Relationships with Third-Party Payers

Employers have traditionally offered dental benefit programs to their employees as an ancillary benefit to improve the oral health of the employees and to help retain and attract new employees. The type of relationship your dental office develops with these third-party payers may depend on whether you’re a contracted dentist or a non-contracted dentist.

 

When you contract with a third-party payer by signing a participating provider agreement, you make promises that will be legally binding on you. If you fail to do what you promise, the other party may be able to terminate the contract or may initiate legal action against you for breach of contract. If you choose to not sign a contract, you will not be subjected to the same terms and conditions of the contracted dentist. It is therefore essential that you review any contract carefully before you sign it.

  • By signing the contract, what are you promising to do? Are you able and willing to do it?
  • What promises are the other party making to you?
  • What remedies will you have if something goes wrong?
  • Are you aware that, by signing a contract you may also be agreeing to policies and procedures that can be changed unilaterally by the plan?

For these reasons, you are strongly urged to consult your personal attorney before signing any contract. In addition, the ADA offers a contract analysis service for dentists that wish further assistance.

ADA Contract Analysis Service

The ADA Contract Analysis Service was established in 1987 and is currently housed in the ADA Division of Legal Affairs. This is a popular member benefit. The Service is authorized to analyze the following:

  • Dental provider contracts;
  • Dental management service organization contracts; and
  • Contracts that offer dental school students scholarships or loans in exchange for commitments for future employment

Members may submit a contract to their state or local dental societies who will forward it to the Service and the Service will provide a plain language explanation of contract terms of each agreement analyzed. The Service does not provide legal advice or recommend whether a contract should or should not be signed. The analysis will be subsequently sent to the member at no charge.

Members may send a contract directly to the Service and will be charged a fee of $50 for each contract analyzed.

The Service remains committed to meeting the current demand in a timely manner, developing new informational material regarding dental provider contracts, and working closely with state and local societies to address member dental provider contracting concerns. Seminars and workshops concerning the legal implications of dental contracts upon request or responses to members’ telephone calls requesting information are also available

For a more detailed explanation about the types of payment issues faced by non-contracted dentists, refer to section E in Dental Benefits: An Introduction

If you are not an ADA member, you can purchase this whitepaper in the ADA Catalog.