MetLife Agrees to Change Recoupment Policy Following ADA & NYSDA Advocacy
Insurer will no longer offset payments to unaffiliated dentists

Thanks to strong advocacy from organized dentistry — including input from the New York State Dental Association (NYSDA) — MetLife has agreed to end an unfair recoupment practice that impacted dentists across the country, particularly in New York.

The issue came to NYSDA’s attention after several member dentists reported that MetLife had reduced payments to them in order to recover overpayments made to unrelated providers — in some cases simply because they treated the same patient or family members under a shared dental benefit plan. NYSDA elevated these concerns to the American Dental Association (ADA), which formally reached out to MetLife in April seeking clarification on the practice.

In its letter, the ADA stated it was not aware of any provision in MetLife provider agreements allowing this kind of offsetting — and noted that this practice is prohibited in some states, including New York, unless the provider is given 30 days’ notice to dispute the overpayment.

In June, MetLife notified the ADA that, after reviewing market practices, it would be changing its policy “to only offset claim overpayments from the provider [it] overpaid.” The insurer is currently working through system changes to implement the update, which is expected to be completed by the end of the year.

The ADA Council on Dental Benefit Programs had previously sought member feedback on recoupment practices to help guide its advocacy. NYSDA is proud to have contributed to this effort and remains committed to protecting our members and ensuring fair and transparent dental benefit policies.

For dental benefits resources, visit ADA.org/dentalinsurance.