PPO Negotiations:

Knowing the Rules Wins the Game for Dentists

When it comes to PPO contracts, it’s easy for dentists to get the short end of the stick. Find out why it’s hard to get a fair deal and what dentists can do about it.

Dentists join PPOs with the expectation that in exchange for agreeing to reduced fees for services, the PPO will send them more patients seeking an in-network dentist. That’s how it should work, with both sides getting something they want. The reality is that PPOs have developed lots of ways to game the system and dentists are losing ground.  Like it or not, most dental practices need PPOs for multiple reasons such as geographic competition and patients that are conditioned to use dentists covered in their network. Therefore, the challenge is to figure out to play the PPO game to your advantage.

There are a lot of reasons why PPOs have the upper hand in their relationship with dentists – here are a few:

Dentists Don’t Negotiate

Too often dentists accept the contract without trying to get a better deal. This is not because dentists don’t want a better deal, it’s because the PPOs make it very difficult to do. To successfully negotiate, a dentist needs to really understand the mapping and inner workings of the insurance companies and the financial implications for their practice. PPOs work hard to obscure that information.

Lease Share Agreements

Many dentists are unaware of the impact PPO network sharing has on their income. This widely held practice, also referred to as network leasing or Lease Share Agreements, refers to an arrangement in which insurance networks can pick up other networks under the same fee schedule. Although it doesn’t seem like it, this creates an opportunity to fall into a lower fee schedule if managed correctly.

Not Enough Time

Dealing with PPOs requires time, something in short supply for dentists who are trying to build a successful practice. This is especially true when trying to negotiate higher reimbursement rates. Dentists need to be equipped with facts and figures to justify an increase.  For example: a dentist does 50 crowns a year and hasn’t received an increase in seven years while their lab costs have risen 15%. The problem is it takes time to do that homework, and time spent away from treating patients costs dentists.

PPO negotiations are a game that dentists have to learn how to play, or they will continue to lose out. I started PPO Advisors over 10 years ago after managing a dental office and learning how PPOs operate. PPO’s benefit from the complexity they create. PPO Advisors cuts through the complexity by showing dentists how their contracts actually work and how much it is costing them. Most importantly, we negotiate with PPOs on behalf of dentists to help them get a better deal upfront at no cost or risk. Knowledge is how you win the game and knowing your ROI first is key to ensuring success.

A lot of PPOs are in the process of making contract changes as we move out of the COVID-19 era. Some of these changes are scary and could negatively impact your practice. Be sure you understand what you’re signing up for. If you’re not, PPO Advisors will review your contract at no charge because we’re good at winning the game. Contact us today.

*The term “PPO” refers to insurance companies, third-party payers and third-party administrators.


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