10 Things You Need to Know About You and PPOs
By Bill Rossi
1. You have more power than you think.
2. Practices with little or no PPO participation generally do get fewer new patients. However, practices deep into PPO participation do not get proportionally more new patients as they take on more and more programs and more discounts.
3. Each practice has to find the “right balance” of PPO participation. When Dentists have complete control over their fees, most of them try to balance the fees so they aren’t too low or too high. In effect, moderating your PPO participation is like setting your fees.
4. Chances are that you are already seeing some patients out-of-network. For every PPO plan, there are providers both in and out of the network in your area. No insurance network, not even Delta, has 100% of providers in a given area.
5. Employers provide Dental insurance to make their employees happy. Of course, they want to save money, but their employees aren’t happy if they can’t see the provider they want to see.
Therefore, most insurance companies do not have “punitive” out-of-network benefits. In fact, for some, the out-of-network benefits are surprisingly good.
6. If you drop a PPO and your staff is properly trained, you will retain the majority of the PPO patients – unless the patients have no out-of-network benefits or very little out-of-network benefits.
7. Whenever dealing with insurance either as in-network or out-of-network providers, it’s important to accentuate the positive,
“The good news is that with your Delta policy, you can go to the Dentist of your choice…”
“We have many patients on this plan and in general things work out quite well.”
8. Some PPO fees can be negotiated. If you haven’t tried, there is a good chance you’ve left money on the table. It costs little to do this and the extra dollars are “free money.”
9. You can’t just leave PPOs without having a strategy. In other words, you must take measures to fortify the practice and build it up in the face of the inevitable patient attrition.
10. If you are collecting less than 80% of your Gross Production, you need to take a serious look at reducing PPO participation. Too often Dentists sign up for a plan too quickly and drop too rashly. There are thousands of dollars and many patients at stake. Make your decisions logically.
5 More Ways To Boost Profits While Dropping Managed Care (PPO) Plans
7 Steps To Boost Your Practice Profits While Reducing Managed Care (PPOs)
The C&A Advantage – PPO Plays for Dentists
Part 1: January 15 – 2017 (PDF) (HTML)
Part 2: February 1 – 2017 (PDF) (HTML)
Don’t Be Proactive With PPOs
You can blow $1000s by acting too quickly. (Read article)
PPO’s & Practice Transitions
Many factors to consider when purchasing a practice. PPO participation is now one of them. (Read article)
Dr. W. Kiesel, Quakertown, PA
“After an analysis by Bill we decided to go ahead and drop Delta Dental. It is quite a leap but with Bill’s coaching and advise we are actually up 20% in production plus, of course, seeing a big increase in collections.”
Deborah Parr, office manager, Dr Olan Parr Culpepper Va.
“Have you ever seen the look on a small child’s face when you try to gently take away their security blanket? Eyes widen in horror and their grip tightens even more. I believe most dentists [and office managers – that’s me] feel the same way when first considering going out of network with an insurance company. The blanket is frayed and doesn’t smell so good [write-offs are so big you lose money on every patient], but the loss is too scary to think about…. Or is it? After being in network with one particular insurance company for 12 years and experiencing exactly ONE increase in what they paid us [not on all codes, just some fillings for about $.25 per filling – yep, that’s 25 CENTS] we were looking for a way out. I hated watching my highly trained and excellent practitioner husband working harder and harder for less and less. The smartest move we made in our bid for independence was to contact Bill Rossi of Advanced Practice Management. We sent reports, details about our practice, investigated which employers used which insurances, and then more reports. The FBI could take lessons from Bill! But because of his thoroughness in finding out about our practice, he could tell us that he believed we would not only survive but do very well out of network with that company. Then he visited our office and walked our team through what to do, say, expect. Had we attempted it on our own, we would have made some serious mistakes in our approach to patients. Seven months later I can honestly say we are doing at least fine. The vast majority of our patients have stayed with the practice and it turns out for most plans the insurance company pays really close to our fees. We are so glad we made this choice. Letting go of the in-network security blanket isn’t easy, but Bill will get you through it just fine.”
Dr Lee Fletcher, Greenville S.C
“Bill analyzed my specific situation and showed me how to negotiate for my practice from a position of strength. He provided me with the knowledge and advice that I needed to manage my insurance relationships in a strategic manner for the long term success of my practice. Bill is a passionate advocate for the solo practitioner and has the knowledge to help you manage your practice in today’s complex environment.”
Lis Bradley - Lisbeth S Bradley DDS
“I first met Bill Rossi when I read an amazing article he wrote for the McGill Hill newsletter. Even tho I am not in his part of the country I was impressed and Bill agreed to talk with me. We ended up working with Bill on several things, one being transitioning out of a PPO which is always a very scary thing to do. He held our hands and walked us through the process. The results have been impressive! Whenever I have a question or need a solution to a problem Bill and his team are always very responsive and have excellent suggestions for me and help with how to implement.
I depend on and trust his expertise.”
Dr Ross Hock, Canton, Michigan
“Bill and his team have been a great resource for me in the advancement of my dental practice. He has consistently given me great advice on topics ranging from questions about staffing issues, integration of a new associate as well as the acquisition and integration of an outside dental practice into my own. Bill also helped me through a major PPO transition. I would recommend him without hesitation.”
Roy Krengel DDS, Bloomington, MN
“I was dealing with a PPO that said they wouldn’t negotiate and wouldn’t pay me more. With the information and advise Bill gave me I was able to successful push
them and received a significant increase in reimbursement allowances.”
Andrew Olsson, DDS
“Bill helped tremendously when I was struggling to find the right path for my practice. I am about 6 months in since our first conversations and we have made several big changes in the practice for the better. The experience Bill brings to the table helped me be confident in making these decisions. We have reduced our PPO participation considerably and will be adding an associate soon. Thanks Bill and APM!”
Dr William Poole, Leola, Pa
“Bill, will be faxing (an unnamed here ppo) new fee proposal to you today. I got firm with them on Monday and they came up quite a bit. Thanks for the advice!”
Dr. Jim Tomhave, Cloquet, MN
“Bill helped us significantly increase our insurance allowances. His advice at a key juncture of practice transition has been very helpful.”
Dr. Joseph Gendler, Hopkins, MN
“Bill Rossi’s advise on insurance-related topics has worked very well. Our work with him has added many 1000s of dollars to our bottom line.”
Dr. Jeffrey Chandler, DDS Dentist - Oral/Maxillofacial Surgery, Elmhurst, IL
“Bill’s advice really helped me organize my approach to negotiating with and making decisions about PPO’s.”