Can I bill full fees after a patient hits their insurance maximum?
In a lot of states, yes, and you may not know it. Roughly 32 states have passed laws saying that once a patient blows through their annual maximum, every service after that can be billed at your routine full fee instead of the contracted rate. Insurance companies fight this hard with workaround language, and for very large self funded employers the federal ERISA picture muddies things, but for smaller plans the state rulings often hold. The catch is nobody hands you this answer. I’ve seen dentists ask their own dental society and get a blank stare. So go find out for your state specifically. If the law is firm where you practice, you can bill full fee past the maximum and a whole category of your big case headaches just disappears.
If the answers you are finding here resonate with you, my team and I work with a small group of clients each year. The next step is a complimentary Discovery Consultation and Practice Review with Dr. McAnally.