Full question:
I am a dentist and am contracted with some dental PPO insurance companies. Some plans allow me to charge my fee for service fees to the patient after the patient has reached their yearly maximum benefit coverage allowance. However, some say that since I am contracted with them, I need to charge my discounted rate for that plan to the patient- even after the patient has exceeded their yearly benefit maximum. I do not trust what the insurance company tells me and would like the opinion of a lawyer. What can I legally charge AFTER their yearly maximum is reached? Can each PPO legally have different rules?
- Category: Insurance
- Date:
- State: Arizona
Answer:
The amount you can charge after a patient reaches their yearly maximum depends on your contract with the PPO. Review your agreement carefully to understand your rights and the obligations of the PPO regarding payment. Insurance policies and provider participation are primarily governed by state laws and the specific terms of the contracts. Each PPO can have different rules. If you have concerns about the information provided by the insurance company, it's wise to consult a local attorney who can analyze your contracts and the relevant laws. In Arizona, for instance, there are statutes that govern unfair claim settlement practices (A.R.S. § 20-461) and rate standards (A.R.S. § 20-383) that may apply to your situation. Users can search for state-specific legal templates at .This content is for informational purposes only and is not legal advice. Legal statutes mentioned reflect the law at the time the content was written and may no longer be current. Always verify the latest version of the law before relying on it.