MetLife agrees to change recoupment policy following ADA letter

Insurer will not offset payments to unaffiliated dentists

MetLife has agreed to change its recoupment policy after the American Dental Association sent a letter in April seeking clarification of its practices.

The ADA had received reports of the insurance company reducing, or “offsetting,” payments owed to dentists to recoup overpayments allegedly made to other, unaffiliated dentists. This has occurred when the dentists separately provided care to the same patient or different family members covered under the same dental benefit policy.

In its letter, the ADA said it was not aware of any provision in MetLife provider agreements that explicitly states this practice is allowed. In fact, there are laws in some states that prohibit it, according to the letter.

In June, MetLife notified the ADA via email that after reviewing market practices, it would be changing its policy “to only offset claim overpayments from the provider [it] overpaid.” The insurer is “working through the systems changes required for this change” and expects it will be done by the end of the year, according to the email.

“This is a meaningful step forward toward a more commonsense approach to the recoupment process,” said Mark A. Moats, D.M.D., chair of the ADA Council on Dental Benefit Programs. “It helps to highlight the critical role of our ADA and CDBP to be a strong voice for our members and seek solutions to the challenges we face. Progress toward a fairer payment policy is a win for dentistry and for the patients we serve. The ADA appreciates MetLife’s corrective actions and urges the payer industry to address other issues that may interfere with the doctor-patient relationship.”

The Council on Dental Benefit Programs previously sought feedback from member dentists on recoupment practices to help strengthen the ADA’s policy surrounding this issue.

For resources from the ADA related to dental benefits, visit ADA.org/dentalinsurance.