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.

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!

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.

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.

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.

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.

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.