The PPO Playbook

On today’s episode, we are joined by a remarkable entrepreneur who has reshaped the dental landscape with her unwavering dedication to helping dental practices thrive in the realm of PPO negotiations. “Shelley DeGroff”, the founder and CEO of PPO Advisors, has an inspiring journey that stems from her experience in a dental office, and she recognized a pressing need for fair deals from PPOs.

Shelley’s story is one of unexpected entrepreneurship. As an office manager for a private dental practice, she dived into the intricate world of PPO contracts, gaining an in-depth understanding of the dynamics that can significantly impact practice revenues. When she successfully negotiated better terms for her own office, revenues soared. Recognizing the widespread demand for her expertise, Shelley founded PPO Advisors in 2013, marking the beginning of her mission to empower dental practices with the tools to negotiate better PPO contracts.

Hailing from a rural background in Nebraska, Shelley’s journey has been marked by her unwavering work ethic and an integrity-based approach to business. Her commitment to leveling the playing field for her clients, allowing them to work smarter and amplify profits, showcases her dedication to driving positive change within the dental industry.

During our conversation with Shelley, we delve into intriguing topics that shed light on the crucial aspects of PPO negotiations. We explore the concept of umbrella networks and whether PPO Advisors accepts them, shedding light on the complexities that dental practices navigate. Fee schedules and time frames also come under discussion, providing valuable insights into the meticulous work that goes into optimizing PPO contracts.

One of the highlights of our conversation is Shelley’s wisdom on reducing dependence on PPOs and identifying the thresholds for maintaining a healthy balance. Her expertise empowers dental practitioners to make informed decisions that align with their growth strategies.

As a pioneering force in the industry, Shelley has nurtured PPO Advisors into a success that is propelled by a dedicated team. We gain insights into the growth journey of her team, the turnaround time to onboard clients, and what truly sets PPO Advisors apart from competitors.

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Main Takeaways

1. Can you share how you began navigating the complexities of dental PPO negotiations and the inception of PPO Advisors?

Absolutely. My journey into PPO solutions began from a place of necessity. Working within a dental practice, I encountered firsthand the challenges of dealing with PPO insurance companies and the constant struggle to understand contract specifics for better terms. The lack of available resources to guide me through the process of PPO negotiation was a significant hurdle. This experience illuminated a gap in the industry for a reliable source of knowledge and assistance, leading to the creation of PPO Advisors. Our mission is to serve as a beacon for office managers and providers, empowering them with the expertise needed to navigate PPO insurance complexities, ensuring profitable PPO engagements, and fostering more effective dental PPO negotiations.

2. From your perspective, is it more beneficial for dental practices to handle PPO negotiations in-house or to outsource this task?

Outsourcing PPO negotiations is undoubtedly the more practical and efficient choice for most dental practices. The landscape of PPO insurance is ever-changing, making it a full-time endeavor to stay informed and effectively manage these changes. In-house management, especially for office managers who already juggle various responsibilities, can detract from focusing on patient care and relationship management. PPO Advisors steps in as a specialized partner, focusing solely on optimizing your practice’s engagement with PPO insurance companies. This enhances PPO profits and alleviates the internal burden, allowing your team to concentrate on delivering exceptional dental care.

3. What can dental practices expect when they work with PPO Advisors for PPO consulting and negotiation?

When a practice partners with PPO Advisors, they gain access to a dedicated team of experts specializing in PPO consulting and negotiation. Our approach is tailored to each practice’s unique stage and needs, whether they are startups, acquisitions, or well-established entities. We delve into the intricacies of existing contracts, explore avenues for better alignment with PPO insurance companies, and execute strategic negotiations to secure more favorable terms. Our comprehensive process includes direct negotiations for increased rates and a thorough analysis of shared or umbrella networks, ensuring that practices are positioned for optimal profitability and reduced dependency on less advantageous PPO agreements.

4. Could you explain the concept of shared or umbrella networks in the context of PPO insurance?

Shared or umbrella networks represent a complex aspect of PPO insurance where multiple providers share a network, impacting a practice’s in-network status with various PPO insurance companies. Understanding the distinctions between direct contracts with insurance companies like Aetna or Guardian and umbrella agreements through third-party administrators is crucial. Practices often unknowingly enter into these shared agreements, which can significantly affect their contractual relationships and reimbursement rates. Our role at PPO Advisors includes demystifying these arrangements and advising practices on navigating these networks strategically to enhance their profitability and operational efficiency.

5. How does credentialing play into a practice’s strategy for PPO participation, and what advice do you offer regarding managing this process?

Credentialing is the foundational step for a practice to become in-network with PPO insurance companies, involving a detailed vetting process. It’s a critical component that requires careful consideration, given its implications for a practice’s broader insurance strategy and profitability. While some practices may handle this process internally, the lack of understanding regarding the interconnected nature of PPO agreements and their impact on practice profitability can lead to suboptimal outcomes. We advocate for a strategic approach, advising practices to consider outsourcing credentialing and negotiations to specialized firms like PPO Advisors. This ensures that every step—from initial credentialing to ongoing negotiations—is aligned with the practice’s overall objectives, maximizing profitable PPO participation and minimizing unwarranted dependency on underperforming PPO contracts.

6. As practices navigate the complexities of PPO insurance, what final piece of advice would you offer?

The landscape of PPO insurance is intricate and constantly evolving. Practices aiming to thrive must adopt a proactive and informed approach to PPO participation. This involves regular reviews of contracts, strategic negotiations, and a willingness to adjust participation based on the practice’s changing needs and goals. Partnering with experts like PPO Advisors can provide the insights and support needed to navigate these challenges successfully, ensuring that PPO engagements contribute positively to the practice

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