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By Dan Schulte, J.D.
MDA Legal Counsel
From the August 2011 issue of the Journal

The federal Patient Protection and Affordable Care Act’s require that health plans and insurers that offer dependent coverage make the coverage available until children reach age 26. This has resulted in many questions. This column will address these questions — some of which are new, and some of which are old standbys.

Question: Parents ask for access to their child’s records and/or want to speak with the dentist regarding their child’s dental treatment. If the child is 18, is this permissible without the child’s consent? What if the reason for the request is that the parent wants to see what he or she is paying for?

Answer: Until the patient reaches age 18 (unless there is a court order to contrary) each of the patient’s natural parents has the right to review the dental record of the child and to discuss the child’s care with the dentist. The fact that the parents are divorced does not change this. Each natural parent has a right of access to the child’s records until the child reaches age 18.

Once the child turns 18, he or she is considered an adult. The child’s parents no longer have a legal right of access to the records or to the dentist to discuss their treatment. The fact that the treatment will be paid for by using insurance or other benefits made available through a parent’s dental plan or insurance does not matter.

Question: What happens when a minor’s bill goes unpaid? Can only the unemployed 18-year-old patient be pursued for collection? Or can the parents be held responsible as well?

Answer: Again, once patients reach 18 years of age they are considered adults. Your contract to provide dental services is with this now legally competent adult patient. If a bill for this patient’s treatment (maybe it is just a co-pay or deductible) goes unpaid, your only claim will be against the patient and the patient’s dental plan or dental insurer, if benefits are due.

If you would like the patient’s parents to be financially responsible for payment of your fees you must obtain the parent’s guaranty of payment. This should be done in a written document signed by one or both of the parents. The document should state that the parents are agreeing to guaranty payment of all amounts you are unsuccessful at collecting from the dental plan/insurer and/or the patient. Click here to download a sample version of such a form.

Question: Can the parent of a patient 18 years of age or older refuse to allow the child to be treated and/or refuse to pay for the treatment?

Answer: If the child is 18 years of age he or she is the only person who can legally give consent to dental treatment. If a child who is 18 consents to treatment but the parent does not, or is not asked, you may go ahead with the treatment. If the only source of payment for the treatment is a benefit made available by the parents’ dental plan and/or insurance and the parent refuses to cooperate, then you may have difficulty obtaining the benefit to pay your fees. If the parent will not provide the information necessary for either you or the child to submit a claim to the dental plan/insurer you will be unable to claim the benefit unless you can independently obtain the information.

For obvious reasons, you do not want to be in this situation. The best practice is to identify the dental plan/insurer up front and make sure you have all the information necessary to submit a claim for payment.

Posted in: Insurance

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