Frequently Asked Questions:
Q. Which companies negotiate and which do not?
Most national PPO companies have the ability to negotiate fees for eligible providers. Companies that are predominately associated with discount plans, HMO plans, and federally mandated programs are far less likely to have the ability to make changes to contracted fees. Negotiating with the “Industry Giants” can also yield little to no results. These companies that control the vast majority of the market are less likely to bend due to their power and size
Q. What kind of increases should I expect to see?
Increases can vary immensely based on several factors; including the company, eligibility, demographics and your practices personal leverage. We see some companies offer increases in the range of 3-10% any given day for eligible providers. It is not uncommon to see increases exceed 20% with the right leverage and technique.
Q. A lot of big companies don’t seem to negotiate, it is really worth my time?
We say YES! Even without cooperation from the larger companies, we have seen practices increase annual revenues by tens of thousands of dollars through other insurance companies. Take this, for example, a practice may find they are contracted with 5-6 negotiable carriers, each of which only makes up a small part of their annual revenue, we’ll say $200,000 total. If you averaged a 5-10% increase for each of those companies, we’re talking an additional $10,000-20,000 annually. This example is very conservative!
Q. What are the benefits of having eDentalMarket handle my negotiations versus my office staff?
e-DentalMarket has assisted hundreds of practices in negotiating higher insurance reimbursement rates for their practice. Our company has built close relationships with many national PPO companies. These relationships allow for a streamlined process that typically yields better results than practices who choose to negotiate on their own. Direct negotiations are only a small part of recognizing where revenue can be increased. Our team has a deep knowledge of how leasing arrangements can work to your benefit and provide detailed information about properly structuring PPO plans through a membership. Not only do we assist in contracted insurance fee increases, but we can help you analyze your office fees to recognize where you are possibly losing revenue and provide software options to create an in-house savings plan to further increase your practice’s profitability.
Q. I don’t take PPO’s but need to start doing so soon. Can you help me negotiate before I am contracted?
YES! Building the most profitable structure and negotiating fees is best done prior to becoming a contracted provider. It is crucial to negotiate fees prior to contracting. Once contracts are signed, fees are often in place for a 24-month minimum. Plus, stacking companies through more profitable alternatives rather than adding direct contracts can typically yield much higher compensation. We have assisted hundreds of clients who have started up a new practice or made the decision to contract with PPO’s after being fee for service for years.
Q. I recently negotiated my fees, can you still help?
Typical PPO contracts include a 24-month agreement. Meaning, if you have received a fee increase from a particular company directly, and signed that increase, you have agreed to accept those fees for a minimum of 24 months. For some companies, you may have better options through leasing networks that could further increase compensation for you. Our team of professionals specializes in recognizing where additional profits can be made and can provide our clients with a range of options to increase further if you feel stuck under a contract that is not eligible to negotiate again.
Q. I already have a “discount plan” in my office. Do I need the PlanPro software?
The stand-alone PlanPro software was built with you in mind. Its entire purpose is to streamline your process so you can stay in one system (thanks to software integration), more effectively track your progress through a financial dashboard, provide a patient portal for your patients, and ultimately spend more time selling the plan!
Q. All my patients are fee for service, why would I introduce a plan to them?
Great question. The feedback from the many dentists we’ve worked with is that it is worth it to offer the plan to their existing patients. It’s extremely uncommon for even the most loyal cash clients to consistently keep up on their 6-month cleanings religiously. Furthermore, almost all practices report that retiring school teachers or other professionals are losing their insurance and your In-Office Savings Plan is the perfect offering. Additionally, your plan can attract uninsured patients in your area who are looking for a dentist but who have been unwilling to go without an incentive. Lastly, if you were ever injured for any reason and unable to perform dentistry for a period of time, having a residual income from your plan purchases could prove to make a difference in your practice.
Q. What is Integration?
Integration is the process of incorporating or combining the data available in your practice management system (PMS) with e-DentalMarket software. Integration takes the place of the data entry process. More specifically, with integration, you will not have to manually enter your office fees or patient information into e-DentalMarket. This information will be pulled from your PMS at the time of integration and will continually update. While integration is not mandatory for application use, it will save time and make using our applications even more beneficial to your office.
Q. What if you don’t integrate with my practice management?
While integration is important for many of our apps, it is not required to access the full benefits of any of them. Even so, we’d like to integrate with as many practice management systems as possible, so, with your cooperation, we’d gladly make you a “beta” client with a temporary reduction in price for your subscription. Speak with an e-DentalMarket representative today and we’ll look forward to working with you.
Q. Why should I update my fees each year?
Increasing your office fees is normal and expected, and should be done annually, if not twice a year. Keeping your fees in line with help increase insurance fee schedules for your area and help you keep pace with the rate of inflation—something that dentistry has struggled to do in recent years. Since 2011, the very common procedure code D0120 has increased by a whopping $1, or 2%, compared to the cumulative inflation rate increase of 8.5% since 2011. Assuming you are just $10 too low on any one procedure, would you rather negotiate an increase on $100? or $110—multiplied by the many times you perform that procedure?
Q. How does FeePro compare to other products?
There are plenty of options and many of them include surveys from dentists and relying on accurate staff reporting. The data that FeePro utilizes comes from the nations largest dental insurance base and is based directly on claim information. Furthermore, FeePro is loaded with unique benefits that you’d be hard-pressed to find elsewhere: Practice Management Integration, auto-storing your top codes for future reference and review, scenario builder to create potential adjustments and calculate the impact, and much much more. Oh, and it’s priced way too low currently at $399/annually instead of $599—much less than comparable solutions.
Q. How will updating my fees impact PPO Negotiations?
Reviewing your fees is integral to the negotiation processes is that the fees you’ve historically billed to the insurance companies will be reviewed. If they find your fees to be significantly lower or higher than the UCR’s in your area, a fee review could be denied. If you have recently updated your fees and can provide a new fee schedule to them, this may be reconsidered.