The Truth about PPO Fee Negotiations

by Kristan Palmer

negotiate

[ni-goh-shee-eyt]

Verb: To deal or bargain with another, as in the preparation of a treaty or contract or in preliminaries to a business deal.

The possibility to “negotiate” or increase your PPO fee schedules is no longer an industry secret. It’s been a very hot topic in the industry for several years now. You’ve probably sat through a presentation or seminar and heard about the secrets to negotiating with insurance companies, including demographics, insurance profiles, reputation, members and relationships that bring about leverage with the carriers. I’m here to tell you it’s all nonsense…

There is only one major component to identifying leverage relevant to insurance negotiations, and it is a complete and thorough understanding of how insurance companies work with each other… knowledge! Knowledge regarding every possible option you have available to continue participation and strategically structure your contracts to maximize revenue and gain the leverage you need to receive an increase.

You’ve all seen how negotiating in real life works, usually favoring one party more-so than the other based on leverage, knowledge, and need. So, in a world where you are just one dentist amongst thousands, what leverage do you have to convince a powerhouse to make a special exception for you? What information do you have that might prove the insurance company needs to increase your fees? We have those answers! Our advanced approach is one of a kind and tailored to fit your personal needs. Competitors with a cookie cutter approach are leaving thousands of your hard-earned dollars on the table. When we introduce real leverage, relevant to your practice and complete advanced implementation, you win! The knowledge needed to truly maximize PPO revenue comes from years and years of very advanced optimization projects, heavy research and industry advancements that makes our team a cut above the rest.

FACT or FICTION:

FICTION: Your reputation, demographics, board certification, fancy equipment and clout is all you need to negotiate.

FACT: Insurance companies only care about 1 thing, what portion of your money they get to keep, requiring leverage directly related to this.

FACT or FICTION:

FICTION: Your office staff can get this done for you in their spare time.

FACT: Practices who try negotiating on their own typically regret it. Not only are they unsuccessful, they’ve also forfeited their rights to negotiate again for up to 3 years by accepting a sub-par offer. Accepting a fee increase without understanding your options and leverage is a mistake you don’t want to make, just ask dozens of our would-be clients who’ve called for help after 7 months.

FACT or FICTION:

FICTION: My full office fee or private UCR has absolutely nothing to do with my contracted rates.

FACT: What you are billing to insurance companies can have a huge impact on not only your personal contracted fees, but also the average or standard fees in your area. Insurance carriers track what you are historically billing to them. If that fee never changes, what added incentive do they have to increase your contracted fee?

FACT or FICTION:

FICTION: All PPO Negotiating Services are the same.

FACT: While our company maintains incredible success rates, we also try to maintain competitive fees for our services. But stating that our company does exactly what another company does is like saying I can get the same type of dental care at any office in the U.S. Our average client sees 500-1000 percent return on their investment in their first year, the benefit carries over for years. We’re also the only organization in the industry with the most comprehensive 3-pronged approach to maximizing revenue and factor in ALL relevant factors to maximizing revenue, not just insurance.

Schedule a call with Kristan to discuss your current PPO structure, how PPO insurance optimization will work for you and a customized plan of action based on your current structure and overall goals.

 

Click Here to Schedule a PPO Negotiation Consultation