Attention Doctors!


 A potential disadvantage is that dentists who signed contracts with one PPO plan can be shocked to find out that they are now contracted with other plans. It is even possible that a dentist who signs a contract with one PPO plan may have agreed to participate with dozens or even hundreds of plans across the country.

If your contract has this information in it make sure you have an expert company looking at the risks, you might be taking. Contact:

The companies are now adding in “An affiliated carrier’s clause” may be in your agreements you are signing. It is an agreement that makes the dentist a participating dentist for the affiliated plan. Dental insurance and PPO leasing companies may lease their network to insurance companies with a limited or small network or to third party administrators that do not have access to a network of dentists.

They are selling you to other companies so again, update your contract yearly, and have an expert read it, since written by lawyers.

By signing this agreement without understanding you are putting the office at a disadvantage by adding other plans without even knowing their names or fees. Dentists agree to charge discounted fees to gain access to these patients. These patients then have access to network dentists with reduced fees.

Plans fail to notify dentists that the dentist is now a participating provider with a new plan. Even though the dentist treats the patient expecting to receive his or her full fee, they are then surprised when their office receives an explanation of benefits (EOB) statement indicating a reduced fee and restrictions against balance-billing the patient. (Make sure your office reads the EOB)

To prevent being caught off guard, important questions to consider asking before signing an agreement with an affiliated carrier’s clause include:

  1. What fee schedule will be in effect?
  2. Make sure they are not using the lowest fees from a lease plan.
  3. What processing policies will be utilized?
  4. What types of treatments do they allow, and how often? Do they down code for services rendered, or have limitations?
  5. How will you be notified when your name is leased to another plan?
  6. Make sure you can approve or disapprove the addition of a plan.
  7. Will you have the option to opt out of participation with a specific plan?

Dentists should always carefully review EOB statements to verify that proper fees and policies are being observed per the signed participating provider agreement. In addition, dentists should check to see if their state has passed legislation regulating PPO leasing. At last count, twenty-four states have passed this type of legislation.

You can contact your state dental board for updates on these laws.

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