Join me on this week's episode of T-Bone Speaks for my discussion with Sandi Hudson from “Unlock the PPO” about how to negotiate with PPO insurance companies.
Sandi is the co-owner and founder of “Unlock the PPO,” which specializes in analyzing the relationship between dental practices and PPOs and helping them to implement a successful negotiation strategy. Sandi has spent over a decade in dental office management overseeing dental insurance participation and negotiations. She’s passionate about helping dentists manage insurance participation in a way that’s right for them and their practice.
On the podcast we discussed:
- How to negotiate with PPO’s
- Why you should negotiate with insurance companies every two years
- Avoiding the common pitfalls that come with negotiating with PPO insurance companies
- The advantages of hiring a professional to help your practice negotiate with PPO’s
- What a shared network agreement is and what it means for your fee schedule
- What to look for when you want to get into an insurance network
- Determining a strategic plan for successful negotiation
- The importance of getting “demographic specific” when searching for the right insurance company
- How to reduce your reliance on insurance companies
- How to transition out of insurance and everything you need to know about split participation
If you would prefer to watch the recording of this episode, there's a video player at the end of the post, or if you'd like to listen to the podcast episode, hit play below:
Read on for a more detailed overview of our discussion…
Negotiating with PPOs
I was interested to find out how often a practice should approach an insurance company to negotiate and Sandi recommended that you hit them up every two years. The reason for this is because most insurance companies negotiate once every two years and you must pay close attention and stay on top of things if you want to negotiate with a PPO successfully.
One of the most significant issues dental practices face is the fact that most insurance companies have at least part of their network coming in through different shared network agreements.
Why is this a problem?
Well, instead of taking your negotiation directly to the source, the process becomes more strategy orientated. In fact, a direct negotiation is so rare that it happens less than 5% of the time.
Remember - insurance companies want to use the contracting to their benefit, so you have to stay one step ahead and really look at your practice and try to shift things around in a way that works for you.
In-House Vs. Outsourcing
Many dental practices choose to handle negotiation themselves, which is excellent, but it can also be very time-consuming. As you know, dentists are incredibly busy. We’ve got to care for our patients, manage our teams and make sure that everything in the practice is running smoothly.
Sandi explained that if your practice has multiple contracts with different insurance companies and particularly with shared network agreements or third-party administrators, things can get messy and you’d probably benefit from hiring a professional to take care of it on your behalf.
Shared Network Agreements
Sandi talked about shared network agreements, third-party administrators and what it all means for you and your dental practice.
Larger third-party administrators include national ones such as Connection Dental, DenteMax, Careington, and Zelis. All of these have massive shared network agreements, which means they can have multiple companies “underneath their umbrella.”
When you agree on one fee schedule with a company like Connection Dental, for example, that same fee schedule can also apply to each of the companies within the same shared network.
Slightly smaller companies include Pioneer Group, which is a regional third-party administrator that only operates in certain states. Sandi also discussed smaller network agreements such as Aetna’s agreement with Guardian that came into effect back in 2015.
Sandi pointed out that each time a new shared network agreement is put in place, you will have automatically opted into that agreement unless you actively take the step to opt out of that agreement.
Getting “Demographic Specific”
Sandi shared a lot of great insights about what to look for in an insurance company, but she also reinforced the importance of getting demographic specific when searching for the right insurance company.
You need to make sure that you choose an insurance company with not necessarily the best fees, but one that will allow you to access the largest pocket of patients without taking chunks of your productivity.
You don’t want to choose a company that gives you, for example, about 75% of your full fee, and then you have to hop on the hamster wheel and do more procedures to make up for what you’ve lost.
Reducing your Burden on Insurance Companies
If you’re at a place in life where you’re ready to “get rid” of a few insurance companies that are no longer necessary for your practice to hold on to, it’s best to start filtering them using a side by side comparison strategy.
Compare your insurance companies and filter the best paying options from the worst paying options. If you’re a relatively new practice, your options are limited, but as you advance as a practice owner, you have the freedom to be more selective.
You can gradually change your strategy and scale back on insurance companies because you no longer depend on them to funnel new patient flow to your practice.
Transitioning Out of Insurance
I don’t believe that a dental business should ever necessarily transition out of insurance, but I do think that in multiple doctor situations, the senior doctor should personally transition out of insurance but keep the associate in a network. Whenever I tell other dentists this, most of them didn’t know it was even a possibility.
So, I asked Sandi if there was any truth behind this plan of action and if it’s possible for the owner dentist to be out of network while keeping the associate dentist in the network.
Sandi cleared up the confusion by clarifying that the majority of insurance companies allow split participation. This means that you can have one or more doctors in your practice participating and others not under the same tax ID number.
Get in Touch with Sandi
If you’re a single location practice with up to two practices and would like to outsource to Sandi and the team at Unlock the PPO, you can visit the website to get in touch, view some frequently asked questions and answers about their service packages or call the office at 855-327-9125.
Hit play to watch the recording of my discussion with Sandi:
This article originally appeared on T-BoneSpeaks.com.