by Kristan Palmer
It’s no secret that today, PPOs are the most common type of network-based managed care program. Providers who contract with a PPO network agree to a reduced fee in exchange for an in-network status and the hope of an increased patient base.
What you may not be entirely aware of is that PPO carriers are agreeing to allow other carriers to “lease” their members, creating more participation for you than you may have initially agreed to. These arrangements aren’t necessarily a bad thing, in fact, they can create patient flow and exposure to many carriers. Many practices are seeing a growing concern because compensation is dropping due to new leasing agreements taking place all the time, and claims being paid differently than they may have been in the past. Years ago, leasing was simple and straightforward. Today, there are literally thousands of ways to configure or structure these contracts, so it’s difficult to follow.
By rule of thumb, an insurance carrier will allow leasing and claims processing through the lowest paying leaser or third party. Since almost all insurance companies lease to several other companies, the leasing that automatically takes place is likely not your best option. It is possible to hand select and structure your PPO contracts in a much more profitable way through advanced negotiation and leasing implementation.
Whether your practice has dozens of PPO contracts and thorough participation or your goal is to be selective about PPO participation, there is always something better for most national carriers through leasing optimization and negotiation efforts.
Schedule a call with Kristan to discuss your current PPO structure, how PPO insurance optimization will work for you and a customized plan of action based on your current structure and overall goals.
The PPO insurance industry is constantly changing, and this is ringing true especially regarding leasing arrangements and how insurance companies are choosing to pay your claims. In most recent news, United Concordia has made quite a few new ties with their leasing arrangements in 2017 including the Tri-care plan, and also leasing of Principal’s network. Effective 10/1/2017, United Concordia will also start leasing Ameritas’ network. This will include: Ameritas Life Insurance Corp., Ameritas Life Insurance of New York, Standard Life Insurance Company, Standard Life Insurance Company of New York, Reliance Standard Life Insurance, First Reliance Standard Life Insurance Company, and Physicians Mutual.
Another big change that we have seen in 2017 is how companies are paying claims. In the past, your direct contract was a way to guarantee your compensation. Most companies are starting to process claims through the lowest paying leasing option that you are contracted with regardless of a direct contract. You may notice that you are taking larger write-offs than usual because companies are no longer honoring your contracted fees, but are accessing other leasers for member benefits. Re-structuring and analysis of your plans deem very useful to optimize your compensation by controlling your leasing arrangements.