As a dentist, do you feel like you are at the mercy of the PPOs? Is writing off tens of thousands of dollars because of how you participate in dental PPOs hurting your practice? Do you feel trapped into giving deep discounts to PPOs in order to keep existing patients? If you are at a point where you are considering cutting back on PPO participation, here are ten things that you need to know when it comes to you and PPO’s.
1. You Have Much More Power Than You Realize
The insurance companies won’t make any money at all if you don’t provide the quality dental care patients need. This gives your practice the upper hand in its relationship with the PPOs. They are simply promoting the dental services you provide and taking too big a share of the money you generate. You are the one making the patients happy with the quality dental care you provide. Let the insurance company know that you will no longer provide services to patients at the repayment rate you receive. They will be forced to give you better rates or lose all the money you generate for them.
2. Dental Practices Can Thrive with Little PPO Participation Or None At All
You may be concerned that if you stop accepting PPO patients, the reduction in your patient base may reduce your production and revenue stream too drastically. But this isn’t true. Many dentists don’t accept PPO patients and still maintain a robust business with a steady stream of income and new patients. High-quality dental care retains existing and brings in new patients. If you provide excellent dental care at competitive prices, your satisfied patients will tell their family, friends and acquaintances about the quality of your dental services. Referrals will continually generate new patients.
3. Dentists Can Determine the Right PPO Participation Balance
When dentists set their own fees they charge, they strike a balance between charging fees that are too high for most patients and too low to be profitable. You can do the same thing when participating in PPO programs. You can moderate your participation in PPO programs by deciding how many PPO patients you will accept, in what plan and at what reimbursement rate. You may be willing to have only 20% of your dental patients come from PPOs and only if the PPO pays what you consider fair compensation for your dental services.
4. You May Already Have Out-Of-Network Patients
Every PPO has some patients who use out-of-network dental care providers because of their exceptional service. These services are still covered by the insurance companies. You may already have some out-of-network patients for
whom you provide care. The patient decides which dentist, in or out the PPO network, they will go to for the quality dental services they need. Dentists providing the best and most advanced dental care possible can be confident in the fees charged. The patients will make PPOs pay you to provide the dental care they need.
5. Companies Select PPOs to Retain Top Talent
Employers provide dental coverage for their employees to attract and retain top talent. PPOs are selected to save money, while providing the dental care that their employees need. Dentists providing employees with critical dental care, not covered by the PPO, are typically paid out-of-network, or the employer will drop the PPO and replace it with one willing to pay the dentist selected by their employee. That is why many insurance companies provide good out-of-network benefits.
6. You Can Drop the PPO and Keep the PPO Patients
If your staff is well-trained, highly skilled, caring, and professional, it’s possible for your dental practice to drop the PPO and yet still retain most of the PPO’s patients. This is true, as long as, the PPO offers some type of out-of-network benefits. Most patients remain loyal to their dentist they trust and feel comfortable with. These patients are willing to pay a little more out-of-pocket for excellent quality care. In most cases, if a dentist drops underpaying PPOs, they will be able to retain the majority of the PPO patients, and at a better reimbursement rate.
7. Accentuate the Positive
Whether your patient’s PPO plan considers your dental practice to be in-network or out-of-network, it’s important when talking to patients, to accentuate the positive. Let them know other patients with the same PPO use your practice. Point out PPOs generally allow patients to use any dentist they choose. Explain to your patient how you are different or better with the dental care provided to the patient. This will benefit them should it be necessary for them to get clearance from their company’s PPO plan administrator.
8. It Is Possible to Negotiate Higher PPO Reimbursement Fees
Dentists or PPO Negotiation Solutions, acting on their behalf, have successfully negotiated higher reimbursement rates from PPOs. The main reason most dentists haven’t gotten better reimbursement fees from insurance companies is because they haven’t tried. Perhaps because they don’t have the time to devote due to their busy post COVID patient schedule, or they fear patient loss, or are intimidated by the red tape that may be met with the PPOs. However, it is in the best interest of the insurance companies to keep as many dentists as possible providing services under their PPO plans. Dealing with PPOs from a position of strength, with full knowledge of relative competitive provider rates in your area, and a particular PPO’s reimbursement rate, relative to others for the same services, will ensure that the PPO compensates you fairly.
9. Consider PPO Negotiation and/or Reducing Participation
In an attempt to increase the number of patients they serve; many dentists opt to participate in PPO plans. However, over time and with careful analysis, you may soon realize you are losing tens of thousands of dollars, because of sub-standard reimbursement from insurance companies. If the PPO reimbursement rate for dental services you provide to patients is less than 80% of its actual value, you should consider first, negotiating your fee schedule with that insurance company, or possibly reducing your PPO participation.
10. Create a Strategy for Leaving The PPO
If you feel your dental practice is losing too much money serving one, or all, of your PPO patients and you have decided to leave the PPO, create a strategy that will fortify your practice and make a plan for how to replace any patients you may lose as a result . You can build up your practice in advance of terminating certain PPOs with an effective marketing strategy that will attract new patients. In this manner your production levels will not be interrupted. Make your staff aware of the changes you have planned. Share your vision for the dental practice. Provide your staff with ways to engage prospective patients responding to your marketing campaigns in order to maintain the level of success that it currently enjoys and surpass it. Your staff will play a valuable role in the transition.
Contact PPO Negotiation Solutions
PPO Negotiation Solutions has been negotiating and optimizing PPO participation since 2012. With 30 years of experience within the dental industry, our success is unparalleled in producing not only the greatest reimbursement revenue increases, but also, the most comprehensive, un-invasive approach. We provide no hassle results quickly, starting with a thorough assessment of your patient participation mix, often through remote access to your practice management software. Your fee schedules are then analyzed relative to other dental practices in your general area.
A negotiation/participation plan is formulated and agreed upon. We negotiate higher fee schedules on your behalf directly with our highly cultivated contacts within the PPOs and meticulously follow credentialing paperwork through the system until you are safely in network. Call us today to realize a minimum 24% increase in PPO reimbursement revenue. Successful completion usually means adding around $10,000 per month or $100,000 annually to your bottom-line and our service pays for itself in the first month.