Part 2: Solving the PPO Puzzle

by | Dec 5, 2018

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 If you caught our article about PPO Optimization and the endless number of structural possibilities available, you’re probably wondering if this might be affecting you. If you are participating with even a handful of PPO plans, the answer is likely YES!

 Insurance companies have merged or contracted with each other to maximize the likelihood of gaining providers, they are sharing members. This means that through any given contract, you likely have agreed to be “In Network” with additional companies. This can work to your benefit, but only when your contracts are strategically structured. Most PPO networks lease to multiple carriers, giving you overlapping participation to the same plans, however, the company who is leasing their members to another will automatically choose the lowest payer to process your claims. This costs most Dentists tens of thousands in missed revenue each year.

The biggest mistake a practice can make is trying to tackle fee negotiation work on their own when several contracts are involved. It’s true that you may have some success reaching out to each company individually to negotiate fees. PPO contracts are so tangled together, that in most cases, you’re missing an opportunity to introduce the exact leverage needed to obtain a much higher fee increase . Accepting a small, standard increase disqualifies you from receiving a fee review with that company again for at least tow to three years. You’re locked in with your increase that doesn’t even cover the inflation you’ll see over the next 12 months.

The truth is that many additional carriers, some of which may not even be predominate or heard of in your area, may be very relevant to the leverage needed to negotiate of structure fees in a more profitable way. it’s important for a PPO negotiation project to be viewed and managed as a whole, just like a puzzle, you can’t move just one piece and expect it to leave the rest of the puzzle unscathed.

If you’ve worked with a negotiating company in the past to receive higher contracted fees or restructuring services, there’s a good chance that leasing options have since changed. We recommend all practices complete a full PPO review every two years to make sure you’re truly maximizing your earning potential with PPO carriers.

At e-DentalMarket, we work with each client to identify the current state of their pPO puzzle and design a customized plan of action to focus on the needs of each individual practice. We’d be happy to schedule a free consultation to explain more about our advanced approach to PPO fee negotiations and how it pertains to your practice.

To find out more about how leasing may be affecting your PPO reimbursement schedule a consultation with our Director of Insurance Optimization today.

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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