By Bill Rossi


Many of the “smaller” dental insurance companies group together under “Umbrellas” in order to compete with Delta and others.

Examples of these groups are: Careington, Connection, Premier PPOs (not to be confused with “Delta Premier”), and DenteMax. These groups line up doctors who will agree to a fee schedule so that insurance companies like MetLife, Cigna, Aetna, and Guardian have a network of providers that they can show their prospects.

Many doctors are not aware that the insurance industry has set things up so if you are with multiple PPO organizations, the one that pays the least reimbursement is the one that you’ll get paid. Most of these PPO Umbrella Groups have a lot of the same PPOs within. So, if you are with multiple umbrellas, drop the lower paying ones! Also, these umbrella groups are much more likely to negotiate their fees than if you tried directly with the insurance company themselves.

Through negotiating or switching umbrella groups you can often gain increases from 10% to 30%. This can add up to many thousands of dollars per year for the typical general practice.

We can refer you to the help of reliable professional negotiators. They sort out the confusion and save you hours of trying to locate the right people on the phone. They know which companies are willing to bargain and how far they will go. And sometimes they can get you fee increases from individual insurance companies (those outside the umbrellas, if you are directly contracted with them).

It certainly makes sense to consolidate. It’s nice to negotiate and get an increase. However, the real money is by phasing out of PPO participation; “Lose the discounts and keep the patients.” When you successfully transition out of network, and keep the majority of patients, the increases are more substantial, and you gain more independence. You can “opt out” of some plans within the umbrella networks if you don’t want to drop the umbrella altogether.

Many dentists are writing off over 30% of their production and it doesn’t always have to be that way. If you have not taken a serious look at this, it’s time. This is especially true because many practices are shorthanded and can’t keep up with the patients they have. When your hygiene is locked-up for months, why are you working at a discount? You can use some of the extra revenue to help attract and keep top-notch staff.

You have patients to take care of and don’t necessarily have a lot of time to deal with this. But don’t just keep your head down and work through each day. We can help you or refer you the help. A little bit of know-how can add nicely to your bottom line without a lot of work on your part. Just call Bill at 952-921-3360, or text 952-228-9486.