By Shelley DeGroff, Founder of PPO Advisors
When it comes to dental insurance, the prevailing wisdom used to be that it’s smart to be in–network with pretty much everything. But lately, that thinking has changed as more dental practice owners realize when it comes to PPO plans, less is often more. These dentists have discovered that it pays to be choosy about insurance plans.
The main argument for being in-network with more PPOs is that it’s an easy way to create a wider appeal for your practice. But what it really does is create more opportunities for insurance companies to pay a lower fee schedule.
The growing trend towards greater selectivity is a welcome change because it suggests more dental practice owners see the need to proactively manage their relationship with insurers. A good place to start is by being strategic about the PPO plans you select for your practice.
Know Your Demographics
The biggest factor in choosing PPO plans for your practice is your patient demographics. Everything depends on knowing and understanding that information. Basically, you want to be able to answer the following questions:
- Who are your current and potential patients?
- What insurance plans are they most likely to have?
Let’s look at a few ways to figure that out.
Researching Patient Base
How you go about researching patient demographics depends on where your practice is based.
If you’re practice is in a community where you already know who the main employers are, reach out to their human resource departments to find out which insurance companies they work with, and which plans they offer. Even if you think you already know this information, it’s worth checking periodically because things can change – especially insurance plans, and it’s to your advantage to have the most current information. If you’re new to an area, contact your Chamber of Commerce. They’re usually happy to provide a list of the main employers in the area, especially if you sign up as a new member.
For practices in urban or large suburban communities, there will be a multitude of employers. Look at your zip code to identify where your patient base is coming from, then look at employer groups from that zip code area. There’s a good chance you’ll see a clear pattern for dental insurance coverage.
For example, GEHA Connection Dental is based out of Kansas City. While they don’t blanket the entire metro area, if your practice is in a region where they are concentrated, such as the Liberty area of Kansas, it’s a good idea to have a direct contract with them.
Be Sure You Understand Your Contract
One important fact to keep in mind is that whenever you make a direct contract with a particular insurance company, you are opening the door to other insurers. All of the networks are tied together through a complex web of agreements. When you sign a contract with Aetna, you pick up all of Aetna’s shared networks. It’s crucial to understand how a contract is structured because if you don’t, you risk losing money
If you have questions about which PPO plans make the most sense for your dental practice, contact PPO Advisors. We understand how the insurance industry really works and we’ve used our knowledge to help hundreds of dental practices negotiate higher reimbursements from insurers. We are committed to leveling the playing field for dentists, so you can work smarter, not harder.