing correct the first time around so later rebilling would be unnecessary. But short of that, the Columbus dentist is correct: The right thing is for the insurance company to notify doctors and patients of underpayments as well as overpayments and to refund any money that a patient may have overpaid. It still will be a nuisance to have to deal with the inefficiencies, but at the very least dentists and patients will know they are being treated fairly.
Jeffrey L. Seglin, author of The Right Thing: Conscience, Profit and Personal Responsibility in Today's Business and The Good, the Bad, and Your Business: Choosing Right When Ethical Dilemmas Pull You Apart, is a lecturer in public policy and director of the communications program at Harvard's Kennedy School.
Follow him on Twitter: @jseglinhttps://twitter.com/jseglin
Do you have ethical questions that you need answered? Send them to firstname.lastname@example.org.
(c) 2013 JEFFREY L. SEGLIN. Distributed by Tribune MediaServices, Inc.
Having worked many years in the administrative departments of several major insurance companies, this type of disputed billing sounds to me like the work of an insurance company which is playing a scam or operating slightly above the law. All insurance companies are under the purview of state insurance departments which would not allow this type of obvious illegal activity by the insurance companies involved and once the full facts are known to the insurance department(s) involved, it is likely the insurance companies involved would be heavily fined or punished by the insurance departments.
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