Trust but Verify

Practice Owners Should Make Sure Promised Fee Schedule Increases are Real


By Shelley DeGroff, Founder of PPO Advisors

If your dental practice hired a firm to negotiate a higher fee schedule for your PPO contract, how do you know you’re receiving the increase? Too often, practice owners trust they’re getting a promised increase, when in reality the insurers use a loophole to pay less than the agreed upon fee schedule. Find out how you can verify you’re getting the increase your practice deserves.

In dealing with insurance companies, I believe in the trust-but-verify approach. I was reminded of this recently when we were onboarding some new clients. They shared with me similar stories about how, before coming to PPO Advisors, they’d worked with competitors who told them they’d negotiated higher fee schedules on their behalf. The practices “thought” the work had been successful, but they weren’t sure. When PPO Advisors dug into their records, we discovered the practices did, in fact, have good fee schedules in their contracts, but the insurance companies never paid out on the higher fee schedule. The contract hadn’t been stacked in the right order, which allowed the insurer to pay a lower fee. As a result, the practices received no benefit from a service they paid good money for. To me, the most surprising part of these stories is that the practices had no clue either way. They trusted but they didn’t verify.

Dental providers who are thinking about hiring a firm that promises to negotiate a higher fee schedule in their PPO contract should make sure they can answer the following questions:

  • What will your return on investment (ROI) be?
  • How will you know if the higher fee schedule has been implemented?

Practice owners who work with PPO Advisors can answer both. We’ve helped over 1200 dental practices increase their reimbursements from insurance by an average of 20%. We call it working smarter, not harder. Here’s how we do it.

Free Analysis Delivers Guaranteed ROI

Our free analysis, unique in the industry, guarantees your ROI before you agree to become a client. As part of the free analysis, we do the work of negotiating a higher fee schedule so a prospective client can see exactly what increases the insurers have agreed to before they commit to anything. On the low end, our negotiations will generate annual revenue increases of $40,000 from higher insurance payments, and for multiple providers, the average increase is closer to $100,000. This represents new income a dental practice will receive for maintaining the same level of productivity.

Audits Verify Increases

A key difference in how PPO Advisors operates is that we don’t just tell our clients they’re getting fee schedule increases, we make sure they actually receive them. After the free analysis, when most practices decide to become clients, we formalize their contracts with the carriers. Once that step is complete, we conduct an audit to confirm the insurer is paying based on the higher fee schedule we’ve negotiated. We ask the carrier for a sampling of Explanation of Benefits (EOBs). If the EOBs show any discrepancies, we take the extra step of working with the insurers to correct the errors. By the end of the audit, we’re able to show the practice that the higher fees are processing on their claims.

Trust and Verify

PPO Advisors is the only firm that takes the extra step to verify your practice is receiving the fee schedule you’re entitled to. We do it because this is not a one-and-done process for us; we are committed to our clients for the long haul. Insurers are always looking for new ways to avoid reimbursing providers fairly. We know how the game is played and we stand with our clients to level the playing field.

If you have questions about your PPO agreement, contact us today. Our free analysis will tell you exactly how much more your practice could earn for maintaining the same level of productivity. Once you’re a client, you’ll see for yourself that the promised increases are real.