Are PPO fees your Standard Fees?

Your standard fees, sometimes called your regular fees or your full fees, should be analyzed to ensure that they best reflect not only the demographics of your practice location but are realistic to your overhead or practice operating costs.

Fees are a sensitive topic for a lot of dentists.  After all we don’t want to scare away patients labeled as the most expensive dentist in town nor do we want to be the cheapest either.

Dental practice experts and the ADA concur that it is wise to bill the standard fees on all claims being sent to insurance companies. This is assuming your standard fees are higher than the UCR fees determined by insurance companies.  They should be.  Some dental offices bill the PPO network fees on outgoing insurance claims because they don’t want patients to see what is written off between the standard fee and the accepted insurance fee.  This is not wise because of the following:

1. Submitted fees on claims are monitored by many dental insurance carriers to establish the UCR or usual, customary and reasonable fees.  If you bill out the PPO fees you will bring down the average fee for the demographic area resulting in lower pay for all.
2. If you are accepting assignment of benefits from secondary insurance they will never coordinate up to a higher amount than you charge on the primary claim even if it is out of network.
3. By billing your standard fee on all insurance claims you will be paid from the patient’s specific group under the insurance company which may calculate payment from UCR for the area and not the PPO network fee which means better reimbursement for the practice.