APM

From Which Era is Your PPO?

*By Bill Rossi

All of us are aware that over the years, PPOs rarely give increases and those that do are rather meager. Meanwhile, reality marches on in dental offices. Following Covid, expenses like PPE, wages, etc. have gone up substantially. But even before Covid, PPO fee increases were not keeping up with inflation. Take a look at what you’re getting from the PPOs. Note how they match up to fees historically. My company has been doing fee surveys for over 30 years, so we thought you might find this interesting. (These fees were from the Minneapolis/St. Paul area and fairly representative of national averages.)

Standard Fee Surveys for 2002, 2005, 2010 and 2015 (Doctor, compare these figures to your current PPO fee allowances)
1110 – Adult Prophy $63 $72 $85 $96
0120 – Periodic Exam $32 $38 $46 $53
0274 – 4 Bitewings $40 $46 $55 $64
2740 – Ceramic Crown $802 $901 $1,079 $1,213
You’ll see that many PPO fee reimbursements are at the 2002 level. That was over 20 years ago!

What Are You Going to Do About It? You can try negotiating with insurance companies, but this is getting to be less and less easy, especially when you are dealing with umbrella PPO plans. If the conditions are right and if you and your team are prepared, you can simply drop a PPO and retain the majority of your patients. Patients do like you for more than your in-network benefits.

You have more power than you think. If your patients like and trust you, the out-of-network benefits for most PPOs are good enough to keep most of the patients. For the PPOs that have punitive out-of-network benefits – well, sometimes it’s best to just get it over with and stop participating with them. If your practice is otherwise healthy, you will be surprised at how well you can heal up over any losses. Post-COVID, your team members want 2022 level pay. You should too.

*Bill Rossi, President of APM can be reached at www.AdvancedPracticeManagement.com or (952) 921-3360.