PPO Exploration
Considering Adding PPOs To Your Practice?
A Few Things To Know…
Many dentists who have an established practice are facing a difficult decision…. should they add PPOs to the practice?
It is a more difficult question than it has ever been because more patients are making in-network PPO participation with their dental plan a more significant factor in choosing a new dentist —- or continuing with their existing dentist.
FAQs
Profitable PPOs offers services for dental specialists, multiple provider practices, multiple location practices, as well as solo practitioners. We also offer services for multi-specialty practices who are looking to incorporate integrative dental solutions.
Unfortunately, no. Not every company will negotiate fees. However, the good news is that many other options exist aside from PPO fee renegotiation, and thus the importance of a comprehensive approach to PPO Optimization, not just PPO renegotiation be considered.
One of the challenges facing dental practices when dealing with dental PPOs is the lack of available time and focus. For the doctor, time is very limited with patient care, reviewing notes, hygiene checks, preparing for patient care, leading, etc., it does not leave much free time! And frankly, very few doctors understand dental insurance well!
For an office manager or insurance coordinator the daily responsibilities (answering the phone, assisting patients, developing treatment plans, checking benefits, financial arrangements, scheduling, and collections, etc.) make it very difficult to study the different PPO relationships between insurance companies – there simply aren’t enough hours in the day!
Adding a PPO?
The decision to add a PPO, some PPOs, or even many PPOs are some of the most financially significant decisions that a dentist and practice will ever make. Why? Well not only does it involve discounting the fees from the UCR fee schedule on NEW patients………more importantly for many practices, it also means lowering the fees on EXISTING patients who are already seeing you as an out-of-network provider!
If you were to add a new PPO and it helped you attract another 25 new patients a year – but it cost you $30,000 in lower revenue on current patients – is that really a good thing?
Unfortunately, dental practices frequently sign up for the wrong PPOs, or choose the wrong tier or plan to participate with… and in doing so cost themselves hundreds of thousands of dollars in lost revenue!
What About Shared Networks?
What many dentists are not aware of are the various different networks that a single dental PPO may have. The reality of today’s dental insurance marketplace is that a dentist signing up with a single PPO plan may also get put into 3-5 other insurance company PPO networks because of all the “shared network” relationships that exist.
In some cases, signing up with a network can put a doctor into over 100 different PPO plans!
This confusing and frustrating reality means that dentists often can’t be entirely sure what plans they will become a provider for when signing up for a PPO plan, and without significant due diligence may not have an understanding of the financial ramifications……until it is too late. That is where Profitable PPOs comes in.
What Does Our Service Include?
As your PPO insurance negotiators and advocates you gain financial advantages through our extensive knowledge and expertise, as well as the peace of mind that comes with knowing that options related to PPO participation are being looked after on your behalf.
With Profitable PPOs acting as your resource and serving as your advocate with the insurance companies, you are able to focus on your patients with peace of mind – knowing that the PPO insurance aspects of your business are being looked after. The PPO Exploration service from Profitable PPOs typically includes:
- Analysis of insurance utilization and claims volume by insurance company as an out-of-network provider which is then used as a key metric when the time comes to make decisions on which PPO plans, if any, you will join.
- UCR fee analysis versus area and insurance company benchmarks.
- Examine practice data and practice management reports, develop options for PPO fee improvement and review findings with the doctor.
- Review findings with the doctor via shared-screen meeting and discuss options and opportunities.
- Initiate contact and represent the doctor/practice with the various insurance companies looking at different participation options and opportunities for direct or indirect participation.
- Handling of your communication and negotiation with the various insurance PPO plans.
- Consult with doctor to make decisions on which PPO plans are a fit.
- Credentialing
Get Started With A PPO, The Right Way
Many dentists make the mistake of signing up in the wrong way with PPOs – and unnecessarily cost themselves huge chunks of profit.
Other dentists, unfortunately, are not aware of the financial ramifications of joining a PPO plan and end up becoming in-network but incur huge losses on existing patients. It’s a really frustrating experience for doctors to sign up for a PPO, and only later find out that it was linked to several others and the resulting PPO participation is going to cost the practice $30,000 to $50,000 in CURRENT revenue with only the hope of attracting enough new patients to offset the loss!
Finally, some dentists sign up too quickly, and do not take the time, or gain the understanding of the dental marketplace to get the best PPO fees possible.
If you are interested in adding PPOs to your dental practice, and would like more information on how to do so in the most profitable manner – and avoid costly mistakes, simply click the link below:
Ready to learn more?
If you would like to schedule a no-cost, no obligation, consultation call to discuss how Profitable PPOs can help we are happy to do so, simply call us at 855-776-4246.
Alternatively, enter your contact information and we will be happy to send you additional information about PPO fee improvement.
Thanks for stopping by and visiting!
