When does a private indemnification agreement with a dental PPO patient make sense?
When the case complexity and required fees substantially exceed what the PPO contract allows, and the patient has the means and willingness to pay regular fees outside the insurance structure for the treatment they need. The agreement is a written contract between the practice and the patient acknowledging that, for this specific case, the practice cannot deliver the work at the contracted PPO rate and the patient agrees to pay regular fees with appropriate consent and waivers in place. The setup requires a local attorney to draft language that complies with state law and the specific PPO contract. Template agreements exist through formal training programs but should always be customized. The patient conversation needs to be candid and leadership-based: this is why the practice cannot afford to deliver this complex case at the contracted rate, here is what regular fees would be, and here is an additional discount as an extra incentive. Patients who agree typically value the practice’s expertise enough that the contracted rate constraint feels secondary to getting the right work.
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.