You prep the tooth.
You remove decay.
You place a core buildup because, let’s be honest, that tooth would collapse like a beach house in a hurricane without it.
Then you seat the crown.

You did two procedures.

Insurance says you did one.

Welcome to the world of “bundling.”

In PPO insurance, bundling is often just a polite word for unpaid work.

The Classic Example: Core Buildup + Crown

Here’s how the story usually goes:

You perform a core buildup because the remaining tooth structure is compromised.

You prep and seat a crown.

You submit both codes.

The Explanation of Benefits (EOB) arrives and voilà.

The buildup has disappeared.

Bundled into the crown.

Translated:
“You did the work. We’re keeping the money.”

And no, this isn’t a processing error.

It’s often built directly into the PPO agreement you signed years ago when you were just trying to keep the schedule full and the lights on.

Why Bundling Exists (Hint: It’s Not for Patient Care)

Insurance companies frame bundling as administrative simplification.

That sounds nice.

What it really means is:
They reduce reimbursement by combining procedures into a single allowable.

It protects their margins.

It reduces claim payouts.

And it quietly shifts financial pressure onto you.

The materials for that buildup? Not free.
The time you spent sculpting it? Not free.
Your clinical judgment? Definitely not free.

Yet somehow it becomes complimentary.

Let’s Call It What It Is

Bundling is margin compression disguised as policy.

It’s one of the many levers carriers use to slowly chip away at practice profitability without ever officially lowering your fee schedule.

You don’t feel it all at once.

You feel it in:

1. Slightly lower collections per crown

2. Subtle production to collection gaps

3. That nagging sense that something doesn’t add up

Because it doesn’t.

How to Fight Back (Strategically, Not Emotionally)

You can’t out yell bundling.

But you can out strategize it.

1. Narrative Precision

Stop submitting sterile claims.

If a buildup was required for retention, say it.

Document the percentage of remaining tooth structure.

Note the structural compromise.

Be clear that this was not routine prep refinement.

Specific clinical narratives can make a difference. Not always. But often enough to matter.

Insurance companies thrive on vague submissions.

Clarity is your weapon.

2. Contract Review (The Real Battlefield)

Here’s the uncomfortable truth:

Many bundling rules are baked directly into your PPO contract.

They’re not claim level decisions.
They’re policy level permissions.

That means appeals alone won’t fix it.

The real solution?
Target those clauses during fee negotiations and contract optimization.

At Veritas Dental Resources, this is exactly where we focus. Not just raise my fees, but:

• Identify bundling language
• Negotiate carve outs
• Clarify definitions
• Optimize reimbursement structure

Because if the contract allows bundling, the EOB will follow the contract every time.

3. Monitor Adjustments Like a Hawk

Bundling leaves fingerprints.

If you see a consistent pattern where:

• Core buildups disappear
• Multiple surface restorations collapse into one
• Adjunctive procedures repeatedly get absorbed

That’s not random.

That’s structural.

And it’s a sign your PPO agreement needs an overhaul.

You wouldn’t ignore recurrent decay.
Don’t ignore recurrent reimbursement erosion.

The Bigger Picture

Benjamin, you’ve helped over 10,000 dental offices. You’ve seen the pattern.

Practices obsess over supply costs, saving 2 percent on gloves, while losing 15 to 25 percent in silent reimbursement leakage through bundling, umbrella networks, and outdated contracts.

Bundling isn’t just about one buildup.

It’s about protecting the financial integrity of quality care.

Because when reimbursement shrinks:

Investment in technology shrinks.
Team morale shrinks.
Long term sustainability shrinks.

And none of that benefits patients.

Final Thought

You are not overcoding.

You are not double billing.

You are delivering clinically necessary treatment.

If a buildup is required for structural integrity, it deserves structural compensation.

Stop letting your revenue get bundled away.

The crown may cover the tooth.

But it shouldn’t cover the truth.

If your EOBs don’t match your effort, it’s time to look at the fine print and fix it.

Benjamin Tuinei
Founder – Veritas Dental Resources, LLC
📞 888-808-4513
Services: PPO Fee Negotiators, PPO Fee Negotiating, Insurance Fee Negotiating, Insurance Credentialing, Insurance Verifications
Websites: www.VeritasDentalResources.com, www.VerusDental.com