Open Dental Forum

Posted: **Tue Jul 24, 2018 7:14 pm**

How does the ppo fixed benefit differ from PPO Percentage? I read the descriptions and it wasn't clear to me..? I've been using PPO Percentage, in what situation might I want to switch to a PPO Fixed Benefit plan def instead?

Thanks!

Posted: **Mon Jul 30, 2018 4:20 pm**

This is useful when you have multiple locations where the PPO allowed fee differs by location but each procedure receives the same reimbursement rate at each location. Suppose that I have 3 locations and each location has a slightly different contract with the same carrier. At each location, the UCR fee for D0150 is $100 and insurance will always pay $45. However, the PPO contract has different allowed fees for each location which leads to different writeoffs and patient portions:

Code: Select all

                      Allowed                 Writeoff             Patient Portion
Location A            $60                     $40                  $15
Location B            $50                     $50                  $5
Location C            $45                     $55                  $0

Posted: **Tue Jul 31, 2018 4:24 pm**

Thanks for the response.

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