What’s the Cost of NOT Negotiating PPO Fees Strategically?

by | Sep 5, 2018

Home » PPO » What’s the Cost of NOT Negotiating PPO Fees Strategically?

September Case Study:
Solo provider with one location, participating with several National PPO Plans, received the following results and recommendations:

  • Aetna provided a standard 4% increase to the practice. Using our advanced leverage, we recommended strategic restructuring of this plan, which resulted in a 58% increase overall. This increase alone resulted in over $48,000 in additional revenue for this practice.
  • We also assisted with negotiations for Cigna, United Health Care, Humana, Principal, Ameritas, Connection Dental, Assurant, DHA, Sunlife Financial, Guardian and more, all of which were increased 13-23%.
  • Final ROI: $84,000 in additional revenue annually.

What’s the cost of not negotiating PPO fees strategically?

The keyword here is “strategically”, which has little to do with negotiating in the traditional sense. The average dental practice with PPO participation is leaving $3,000-$8,000 on the table every month. The best time to implement strategic PPO structuring and negotiating was yesterday … why wait any longer?

You may have seen some fees decreasing throughout 2017 and 2018 due to a massive expansion of new leasing contracts between several carries. Often, these decreases go unnoticed until the end of the year, when you realize your collections aren’t where they should be. Truth is, this has been happening for quite some time, but the changes are becoming more and more noticeable as leasing contracts continue to grow. For those who are unfamiliar with leasing, it’s the ability for an insurance carrier to process your claims in network with another company’s fee schedule to pay you the lowest they possibly can, even lower than what you had initially agreed to through a direct contract.

Leasing, by default, can hurt a practice in time. Leasing strategically by understanding options, precedence and loop-holes can be the most profitable thing you’ve ever done in your office. When we say “PPO Negotiations” it sounds like a simple concept. PPO negotiations, and the success that follows, is 100% contingent on understanding these leasing agreements and the options you have to continue participation without accepting rock bottom IN Network fees. Today, there are literally thousands of ways to donfigure PPO participation, both for better or for worse. You don’t stand a chance unless you understand how to pull leverage based on your current participation, potential participation and leasing available to you through those details.

We offer free sondultations to all dental practices to discuss your current situation and hel you identify some of the major contributors to huge write-offs. We’d be happy to share these details and discuss options on how you can improve PPO fees moving forward.

Investing in a project like PPO Fee Negotiations can seem like an unnecessary cost. Without understanding the leverage needed to see results, you’ll find yourself trying for months with little to no success. Furthermore, if you accept small increases, you’re stuck with them for up to three years. Our average client sees a full return within months of implementation and averages a 10x return on their investment their first year alone. Ask us about our Money Back Guarantee program. We are confident that we can show you how to make improvements that will impact your bottom line significantly.

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“This is the second time we have used this company. Without a negotiation company there is no way I would have gotten higher fees. Last time they paid for themselves in a matter of just a few months. I anticipate the same to be true this time.”

Dr. Waggoner, NV