Honest Talk About Dental Insurance

Navigating PPO Solutions with PPO Advisors

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1. Could you introduce yourself and explain your role at PPO Advisors?

I’m Shelley DeGroff, the founder of PPO Advisors, a company specializing in optimizing and managing PPO contracts for dental providers. Our mission is to help providers understand the complexities of insurance networks and make informed decisions to maximize their profitability and practice success.

2. How does PPO Advisors assist dental practices with insurance optimization?

At PPO Advisors, we guide providers through the entire process of analyzing and optimizing with insurance companies. We aim to educate practices on how they can optimize their network participation, whether through PPO negotiations, analysis of dropping PPOs, or new contracting.
Our goal is to empower practices with the knowledge to maximize their network involvement. This includes guiding them through PPO negotiations, advising on the strategic advantages of reducing PPO dependencies, or exploring opportunities for new contracts. We strive to alleviate the common frustrations associated with PPO participation and empower providers to optimize their contracts for profitability and efficiency.

3. Can you provide a basic overview of what a PPO is and how it differs from other insurance plans?

PPO plans, or Preferred Provider Organization plans, are the most common insurance plans available to both employers and individuals. These plans offer a network of preferred providers who provide services at at agreed upon rates rates. Unlike HMO plans, which have fixed caps on services, PPO plans provide more flexibility and choice for patients. At PPO Advisors, we specialize in assisting providers with PPO negotiations, maximizing their reimbursement rates, and optimizing their participation in these networks.

4. What level of negotiating power do providers have when working with PPOs?

While providers can negotiate directly with insurance companies, the complexity of the negotiation landscape often requires specialized knowledge and strategy. At PPO Advisors, we leverage our expertise and understanding of the insurance industry to advocate for favorable terms on behalf of our clients. By navigating the intricacies of the negotiation process and utilizing various negotiation tactics, we strive to secure the best possible fee schedules for our clients, maximizing their profitability and success. It is also important to remember that the web of insurance is complex , and knowing exactly how to stack and arrange contacts is imperative for PPOsuccess.

5. How long do PPO contracts typically last, and do providers have the flexibility to term out?

PPO contracts typically undergo periodic re-credentialing processes, which vary depending on the insurance company. Providers generally have the option to terminate their participation in a network with proper notice, typically around 90 days. While some contracts may have more extended commitment periods, providers ultimately can evaluate their participation based on their practice needs and preferences.

6. How does working with PPOs differ for associates versus practice owners?

The dynamic is the same. Optimization happens since both the practice owner and the associate submit claims under the practice TIN. Most associates get paid a percentage of their collections. The associate will benefit from higher collections if PPO contracts are negotiated and stacked correctly. Many practice owners ask if they have to be in-network with the same PPOs as the Associate, and the short answer is, no. Although each network has its stance on this, for the most part, an associate can take insurance that the practice owner does not participate in.

7. What advice do you give new graduates regarding credentialing timelines and negotiating strategies?

New graduates should prioritize understanding the intricacies of PPO participation and negotiating favorable contracts early in their careers. Starting the credentialing process promptly upon graduation and advocating for competitive fee schedules can set the stage for long-term practice success. By leveraging resources like PPO Advisors and staying informed about industry trends, new graduates can navigate the transition into practice ownership with confidence and profitability. A good rule of thumb is as soon as a new graduate signs a letter of intent to be an associate, or if they are opening their practice, the credentialing process should be started as soon as the letter of intent is signed.

8. How can listeners contact PPO Advisors for assistance or further information?

Absolutely. Whether you’re a new graduate exploring practice opportunities or an established provider seeking to optimize your PPO contracts, PPO Advisors is here to help. We’re committed to empowering providers with the knowledge and support they need for success in today’s competitive landscape.

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