8/21/2025
The Switch-Up
Suddenly, they claimed they don’t take that insurance—despite saying earlier, “we accept all PPO plans.”
When I called the biller myself, here’s what she said:
- “We only take certain PPO plans that have contracts to pay our rates.”
- “We won’t bill your plan unless it’s one of those—even if it pays out-of-network.”
- “If he wants a superbill, he has to pay our full ‘usual and customary’ rates—$527 per child—because giving a discount and providing a superbill is insurance fraud.”
Why That’s Wrong
It’s not fraud to give a cash-pay discount and provide a superbill. It’s fraud if you lie about the codes or charges. Cash-pay discounts are common, legal, and appropriate—when you clearly show what was paid and submit the actual receipt.
The Real Problem
This situation highlights how:
- Many dental offices use the “we take PPOs” line as a trap
- Patients can be punished for trying to use insurance honestly
- The healthcare billing system is built to confuse—and overcharge—patients
The Takeaway
If you don’t have someone helping you ask the right questions, you could end up paying hundreds more than you should.
Moral of the story: Don’t navigate the dental or medical billing maze alone. Work with someone who knows the system and can protect you from overcharges.
I do this every day for my clients. Call or text (716) 503-1113 if you want an advocate in your corner.