The My Practice My Business Dental Podcast

NO, ADA, You Should Not Report Full Fees To Payers

July 25, 2023 Robert Thorup, DDS Season 5 Episode 10
The My Practice My Business Dental Podcast
NO, ADA, You Should Not Report Full Fees To Payers
Show Notes

Let me be very clear from the start. Dental Insurance Companies, commonly called “third-party” payers, DO NOT SET THEIR REIMBURSEMENT FEES BASED UPON YOUR FEE-FOR-SERVICE FEES. For the ADA to imply this false statement is factual is unbelievable to me. They should know better. It’s articles like this that drive membership downward, because those of us in PPO driven states know this article to be anything but true. My goodness ADA, they set those reimbursement fees based upon their profit and loss of their company. How much comes in via premiums, and how much is paid out, guarding their set profit margins. 
Insurance companies are lowering negotiated fees to LESS than what was agreed to as a financial business strategy that is rarely caught by front office teams.  How would you catch this if you billed your FFS fee?  We caught TWO insurance companies doing this last year and when we called them out on it, they stated there was a “Bug” in the system, and they would fix it and send us another check to account for the percentage they should have paid.  How many offices are unnecessarily writing off or reducing services because they are billing their fee-for-service fees, and not seeing this little insurance tactic? You would almost never catch this little bait-and-switch tactic dental insurance companies do if you were sending in your full fees. Chew on that one little accounting problem if you don’t send in your contracted fees. 

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