Insurance-Free: Is It for Me?

Interview with ACT Dental

ACT Dental recently interviewed Shelley DeGroff, PPO Advisors Founder and CEO. She shares insight into how PPO contracts work and advice for strategically dropping your PPOs. Insurance-free is the way to be!

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1. How early should I start the PPO setup process for my dental practice?

Initiating the PPO setup process early is crucial. Start as soon as you sign the letter of intent for acquiring a practice or at least six months before opening a new practice. Essential steps include obtaining a tax ID number, a physical address, and a contact number—a Google number can suffice initially. Early preparation prevents overwhelming yourself and your staff, ensuring a smoother transition into working with PPO insurance companies.

2. Can you explain the challenges of acquiring a practice with Delta Premier status?

Delta Premier presents a unique challenge. Most states no longer honor Premier status through acquisition or any significant change, such as bringing on a business partner or altering your tax ID. This means you face significantly lower reimbursements than the previous owner. It’s vital to strategize on improving negotiations with other PPOs to mitigate this impact, showcasing the importance of adept PPO consulting in these scenarios.

3. How can mature dentists manage transitions, such as introducing an associate, without affecting their PPO status?

For seasoned dentists contemplating introducing an associate, it’s crucial to understand that the associate may receive different reimbursement rates, particularly with Delta Premier transitioning to Delta PPO. This scenario often leads to a decrease in reimbursements, necessitating a comprehensive review of your practice’s PPO contracts and possibly acquiring additional PPOs to balance the financial impact.

4. How does adding or dropping PPOs impact a dental practice?

Strategically adding or dropping PPOs can significantly influence your practice’s financial health. By thoroughly evaluating your practice’s PPO reimbursements and patient demographics, we identify opportunities to enhance your PPO portfolio. This might involve negotiating higher reimbursement rates or reducing reliance on lower-paying PPOs, thereby working smarter, not harder, towards a more profitable PPO model.

5. How has the landscape of PPO negotiation changed, and what strategies should dentists employ?

PPO negotiation has evolved; it’s no longer a straightforward process. Insurers often try to dissuade negotiation attempts by making the process cumbersome. However, negotiation remains critical. Understanding shared contracting and exploring all avenues for better reimbursement rates are key strategies. It’s about playing the game smarter—leveraging every possible angle to ensure your practice’s profitability.

6. What should dentists know about shared coverages and umbrella companies?

Shared agreements and umbrella companies are essential concepts in PPO management. They refer to the interconnectedness of various insurance providers, allowing practices to be in-network with multiple insurers through a single agreement. Navigating these agreements effectively can unlock better reimbursement rates and broader network participation, underscoring the value of skilled PPO advisors in optimizing your insurance strategy.

7. How can dental practices remain profitable With rising overhead costs and write-offs?

The increasing burden of overhead costs and write-offs demands strategic management of PPO contracts. Practices must strive for write-offs in the 20% range, rather than accepting the current averages of 42%-45%. This involves diligent negotiation, strategic contract management, and reevaluating your participation in certain PPOs to ensure financial viability.

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