Dental practice discounts vs. copay forgiveness

April 2023
Tiffany Wesley, FAADOM
Admin/Record Keeping/Charting

Dental practice discounts vs. copay forgiveness


Do you have confusion and concern surrounding dental practice discounts and copay forgiveness? Maybe your office wants to extend a helping hand to patients who are experiencing financial hardship as a show of goodwill. How do you do this without risking a dental insurance audit – or worse? Let’s dive into the good, the bad, and the ugly when it comes to dental practice discounts vs. copay forgiveness.


Dental practice discounts in your state

In general, doctors should proceed with caution before advertising or promoting discounts. State legislation regarding these marketing decisions varies; thus, before doing so, consult with a licensed healthcare attorney regarding your state’s specific laws and policies regarding dental practice discounts.


If you do proceed with a discount, here is a best practice scenario:


You extend a 30% discount to a patient on a procedure with a standard full practice fee of $1,000. The discount extended to the patient is subtracted from your standard full practice fee, meaning $700 is reported on the claim form to reflect the actual fee charged to the patient. (Keep reading to find out why.) 

The patient is responsible for any copayment related to the $700 fee after the insurance payment and any PPO discounts have been applied.

The adverse consequences of copay forgiveness



As the American Dental Association’s (ADA) Code of Ethics states above, doctors cannot and should not accept payment from third-party payors as payment in full when a copayment is contractually required by the patient’s dental plan. This applies whether the doctor is in or out-of-network. Patients accept responsibility to pay their copayment by signing Box 36 of the 2019 ADA Dental Claim Form.


All states have laws prohibiting copay forgiveness in one form or another—either directly or indirectly. A few states do allow limited copayment forgiveness in the case of financial hardship, extreme circumstances, etc. Some states require third-party notification if copayments are forgiven. Every dental practice should understand the specific laws of their state before granting any copay forgiveness.

Alternative options to copay forgiveness

Even with the best pre-planning efforts, sometimes a patient is left with an unexpectedly large balance and may request you waive or discount their balance due to financial hardship. Remember, the amount of the patient's balance does not diminish their responsibility. Thus, to maintain fairness to the practice and the patient, consider the following:


  • Offer credit card & third-party financing options, allowing patients to make monthly payments

  • Billing statements should include reminders of any outstanding balance and minimum due amounts

  • Large balances which are considered to be uncollectible (i.e., the patient has not made payments nor responded to reminders, phone calls, etc.) may be turned over to a collection agency

  • Consider dismissing patients who do not make reasonable efforts to fulfill their financial obligations

  • Alternatively, you may want to require unpaid balances to be settled before a requested appointment is made

Learn more about copay forgiveness and dental practice discounts

Want to learn more? Dental Administration with Confidence dives deeper into this subject, along with many others. This guide is filled with proven solutions for both common and complex problems facing every practice today. Dental Administration With Confidence is easy to understand and packed full of information, tools, and solutions to help your team maximize reimbursement, reduce claim denials and delays, increase patient satisfaction, and boost revenue. Plus, it is perfect for both new and experienced team members. 


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