Monday, March 28, 2005

Negociating Higher Fees

Is it possible to get a higher fee schedule from an insurance company than their standard PPO fees? If so how do I go about it?

Usually not. Why? PPO schedules are published to both doctors and patients. If a patient were to receive say, a crown, from Dr X who had negociated a higher benefit, that additional money would have to come from either A - the patient, who could perceive this plan as a bait and switch or B - the insurance company, who base their premiums on anticipated payment based on the fee schedule. In addition, if area doctors were aware that another was receiving a higher benefit, they would also want an increase.

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At July 12, 2005 at 1:34 PM, Anonymous Anonymous said...

I respectfully disagree. As an employee of a large dental benefits carrier, I know for a fact that we sometimes provide "negotiated" schedules for dentists who threaten to leave our network. While it is rare, if the dentist treats a large number of plan members belonging to a profitable customer (employer), we will often negotiate the dentist's fee schedule to ensure he/she remains in the network. The increased fees we pay to the dentist is negligible compared to the loss of a customer.

The advent of cosmetic dentistry, coupled with the decrease in available chair hours means that dentists are no longer dependent on insurance networks. As a result, carriers are becoming more flexible when it comes to partnering with dentists. In all cases, it is worth having a conversation about fees with the carrier's network representative.

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