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, starting with knowing whether your state has passed a law letting you bill full fee once the maximum is exhausted. Many have. Stop accepting the contracted fee on big cases as if it were a law of nature. It usually isn’t.
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.