MYTH: It’s illegal to charge for upgrades with PPO patients.
FACT: Your contract allows you to charge an additional fee for better technologies, materials or techniques.
Dental insurance typically covers the “least expensive, professionally acceptable treatment,” but our expertise suggests this may not always be the best choice for the patient. Transparency in charging for advanced materials, technologies, or techniques is part of our ethical commitment to educate our patients. Refer to a major insurance company’s statement below, which closely mirrors the policies of nearly all dental insurance companies:
“If there are alternative upgrades to a procedure which are not covered, but the base procedure is covered, providers must explain that a covered benefit is available to the patient and the patient must sign their consent to receive any upgraded, non-covered alternative or additional services.”
—January 1, 2023 Operating Handbook
Many dental practices that accept PPO plans feel trapped with only two choices: accept the losses or drop insurance plans. But there’s a third, more profitable path that retains those wonderful patients. At My Practice My Business, we specialize in teaching dental practices how to be profitable on PPO Plans. Our knowledge and expertise of dental contracts and state laws ensures your success. Our guarantee: if you don’t profit, neither do we. Why wait?
Request a Free Practice Analysis
More Questions to Explore
Q: Is it possible to bill PPO patients for advanced materials and technologies?
A: Absolutely. You have the option to invoice PPO patients for upgraded materials and technologies, but it’s crucial to adhere to specific guidelines. Those who suggest otherwise likely haven’t taken the time to read or understand dental insurance contracts or the legal statutes that govern dentistry in your state.
Q: Will my PPO patients experience an increase in their out-of-pocket expenses when opting for more costly treatment alternatives?
A: Indeed, the additional expenses become their responsibility. Consider this, Doctor: How much compensation do your fee-for-service patients provide? Dental insurance stipulates that they will only cover the “least expensive, professionally acceptable treatment” (LEPAT). However, dental education and experience often reveal that this may not be the optimal choice for the patient. Therefore, unless dentists are content with conforming to insurance constraints, the patient bears the financial responsibility for the more expensive alternatives.
Q: Isn’t offering upgrades to patients akin to nickel-and-diming them?
A: Doctor, it’s not the patients who are getting “nickel-and-dimed” here; it’s you and your team. You’ve been subject to cost-cutting maneuvers by PPO plans because there hasn’t been a comprehensive review and understanding of the contract you entered into or the complexities of state laws.
Q: Do I really need to rely on a consultant or contemplate joining a DSO due to my limited business expertise?
A: No. How many of these self-proclaimed “experts” can claim genuine hands-on dental experience coupled with business degrees to support their claims? Have they grappled with payroll challenges, negotiated with dental insurance representatives, or shouldered the responsibility of hiring and terminating employees? At MPMB, we’ve been through all of that, navigated the maze of state laws, and assisted numerous dental professionals. We strongly believe that dentists and their teams can acquire the necessary business acumen to run a profitable practice without constant dependence on dental consultants or DSOs. We witness this transformation every day.
Q: Might implementing extra charges for upgrades and value-added services result in patient attrition?
A: Extensive academic research has consistently demonstrated that choice fosters trust. When you educate your patients and provide them with options, you’re actually strengthening the doctor-patient relationship. It’s crucial to recognize that you’ll only lose those patients who have been taking advantage of your and your team’s goodwill for an extended period. It’s time to part ways with them!
Q: I’m concerned about the cost of training with MPMB. How can I afford it?
A: When it comes to the affordability of our training, it’s important to understand that we have a unique approach that sets us apart from other consultants. Our model is based on a guarantee, which means we only earn when you earn.
Here’s how it works: You start with an initial payment of $5,000, and the remaining balance is collected monthly based on 20% of your new monthly production increase. This increase is calculated from new procedure codes you’ve never used before. In simpler terms, we only get paid if you see a boost in net revenue. We believe that our success should be closely tied to your success.
Once your tuition is fully paid, you get to keep all the new net revenue you’ve generated. The only ongoing monthly fee is a nominal one, covering our educational and statistical web-based applications, ‘My Dental Docs,’ and ‘My Dental Stats.’ These tools are revolutionary in terms of improving case presentation, patient education, evaluating procedural profitability, and are unlike anything else in the dental industry.