Why negotiate Insurance fees? Insurance companies pay different reimbursement fees to different dentists for the same services. Some dentists are paid as much as 10% more for their services. The difference in the amount dentists receive from insurance companies is based on the ability of the dentist to successfully negotiate insurance reimbursement fees that are at least a little higher than what they had received previously. Some dentists handle negotiations themselves. Others partner with companies that are experts at negotiations. Dentists had been able to simply ask the insurance company for a 5% annual increase and receive it. But those days are over. Today, PPO negotiation is the norm.
The Growth of Preferred Provider Organization Plans
One reason insurance company’s no longer simply give dentists annual payment increases when they request it is because Preferred Provider Organization (PPO)plans have grown in popularity. PPOs now account for more than 85% of the dental plans under which most dentists provide services. As more dentists work under in-network plans, the insurance companies feel less pressure to negotiate. As employers embrace the PPOs as a way to reduce the cost of providing medical and dental care for their employees and increase their bottom line, insurance companies are less willing to negotiate fee increases.
Know Where You Stand
Before dentists begin trying to negotiate for higher fees, they have to know how the fee they currently receive compares to other dentists in their area. The key is to select the right company to conduct large and accurate fee surveys. The information a survey of all the dentists working within the same five-digit zip code provides has a direct impact on the ease and accuracy with which a dentist can compare the fees they charge the insurance company with what other dentists receive. This is very important for a dentist to know to make a strong case for a dental fee increase during POP negotiation.
How Many Insurance Companies are Involved?
In addition to conducting an accurate dental service fee comparison, a dentist that is considering negotiating for better fees should know the number of insurance companies for which they are contractually obligated to provide dental services. That number is often unclear because insurance companies sometimes have contracts with each other that allow them to be able to share both patients and fees. A dentist may have signed an agreement with one insurance company, but the fine print contains an agreement to work with the group of interconnected insurance companies to which they are but one member.
Negotiating Fee Increases Can Be Difficult
Negotiating with insurance companies for a payment fee increase can be difficult and very time consuming. The average dentist does not have the time, training, experience and expertise or PPO contacts to successfully handle this negotiation process. However, if they really want better fees without having to deal with all the headaches and hassles involved in the negotiation process, they can hire companies with teams of professional negotiators to do it for them. These companies often represent large groups of dental offices, so this gives them a powerful advantage and valuable information to use when negotiating.
Getting Adequate Compensation for Dental Services
To ensure they are getting fair and adequate compensation for the dental services they provide, dentists sometimes have to seek out information about the fees other dentists in their service area are receiving. Insurance companies or even other dentists may not be willing to share this important information. However, a survey of dental service fees paid to dentists in their area done by professional researchers can give a dentist the information they need to decide if they are being fairly compensated. Then they can decide if they should contact the insurance companies they signed with to negotiate a fee increase.
Helping Dental Practices to Thrive
When dentists get adequate compensation for the services which they provide, they are able to invest in the best dental equipment and technology, hire excellent staff and provide their patients high quality care. This helps their dental practice to thrive and become a valuable asset to the people and community it serves. This makes the decision to negotiate with the insurance company to get adequate compensation, one that is essential for your practice to thrive and provide the best dental services possible for your patients. It can also make a dramatic improvement in the health and future of a dental practice.
Better Fees Mean Better Dental Services
When dentists and dental practices receive fair compensation for the services that they provide, it enables them to be able to focus on delivering the best possible care for each patient. Most dentists want to be able to feel good about accepting patients from PPO plan providers. Negotiating the right fee structure from the reimbursement plan of the insurance company positively impacts the quality of the services a dentist and dental practice can provide. Reimbursement fees that are too low create a large gap between the real fees and the amount substandard reimbursement forces dentists to write off.
Dentists Are Important to Insurance Companies
Many employers stopped providing dental insurance for their employees during the recent depression and did not add it back when the Great Recession was over. As a result, the insurance companies saw their income reduce significantly and it has not recovered. So, each of the dental offices that remain under contract with and are providing services under the auspices of the insurance companies through PPOs and other plans are important to them. Dental offices have more leverage to negotiate fees than they realize. Dentists should not be afraid to ask for and be willing to negotiate better reimbursement fees.
Reimbursement Fees Are Not Non-Negotiable
It is a myth that insurance reimbursement fees are non-negotiable. This myth has caused many dentists to develop a mindset where they never even consider requesting insurance companies negotiate better rates. Many dentists would be surprised to see how many of the insurance companies they deal with every day are willing to negotiate and increase the reimbursement fees that they pay. Dental practices that are sole proprietorships, as well as those that are members of a group practice,have the power to negotiate with insurance companies to increase the reimbursement fees. They just have to take action.
How To Start Reimbursement Fee Negotiation
Read over the contract you have with the insurance company carefully. Identify where it talks about when and how to request a fee increase. A practice administrator can also provide valuable insight into the fee negotiation process. Negotiating will take some time and patience. Send letters asking for a fee increase to the company’s practice relations department and give them a deadline by which to respond. The letter that you send should contain a copy of the fee schedule for your practice. This provides them with all the data they need. If they won’t negotiate with you, hire a professional.
Resolving the Issue Of Increased Reimbursement Fees
Insurance companies try to make as much money as possible. But it should not be at the expense of hardworking dentists. The insurance companies sometimes use stall tactics to keep dentists from receiving the fee increase they request. In recent years, several major insurance companies have negotiated increases in the reimbursement fees they pay to dentists. But success only happens when dentists request fee increases. Dentists can successfully negotiate insurance reimbursement fee increases. There are companies specializing in negotiating and optimizing dentists’ reimbursement fees. They free the dentist to focus on providing all their patients with the best care possible.