If you choose to stay in-network with an insurance company, you need to be prepared to negotiate. In this episode of The Art of Dental Finance and Management podcast, Art meets with Shelley DeGroff, Founder and CEO of PPO Advisors, to discuss how you can maximize insurance reimbursements for your dental practice.
Listen The Podcast
🦷 What to Expect?
✅ Invaluable insights for any dental provider, whether a startup, acquisition, or long-standing practice
✅ A deep dive into the nuances of credentialing and insurance company dealings
✅ Tips on navigating the ‘Most Favored Nations’ clause and its impact on your practice
✅ Discover why credentialing is more than just filling out an application
✅ Understand the crucial role of credentialing in your practice’s future
✅ Learn how to leverage your position when negotiating with insurance companies
💼 Why It’s a Must-Watch:
✅ Learn how a free PPO analysis can transform your practice’s profitability
✅ Understand how to interpret your 12-month insurance history for better decisions
✅ Get a sneak peek into the negotiation process for more favorable fee schedules
✅ Never settle for the first fee schedule offer
✅ Utilize your unique position as a new contract holder for better terms
✅ Recognize the long-term impact of your credentialing choices
🌟 No Commitment, Just Valuable Knowledge:
✅ Aimed at empowering providers with the right information to grow their business
✅ Tailored advice for both new and experienced practitioners
✅ Open invitation to all dental professionals seeking guidance on their next steps
✅ Gain valuable knowledge to make informed decisions
✅ Understand the importance of thorough research and negotiation in credentialing
✅ Transform your approach to insurance contracts for optimal success
Summary:
1. Shelley, the ADA reports that one in six dental practices consider dropping one or more insurance plans due to financial pressures. What are you hearing from your clients regarding this trend?
This statistic resonates with what we’re seeing across the board. Whether in specialty or general practice, our clients express a universal frustration with insurance. The process is overwhelming, non-transparent, and, frankly, unfair. With costs skyrocketing and reimbursements stagnating, more dentists are contemplating stepping back from specific PPO contracts. It’s a critical decision point, and at PPO Advisors, we’re deeply involved in guiding practices through this maze, focusing not just on staying within the insurance fold but optimizing participation for maximum profitability.
2. Insurance contracts are notoriously complex. Can you explain how fee schedules are determined and their impact on practices?
Insurance companies typically base their fee schedules on the zip codes of dental practices, using UCR (Usual, Customary, and Reasonable) analyses to establish a starting point. It’s essential for practices to update their master fee schedules regularly every year and always bill their full fees for insurance claims. Such a proactive stance communicates to insurance companies the necessity of adjusting fee schedules. At PPO Advisors, we focus on educating dental practices on the strategic nuances of navigating insurance company protocols. It’s about equipping practices with the knowledge to effectively engage in the system established by insurance companies, therebyenhancing their practice’s profitability.
3. What advice do you have for new or existing practices considering their insurance options?
The first step is understanding your demographic and patient flow. Only some PPO contracts will be beneficial, and signing up for everything out there can lead to a quagmire of unfavorable terms and reduced profitability. It’s about strategic selection and negotiation, areas where PPO Advisors excels. We help practices understand the landscape, including the interconnectedness of various PPO networks, to make informed choices that enhance profitability.
4. Negotiating with insurance companies is a daunting task. What has been your experience in this area?
Negotiation is still possible and fruitful, but it requires a deep understanding of the insurance landscape and a strategic approach. At PPO Advisors, we’ve developed effective tactics for engaging with insurance companies, ensuring our clients don’t just accept the status quo but actively seek contracts that will sustain the practice and have future negotiation success. It’s about knowing how to navigate the web of insurance and understanding the longterm goals of your practice.
5. Shelley, tell us more about how PPO Advisors supports dental practices in navigating these challenges.
At PPO Advisors, our mission is to demystify the insurance process for dental practices. We provide comprehensive analyses of a practice’s insurance participation, identifying areas for improvement, whether through renegotiation of contracts or strategic dropping of unnecessay ones. Our approach is education-first, ensuring practices understand their options and the potential impact on their bottom line. We’re not just about increasing participation in PPOs but optimizing it for profitability and sustainability. We strongly believe in transparency and ensuring that the practice obtains all the necessary education about any particular insurance company. We are hired for a reason, and most of the time, it is because practices no longer have the time, capacity, or understanding of their PPO contracts. We are honored to be able to bridge that gap between the provider and the payor.
6. As practices face increasing pressure from insurance companies, what final advice do you have?
Dental practices need to view insurance participation strategically, focusing on profitability rather than just volume. With the right guidance and a clear understanding of the landscape, it’s possible to navigate the complexities of PPO insurance to your advantage. PPO Advisors is here to ensure that dental practices don’t just survive in this challenging environment but thrive, leveraging our expertise in PPO solutions, dental PPO negotiation, and consulting to maximize profits.
7. How can someone contact PPO Advisors for assistance with PPO solutions?
For anyone looking for expert PPO solutions or dental PPO negotiation, contacting us at PPO Advisors is straightforward. You can find a form at the end of this page. This allows you to schedule a meeting with myself, Shelley DeGroff, CEO of PPO Advisors, or a member of my dedicated team. We offer a complimentary consultation, including a free analysis with negotiations for all established practices, to demonstrate the potential return on investment before we begin our partnership.
8. What makes your approach to PPO insurance companies and negotiations unique?
Our approach at PPO Advisors centers on transparency and risk management. We conduct a thorough analysis and communicate with PPO insurance companies to negotiate better terms before charging any fees. This way, we can show practices the tangible benefits (ROI) they’ll receive from our services, making our work with PPO insurance companies a risk-free proposition for them. We aim to establish a trusting relationship, ensuring we are a perfect match for each other.
9. How does PPO Advisors help practices become more profitable with PPOs?
Our PPO consulting and negotiation expertise is designed to help dental practices enhance their profitability. We dive deep into each practice’s situation specifics, leveraging our knowledge to negotiate better fee schedules with PPO insurance companies. By eliminating unnecessary complexities and focusing on the most profitable PPO strategies, we help practices increase their PPO profits significantly.
10. Can you share how practices can successfully transition out of network with PPO plans?
Transitioning out of network with PPO plans requires careful planning and communication. At PPO Advisors, we guide practices through this complex process, providing strategies for communicating changes to patients and preparing the practice for a smoother transition. Our aim is not just to help practices move out of network but to do so in a way that retains patient loyalty and minimizes financial disruptions, ultimately leading to a more profitable PPO practice.
11. What advice do you have for practices looking to improve their negotiations with PPO insurance companies?
To improve their negotiations with PPO insurance companies, practices should focus on understanding their contracts and renewal dates. Our team at PPO Advisors specializes in analyzing and leveraging these contracts to secure better terms for our clients. By staying informed and proactive, practices can significantly improve their negotiations with PPO insurance companies, leading to more favorable fee schedules and enhanced profitability.