Dentists may have claims against assignment of benefit denials
October 19, 2015
The ADA has learned that some dental plans covered by ERISA, but subject to certain exceptions, may be improperly refusing to honor assignments of benefits from participating patients.
In an effort to gauge the impact of this practice, the ADA is seeking information from members who:
Practice in states having assignment of benefit statutes (i.e., where state law protects the right of patients to enter into such assignment arrangements with their dentists).
- Have had an assignment of benefits disallowed by a church or government employee dental plan.
Where the reason given by the dental plan for its refusal to honor the assignment is that the plan is a plan formed under ERISA and is therefore exempt from the state’s assignment of benefit statute.
Where the patient has failed to pay the dentist for the services that were the subject of the unsuccessful assignment.
The ADA Legal Division reports that it is not clear how widespread this problem is. It appears, however, that because church and government plans are subject to certain exemptions from ERISA (Employee Retirement Income Security Act of 1974) provisions that apply to plans offered by other types of organizations, the refusal to honor assignments of benefits from members of church and government plans may not be legally permitted. Consequently, dentists meeting these four criteria may have a claim for compensation.
If the four criteria listed above apply to you in one or more instances, please contact the ADA Legal Division at firstname.lastname@example.org
or via the ADA toll-free number.