June 2018--Negotiating dental fees can be daunting. You may think you do not have the time to get credentialed or negotiate fees with new dental insurance plans. Still, looking for insurance companies may be worth it for your practice's increased profitability and growth.
There are many things to consider when deciding to go in-network with a dental insurance company.
And there are ways a dental practice can optimize PPO credentialing and negotiating fees to increase the benefits of their network participation.
The following tips apply to general dentists and specialists in private practice, group practice, or a dental service organization (DSO).
Table Of Contents
How to deal with PPO insurance fees?
Contracting with insurance carriers costs dental practices time and money, so make sure each insurance plan under consideration is worth the effort.
Find out which employers participate in these plans. Credentialing with a plan selected by a large employer can make you close to hundreds of new patients.
If many of your existing patients have that plan, could going in-network reduce the income you now receive from them out of network?
If many of your existing patients have that plan, could going in-network enable them to achieve more of the restorative dentistry they need?
For efficiency and best results, utilize a well-informed and skilled negotiator to credential and negotiate the reimbursement fee schedule.
If you are frustrated with your insurance reimbursement or unable to effectively select plans and optimize credentialing and fee negotiation, APEX Reimbursement Specialists can help you with this.
APEX Reimbursement Specialists also can help you find and correct under-utilization while providing you and your team with the knowledge you need to optimally carry this forward.
You can go back and forth before settling the fees and signing a contract. Fee schedules must be flexible.
The emerging DHMO plans offer opportunities to negotiate if you are a specialist.
They also have the negotiating leverage of simultaneously bringing many practices into the network.
For a solo dental practice to be competitive, it might make sense to outsource negotiations or at least ensure your staff is keeping up with the latest information they need and putting serious effort into the process.
They have become more popular because of the better fee schedules.
But there are hidden costs, and there is no guarantee that a sub-participating carrier will stay within that third-party relationship forever.
Some dentists say, “I have MetLife, but I heard I could get MetLife through a third-party network and the reimbursement fees are higher.”
You must be careful in making that decision because you may be 180 or more days out of network during that transition.
Creating opportunities for profitability does not stop with fee negotiation or participating in more plans.
Many dental practices are unaware of all the insurance plans they are enrolled in.
Many dental practices are underutilizing the tools provided by their insurance carrier relationships.
Stop and ask yourself if your dental practice is among these?
Your team should include someone who:
That could help create opportunities for patients to afford more treatment.
Have you or your team invested time and energy in researching this?
What income are you potentially leaving on the table?
Update your UCR if you have undervalued your usual, customary, and reasonable fees for out-of-network patients.
Should you adjust this rate to remain competitive and be more profitable?
This is a must-do strategy to attract the new patients you desire.
Keeping a list of your in-network plans on your practice website will help attract the people you are targeting.
Whether private practice, group practice, or a dental service organization (DSO), optimizing credentialing and fee negotiations is vital for your practice's increased profitability and growth.
It's essential to decide carefully what dental care insurance to go in-network with. And dental practices should learn how to optimize their PPO fees & credentialing and negotiating for increased benefits.
If you’re looking to grow your practice even further, Patient Prism’s call tracking software helps practices of all sizes to optimize their marketing campaigns, train their front desk team, and book more patients over the phone with scrips and guides and excellent customer service.