Home Forums Practice Management Systems Understanding Insurance and PPOs Reply To: Understanding Insurance and PPOs

Travis Campbell
Participant
@drtcampbellgmail-com
#1460

Bill,

Sure

5) Agreements of any kind to keep negotiated fees regardless of state laws or non-covered status.  Agreements to not charge/offer upgraded service to patients.  Any agreement about specific coding being inclusive of another (BU/Crowns for ex)

14) No.  I mean you must submit the same fee to ALL patients regardless of payment method the same fee for each service.  When you submit a fee to insurance, you are telling them THAT fee is what you charge cash patients.  To do anything else is fraud.
Most common example is:
“Mrs. Jones, our fee for a crown is $1200, but since you are a cash patient we are only going to charge you $1000.”   In this example your fee is really $1000, which is what should be submitted to insurance companies as your fee.  Submitting $1200 would be fraud.

The correct way to do what this example dentist is trying to do would be:

“Mrs. Jones, our fee for a crown is $1200, but we do offer a prepayment discount if you would like to pay $1000 now upon scheduling you can save $200.”  (The ledger should show the $1200 as the base fee)