PPO Negotiations and PPO Optimization

2023 Update

e-DentalMarket’s Dental PPO Negotiations & Optimization service offers the most comprehensive approach to a successful PPO Negotiation project. The simple approach with PPO negotiations is no longer affective without the proper knowledge on complicated PPO leasing. We’ve seen accelerated changes in how the insurance companies operate, share networks and lease to one another. Those industry changes make it very difficult to get ahead on your fee reimbursements without a strategic and comprehensive approach. With our long-standing Dental insurance negotiations, we have been able to increase PPO revenue through negotiation and expert advise on how to manage your contracts, structure and leasing arrangements. 

Schedule a no-cost consultation today so that we can discuss possible success for your dental practice and determine if you are a good candidate for a PPO negotiation & optimization project.

Dental PPO Negotiations and Optimization

Contracting with insurance carriers costs your dental practice time and money. It’s no longer a simple solution to sign up directly with each insurance company. We work tirelessly in our PPO negotiation efforts with strategic leverage and knowledge of your options to be in network with each company for the best market rates. 

e-DentalMarket’s Dental PPO Negotiations & Optimization service is the most efficient and effective way to improve insurance revenue in the industry. Our PPO Negotiators are well seasoned with years of experience in PPOs and how they operate and negotiate. 

  1. Optimize UCR office fees
  2. Maximize PPO Insurance Revenue
  3. Reduce Dependency on Insurance Companies.

PPO Negotiations
Service Features and Benefits:

  • We do all the heavy lifting! Our team collects data, fee schedules and participation directly from insurance companies. 
  • Highly experienced, well-seasoned team with thousands of assisted providers in PPO Negotiations
  • Reliable and professional communication with thorough updates on your PPO negotiation project. 
  • Utilization of key demographic research specific to your area.
  • Established insurance relationships as well as modes of communication to ensure expedited and successful negotiation results.
  • Implementation of proven strategies to effectively yield optimum PPO negotiations on your behalf.
  • Measurable forecasting of potential revenue increases.
  • Professional, practice specific recommendations for a more competitive and profitable PPO structure and optimal PPO negotiations.
  • Effective dates secured for all improved fee schedules.
  • Knowledge and training for your team in understanding negotiations, leasing and claims. 
  • Custom pricing for your practice with installment options available.

PPO Negotiations

Who We Work With:

    • Solo Providers
    • Start-Up Practices
    • Multi-Location Practices
    • Multi-Provider Practices
    • Specialists
    • DSOs
    PPO Negotiations

    PPO Add-On Services:

    • Credentialing
    • Add, Change, or Remove Locations, Associates, or TINs
    • Practice Acquisition and
      Ownership Changes
    • Terminations and Restructuring of PPO Plans
    PPO Negotiation & Dental Insurance

    Avoid the Anxiety

    It is important to realize that as a dentist you are required to have complete knowledge about dental care and procedures. Your practice should also be able to provide quality dentistry to patients who seek professional advice as well as to those who are in need of diverse treatments. It is equally important to have specialized knowledge of dental insurance plans and the benefits you and your patients can receive from them. Consequently, this load of responsibility can cause dentists and their staff a lot of unnecessary stress and anxiety. e-DentalMarket’s PPO Negotiations service allows you to focus on your practice and patients while we dedicate the necessary time for Dental Insurance negotiations required to achieve ultimate results.

    If you feel that the many hours of work and scarcely available information about how to run profitable PPO negotiations for dental insurance rates leaves you wanting to hire a proven and affordable professional team, look no further.

    Dental PPO Negotiations
    Whether you are a solo-practice or a multi-location group, it is important to realize the necessity of hiring someone who understands the complexity of co-leasing arrangements and shared networks.

    Our experienced PPO negotiators take tremendous satisfaction in assisting our clients by analyzing the complete picture. With attention to your insurance contracts, office fees, reimbursements, and client demographics, your complete existing Dental insurance negotiations structure will be thoroughly evaluated.

    Regardless of the size of your practice, we’ll make sure that you receive the profits you deserve.

    Contact us today for a complimentary consultation at 844-464-2777 or schedule online.

    FAQ – PPO Negotiations

    Which companies/plans have the ability to negotiate?

    Most national PPO companies have the ability to negotiate fees for eligible providers and more importantly have the ability to lease/share their members through other carriers. 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 because they control the vast majority of the market are less likely to bend due to their power and size. Regardless, you have the ability and flexibility to increase reimbursements with dozens of PPO carriers especially through leasing optimization.

    Does PPO leasing impact negotiations? Is PPO leasing good or bad?

    PPO leasing is when insurance companies share members and you can be considered in network through various fee schedules or contracts. PPO leasing impacts negotiations in a major way. Through our in-depth PPO Negotiations and Optimization, the way that companies lease their network gives providers dozens of fee schedule options to be in network with each carrier. Knowing how leasing works adds major leverage to direct fee negotiations. Although PPO leasing is designed to be a disadvantage to providers, if properly used, it can be a major benefit to your practice.

    A couple 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!

    Should I just go out of network with PPOs?

    Moving to a more fee for service model is a process and depends a lot on how well your team communicates with patients in order to retain them. Our recommendation is to first work to increase, negotiate and optimize revenue with all of the PPO plans that have flexibility and different leasing options. By increasing revenue and getting a major part of your PPO to the highest possible reimbursement, this will allow you to review the low hanging fruit and strategically and gradually move off of your PPO plans.

    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.

    What kind of increases should I expect to see?

    There are two types of fee increases. Direct fee increase can vary immensely based on several factors; including the company, eligibility, demographics and your practices personal leverage. We see some companies offer direct fee increases in the range of 3-10% any given day for eligible providers but it is also not uncommon to see increases exceed 20% with the right leverage and technique. Through leasing optimization recommendations, we’ve successfully assisted with contract changes resulting in increases between 15%-70%+. Our strategic approach results in great increases even if your contracts are technically not eligible.

    What are the benefits of having eDentalMarket handle my negotiations versus my office staff?

    e-DentalMarket has assisted thousands 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.

    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.

    Insights on PPO Negotiation

    Dental PPO Leasing: Navigating through the maze

    Dental PPO Leasing: Navigating through the maze

    Many providers are still unaware of PPO leasing, how it works or how to keep it from affecting the bottom line. Dental PPO leasing has pretty much leaked it’s way into every major PPO plan and the combination options to be in network are endless.

    Debunking PPO Negotiations

    Debunking PPO Negotiations

    Recently the ADA released a letter on negotiating and handling contract negotiations. While we appreciate the ADA’s commitment to advocating for dental practices, we found that most information included in this letter is inaccurate and has proven to be ineffective over the last couple of years.