In response to the June JADA Ethical Moment by Dr. Rickland Asai, "Is It Ethical to Have More Than One Fee Schedule?" (
JADA 2007;138[6]: 823–4
), I’m compelled to say it may be legal, but there is nothing ethical about giving discounted fees to insured clients and charging those without insurance a higher fee. We can debate the merits of the acceptance of lower fees for filling unused chair time; in my practice this is usually not the early-morning before-work or the late-afternoon after-work appointments that the typical insured patient would need.
However, there is no doubt that if any patient should be given a discounted fee, it is the patient who is standing at the front desk, paying his or her account in full. These self-pay patients produce no additional costs to the practice for filing insurance claims, posting insurance claims, duplicating films or sending detailed periodontal charts to justify a treatment decision. Even if the dentist does not accept assignment of benefits, it seems only reasonable to help the patient receive what the insurance would normally cover by preparing these required documents.
In spite of the fact that the courts have held that it is illegal to have two fees, most of our patients continue to believe that the insurance fee may be a little higher. I personally think that if the self-pay patients knew that, not only were the insurance patients getting reimbursed for services rendered, but were also getting charged a lower fee for the same service and, to top it all off, the self-pay patients are subsidizing this, they would be surprised that it is legal, but definitely would not think it was ethical.
