Dear ADA: Recoupments
Dental insurance issues are often cited as one of dentists’ biggest challenges.
In response to an ADA Health Policy Institute poll in late 2025, more than half of dentists reported that one of their top concerns looking ahead to 2026 was related to insurance, including low insurance reimbursement rates and delayed or denied payments.
This ADA News series aims to address some of those challenges. “Dear ADA” will feature answers to common insurance-related questions the American Dental Association receives from members to help provide clarity and direct members to additional resources.
The answer to this month’s question is provided by Liz Papineau, D.D.S., a member of the ADA Council on Dental Benefit Programs.
Dear ADA: I've received a notice from a payer that they've automatically withheld funds from a remittance because they say they overpaid me on another unrelated patient. How can they do this?
Dr. Papineau: You're not alone. Many dentists and staff members are surprised and frustrated the first time a payment is reduced because of an issue involving an entirely different patient. Most of us think of claims and payments as patient-specific transactions, but payers may not. This practice, commonly known as a recoupment or offset, is a mechanism many payers use when they believe they have overpaid a provider.
