by Christine Taxin
August 11th, 2017
Question: A subscriber from the State of Michigan has asked this:
Has anyone from other states seen the fees for crowns lowered by Delta or Blue Cross?
Answer: First look at your contracts, and see if there is anything in it that allows for fees to be lowered. Next, look up your zip code to find the average fee for the procedure you are looking at to see what the fees are in all percentages starting from 40% up to 90%. Now, subtract lab bill and time needed for a doctor, plus $75.00 per visit to cover all team, and supplies to seat a patient.
When you come up with a fee, you must then appeal to the State Commission office and the insurance company as to why you are unable to accept this fee. If you are able to do that, you can renegotiate fees based on solid information. If not, why would you stay on a plan that loses you money? I recommend this to all offices I work with when they are on plans that are losing them money.
A sample of how to look for fees:
I have looked at the zip code fees for the code D2740. It tells me that the fees range from 50% through 90% for the following:
48001 Standard Algonac, Clay, Pearl Beach, Russell Is, Russell I... St. Clair County Area Code 810
The range of fees at 50% $525.00 per insurance, 60% $550.00, 70% $576.00, 80% $605.00, 90% $649.00 that is without the co-payment of the patient
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