What do you charge when the patient is over their max - and you're in their network?

There are two opinions, even within our group. Of course, if this situation is addressed in your provider contract, ignore the rest of this post. You're obligated to follow that path.

However, the first thought is that even if the patient goes over their max, you're still obligated to stick to the fee schedule.

The second thought is that once the patient has exceeded his/her max, the office can charge their normal fees.

What should you do? Check with the plans to participate with to find how they deal with these situations.

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