Are Old Fees Costing You?

Watch Out for Insurance Plans That Use Old PPO Schedules

Each month at Profitable PPOs, we get a chance to look at broad trends across the country involving dental offices and the insurance networks they use. We primarily check the Explanation of Benefits (EOB) that show how much an insurance company has paid for a particular procedure. As we’ve looked at these, we’ve noticed an alarming trend we want you to know about so you can prevent it from happening at your practice.

What we’re seeing that concerns us are situations where claims are being processed using the PPO fees of a plan that the doctor dropped years ago. Unfortunately, we’re finding that some insurance companies just never remove the old PPO fee schedule from their system. As a consequence, what ends up happening is the insurance company payouts continue to be at the old PPO fees and the practice ends up writing off an unnecessary amount when they should be getting the UCR fees.

So, now that you’re aware of the trend, you might be wondering what you can do about it. After all, it’s more the insurance company’s mistake than the doctor’s. Nevertheless, you can do a few things to make sure the insurance carriers you work with process claims with the correct fee schedule.

On an annual basis, you should look very carefully at the specifics of your office’s insurance participation. Then, make sure everyone who works at your office has a clear understanding of which insurance companies you participate with and which ones you’re now out of network with and no longer need to honor PPO fees for. Insurance companies are certainly not immune from making mistakes so the steps above can keep you from becoming a victim of those mistakes!