In this week’s episode, I’m joined by “Shelley DeGroff”, Founder and CEO of PPO Advisors, to share her expertise in managing Preferred Provider Organizations (PPOs) for dental practices.
Shelley cultivated strong relationships with insurance companies and their representatives, allowing her to provide listeners with a comprehensive understanding of the big picture, identify opportunities for dental practices, and evaluate the impact of negotiating and structuring PPO contracts.
Shelley offers valuable insights into how PPOs impact dental practices, unraveling the complexities of insurance. From negotiations to credentialing, she also outlines the tools and processes that providers should be aware of to maximize the value of their practices and work more efficiently. Tune in to learn more!
Main Takeaways
✅ Boost your dental practice’s profit with PPO management (00:00)
✅ The top PPO trends in 2023 (01:32)
✅ Why TPAs are becoming more common in dentistry (03:33)
✅ How PPO Advisors helps dental practices (05:36)
✅ How the negotiating process works (10:17)
✅ Why you’re being bullied by insurance companies (13:23)
✅ The problem with credentialing (16:55)
✅ What makes PPO Advisors unique (23:29)
✅ Lightning round Q&A (31:41)
1. Many practices feel ‘bullied’ by PPO insurance companies. Can you elaborate on this issue and how practices can navigate these challenges?
The sentiment of being ‘bullied’ by PPO insurance companies is widespread among dental practices. This intimidation factor is not just a feeling—it’s a strategic move by insurance companies designed to maintain their dominance by enforcing the notion that being in-network is indispensable for survival. However, this narrative overlooks the agency practices possess in renegotiating terms and exploring alternative PPO solutions.
At PPO Advisors, we empower practices by demystifying PPO insurance complexities. We guide them through the intricate process of dental PPO negotiation, providing them with the tools and strategies to assert their needs effectively. Our approach is to educate practices on leveraging their strengths, understand the fine print of PPO agreements, and negotiate terms that respect their value and contribution to dental care. This way, practices can achieve profitable PPO operations without succumbing to the pressures exerted by PPO insurance companies.
2. With the landscape of PPO agreements constantly evolving, particularly regarding shared agreements, what trends should practices be aware of in 2023?
The landscape of PPO agreements is in flux, with shared agreements at the forefront of this evolution. A trend that’s become particularly noticeable is the restructuring of these agreements by major carriers, like Aetna, which has profound implications for practices and patients alike. For instance, the recent discontinuation of shared agreements between Aetna and other entities has left many practices and their patients navigating a new, often less favorable, in-network status unexpectedly.
To navigate these changes, practices need to stay abreast of the shifts within the PPO ecosystem. This includes regularly reviewing their agreements, understanding the implications of changes, and preparing both their teams and patients for possible transitions. At PPO Advisors, we specialize in ppo insurance companies’ trends, offering ppo consulting that helps practices anticipate changes, adjust their strategies accordingly, and maintain or even enhance their profitability amidst the evolving PPO landscape.
3. How does PPO Advisors assist practices with TPAs and secure better negotiated rates?
Third-Party Administrators (TPAs) are becoming a staple in the PPO management strategy of many practices, offering an alternative route to potentially better rates. However, navigating the complexities of agreements with TPAs requires a nuanced understanding of the broader insurance ecosystem and the ability to leverage these relationships effectively.
At PPO Advisors, we offer comprehensive ppo solutions that include analyzing current TPA agreements, identifying opportunities for improved terms, and engaging in strategic negotiations on behalf of practices. Our expertise allows us to dissect the often complex and interconnected agreements, ensuring practices are not inadvertently entering into less advantageous terms. By optimizing TPA relationships, we help practices secure better reimbursement rates, which directly contributes to their bottom line and overall profitability.
4. Can you dive deeper into how PPO Advisors specifically enhances practices’ profitability through effective PPO management?
Enhancing a practice’s profitability through effective PPO management is multi-faceted and requires a strategic approach. At PPO Advisors, we begin with a deep dive into the practice’s current PPO agreements and reimbursement rates. This initial analysis is critical for identifying underperforming contracts and opportunities for improvement.
Our next step involves a meticulous negotiation process with PPO insurance companies. This is where our expertise in dental ppo negotiation shines. We don’t just ask for better rates; we build compelling cases for why our clients deserve them, backed by data and a thorough understanding of market rates. Additionally, we explore all avenues of PPO management, including the optimization of shared agreements and the strategic use of TPAs to ensure our clients are maximizing their reimbursement potential.
Moreover, we believe in empowering practices through education. This means we don’t just negotiate on their behalf; we also provide them with the knowledge and tools to understand PPO contracts better, manage them effectively, and make informed decisions about their insurance strategies moving forward. By enhancing their profitability, we help practices focus more on providing quality care rather than worrying about navigating the complexities of PPO management.
5. The credentialing process can be lengthy and complex. How does your company simplify this for dental practices?
Credentialing is indeed a critical yet often cumbersome process for dental practices. The extended timelines, which can now stretch up to 16 weeks or more, pose significant operational challenges, particularly for practices looking to bring on new associates or expand their networks.
At PPO Advisors, our goal is to streamline the credentialing process, making it as efficient and painless as possible for our clients. We start by setting realistic timelines and expectations, advising practices to initiate the credentialing process well in advance of any planned changes or additions to their team. Our team of experts then takes the lead on managing the entire process, from completing the necessary paperwork to following up with insurance companies, ensuring that all steps are completed accurately and promptly.
Furthermore, we leverage our industry relationships and knowledge of insurance company protocols to expedite the process whenever possible. By handling the credentialing process on behalf of our clients, we allow them to focus on their primary goal: providing excellent dental care to their patients.