Taking the Leap: Embracing Out-of-Network Patients in Your Dental Practice
Let’s face it: the phrase “Out-of-Network (OON)” can send shivers down even the most seasoned dentist’s spine. If you own a dental practice, the thought of stepping into the OON world might feel like diving into uncharted waters. But here’s the good news: you don’t have to let fear (or insurance companies) control your success. In fact, being an OON provider can offer you and your practice more freedom, less red tape, and a better experience for your patients.
So, grab a cup of coffee (or a dental mirror if that’s more your thing), and let’s unpack the truths and tips about managing out-of-network patients.
Why Does Going OON Feel So Intimidating?
We get it. Insurance companies don’t make it easy. They’ve got their playbook of complicated claims processes, confusing codes, and customer service that seems designed to make your life harder. It’s no wonder that many dentists worry about how they’ll handle OON patients.
But here’s the secret: you don’t need to let the insurance giants bully you into submission. With the right approach, you can manage OON claims efficiently and confidently—without sacrificing patient care or practice profitability.
Common OON Scenarios: You’re Not Alone
Whether you’re choosing to go OON or are forced OON due to these common scenarios, managing your OON claims is the same:
1. When the Practice Changes Hands
Selling or buying a dental practice is an exciting milestone, but it comes with some challenges. Credentialing the new owner can take months, leaving you (and your patients) in OON limbo. While it’s frustrating, it’s a normal part of the transition.
2. When a New Associate Joins
Adding a new associate is a great way to grow your practice and better serve your community. But, as with ownership transitions, credentialing for new associates can take a while. If your associate starts seeing patients before their credentialing is complete, guess what? They’re OON for a time.
These scenarios might feel overwhelming at first, but the good news is that managing your OON claims doesn’t have to be complicated. With a solid plan in place, you can keep your practice running smoothly and keep your patients happy.
Tips for Navigating OON Claims Like a Pro
Now that we’ve established that going OON isn’t as scary as it seems let’s dive into some practical tips for managing claims during transitions:
1. Use the Correct NPI (National Provider Identifier)
This is non-negotiable. Make sure the individual provider’s NPI 1 is on the claim and matches the provider seeing the patient. Submitting claims under another dentist’s NPI (even if it’s unintentional) can be considered insurance fraud. Accuracy is everything here.
2. Submit a W-9 and Letter of Acquisition
PPO Advisors recommends submitting your W-9 and a letter of acquisition explaining that new ownership has taken over and that you wish to have the claim processed as OON until you decide on how you are credentialing. This proactive step can help streamline claim processing and reduce confusion.
3.Offer PPO Discounts (Legally)
You can offer PPO discounts to patients if you’d like to help ease the expense of being OON. However, to legally provide a PPO patient with a discount, you must discount the insurance claim itself. Insurance companies view patient-only discounts as fraudulent and overbilling the insurance company, so make sure you handle discounts properly.
4. Educate Your Patients
Communication is key. Let your patients know upfront that you’re temporarily OON but are committed to helping them navigate their benefits. Provide estimates for their out-of-pocket costs and reassure them that you’ll still submit claims on their behalf.
5. Master the Art of Documentation
Insurance companies love to nitpick OON claims. Make sure your documentation is thorough, accurate, and easy to understand. This minimizes the chances of denials or delays.
6. Lean on Experts
Whether it’s a credentialing specialist or a service like PPO Advisors, don’t hesitate to get help. Handling insurance is a full-time job, and you’ve got a practice to run. Delegating can save you time and stress.
7. Stay Persistent
Insurance companies may push back on OON claims, but persistence pays off. Follow up on claims, respond to requests for additional information, and don’t take no for an answer. Your patients and your practice will thank you.
Turning the OON Challenge into an Opportunity
Here’s the thing about being OON: it forces you to focus on what really matters—building strong relationships with your patients. When you’re not tied to the constraints of in-network agreements, you have more flexibility to provide personalized care, set your own fees, and ultimately create a patient experience that sets your practice apart.
So, whether you’re navigating a transition or intentionally choosing to be OON, embrace the opportunity to take control of your practice. It might just be the best decision you ever make.
Final Thoughts
Being an OON provider doesn’t have to be daunting. Insurance companies will try to complicate things, but with the right mindset and strategies, you can handle OON claims like a pro. Whether you’re transitioning or planning to step out of network permanently, remember: you’ve got this—and we’re here to help.
So go ahead, take the leap, and watch your practice thrive.
Contact PPO Advisors today to schedule your risk-free analysis and learn more about how we can help your practice thrive.