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Contracts are important — read them thoroughly before signing

May 03, 2017

By David Burger

The ADA Council on Dental Benefit Programs receives many letters and calls from often-frustrated member dentists regarding contracts, said Dr. Ronald Riggins, council chair.


Dr. Riggins
Many of the questions are about third-party payer contracts. Some examples of the complaints include schedules of benefits; predetermination of benefits; the bundling of codes and downcoding; and reduced fees for services. Some of those dentists are unclear of the terms of the contracts they sign, he said.

"When dentists receive a third-party payer contract, they should read, understand and evaluate it thoroughly to determine if signing the contract is a sound business decision," said Dr. Riggins. "When you sign a contract, you make promises that will be binding in a court of law. If you fail to do what you promise to do in the contract, the other party may be able to terminate the contract or, in a worst-case scenario, initiate legal action against you for breach of contract. It is therefore essential that you review any contract carefully before you sign it."

ADA.org has resources to help member dentists navigate the contract process to help them make the best choices for their practices and, ultimately, their patients.

One good place to start is an article called "What Every Dentist Should Know Before Signing a Dental Provider Contract," available at ADA.org/Thirdpartycontract. "While the article is not intended to be legal advice — dentists are strongly urged to consult their personal attorney before signing any contract — it provides a good overview of questions to ask during the contract-signing process," Dr. Riggins said.
 
In addition, the ADA recommends that member dentists use the ADA Contract Analysis Service, a free service which will provide them with information concerning a proposed contract so they can better understand and analyze its terms.

"After all, receiving a clear, concise explanation of the terms of a provider contract may help them decide if participating with such a plan is best for them, as well as helping them avoid unpleasant surprises in the future," Dr. Riggins said.

The service analyzes:
  • Dental provider contracts with third-party payers.
  • Dental management service organization contracts.
  • Contracts that offer dental school students scholarships or loans in exchange for a commitment for future employment.
The service can be used by submitting a copy of the unsigned contract and an analysis request to the dentist's state society — which will then send the information to the ADA Division of Legal Affairs — prior to signing the proposed contract.

For its part, earlier this year the ADA met with the Board of the National Association of Dental Plans and pitched the idea of developing best practices for contracting that might serve as some basic standards for the industry.  

For more information, dentists can contact the ADA Member Service Center at 1-800-621-8099 or email dentalbenefits@ada.org.