Stuck With PPO Contracted Fees After the Maximum?

2026-06-16T00:00:00-04:00

Why am I stuck with contracted fees on a PPO patient after their maximum? Because that's the trap most PPO contracts are written to spring. You hit the patient's 1,500 or 2,000 dollar annual maximum, and the contract still forces you to bill every dollar past that at the discounted rate. On a routine filling that's annoying. On a full mouth rebuild it's fatal, because you're carrying enormous risk and the margin simply isn't there to make the case pay. A lot of dentists just quietly eat it or turn the case away. You don't have to. There are real solutions, [...]

Stuck With PPO Contracted Fees After the Maximum?2026-06-16T00:00:00-04:00

Solving Insurance Big Case Problems in Dentistry

2026-06-16T00:00:00-04:00

How can I solve big case problems caused by insurance? Most of them are solvable, and faster than you'd expect once you have clarity. I spent twenty years fighting these issues and eventually realized the whole tangle comes down to a handful of tools. Know your state law first, because in many states you can simply bill full fee once the patient passes their maximum. Where the law doesn't help, you have the option of the patient temporarily dropping their plan, backed by an indemnification agreement so they lose no benefit. Beyond that, a HIPAA privacy release can put a specific [...]

Solving Insurance Big Case Problems in Dentistry2026-06-16T00:00:00-04:00
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