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Taking The Headache Out Of Starting Up - Insurance

Posted Sep 03 2012 4:00pm

Should you or shouldn't you?  That's the question, and you'll get so many different points of view that you may be sorry you asked.  Ask anyway, you need to make an informed decision.  

Should you sign up as a perferred provider for insurance plans?  On the plus side, it will help you build a practice base quickly.  If you negotiate your fees well, it may be worth it at least for a while.  There is finally an established company to help you with that. Sandi and Lisa at Unlock the PPO  can help you decide which insurance plans will work best for you and they can also help you negotiate fees. They offer:

  • Personalized strategy based around each dentist’s individual practice goals
  • Gradual approach that gives dentists the tools to monitor progress
  • Insurance tips to help focus on maximizing fee schedules and most relevant codes used by each office
  • Front desk support to ensure changes are communicated effectively with patients
  • Real financial analysis giving dentists clear information about the cost associated with each plan
  • Updates on insurance industry changes and tips, be sure to check out our blog
  • Real world experience from 15 years in the dental industry
  • Common sense approach encouraging dentists to make smart financial decisions rather than abruptly dropping all plans

Both of these ladies are good friends of mine so I feel free to tell you that they are both just warm and sincere and so easy to work with.  (I am receiving no renumeration in return for this endorsement, they don't even know I'm writing it.  I hope they don't mind me copying and pasting the above from their site).  It's also a good idea to talk to them if you're buying an existing practice.  They can look at the ratio of insured patients to non-insured and they'll also see if the plans that the dentist is currently involved with will work the same for you.  Just remember, if you sign up as a preferred provider it may help you build your practice in the beginning, but it may be tricky to drop plans later once you're established without losing the patients who came to you because you were "a part of their insurance."  No matter whether you participate, or not, always make sure you and you're team understand insurance participation or non-participation and know what to say to your patients either way.

I recently heard of a situation where an insurance company stopped grandfathering in new dentists as premier providers.  The dentists were buying practices that showed an income from insurance based on the fact that the selling dentist is a premier provider.  When the new dentist takes over he finds out that he can not be a premier provider and then has to accept a lower fee per procedure than the previous owner.  That can drastically lower the income potential for the new dentist. I like to watch out for you new dentists and I don't want to see this happen to you so be careful and do your homework on any practice you want to buy.

Another option is fee for service (FFS), or partial fee for service. In a fee for service practice, patients pay at the time of service and send in their own insurance form and are reimbursed directly.  The office will often print out the form for them along with any necessary narratives and x-rays.  In a partial fee for service practice, the practice may agree to allowing the patient to extend payment over a few months.

Naturally, patients initially prefer to visit a in network dentist because they perceive it to be the best way to get their dentistry for "free."  They can become so "insurance bound" that they actually start to believe that they are "not allowed" to exceed the yearly maximum.  It takes patience and excellent communication skills to be able to educate the patient on the limitations of their insurance, their right and ability to choose out of network care, and to reassure them that they are not "losing their benefit" by choosing a non-participating dentist in most cases. For the dentist, becoming a participating provider can mean more paperwork, necessitate hiring additional staff, require accepting less per procedure, and often results in a certain amount of professional dissatisfaction depending on the temperment and sensibilities of the dentist.  

It's not an easy decision and that's why I'm so happy to see Sandi and Lisa ready and willing to help you navigate these important and difficult decisions.


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