Resources
All of our clients share the same primary concern about working with us to reposition their insurance contracts and network statuses: what about losing patients? Won’t they go somewhere else if we leave the networks their plans access? How are we going to increase our income without increasing our patients’ expenses?
S101 was invited to join this webinar with Wendy Kelly from Paladini Financial. They dive into the complexities of insurance negotiations and share practical insights on restructuring payor contracts. We explore the challenges posed by market saturation, patient and employer plan selections, shifting leased network connections, fee setting, and compliance with contract terms.
The insurance industry is deeply entrenched in the majority of dental practices in America. Practice owners have to become more educated about how different plans work, how and why they pay differently, how insurance networks are linked together via provider leasing agreements, and what plans their patients are bringing to their office specifically.
One PPO can “lease” their network of dental providers to another, so the dentists in-network with the first PPO must accept patients from the second as in-network, even though they might not have a direct contract with those patients’ plans. So, patients have more options for dental providers, and providers have a much wider pool of potential patients who can see them in-network. What’s the downside?There are several.
How do self-funded plans work, and how are doctors reimbursed differently when patients use them instead of fully insured plans? Why is important to know all of the plans your patients are bringing into your office? How do different plan types determine the options you have for leaving low-reimbursing networks?
Many feel trapped in upside down insurance contracts by the fear that they’ll lose all their patients if they leave. And yes, this probably is the single biggest thing you need to worry about.You can’t just exit all your contracts at once, you’ll destroy your patient base. But it is very possible to completely change your dental benefits contract situation, dramatically increasing your revenue, while also retaining the vast majority of your current patients. It just has to be done methodically, strategically, one step at a time.
Does that seem like an odd question? After all, providers aren’t charged when they join a new dental insurance network. It’s mutually beneficial, isn’t it? Providers get access to more patients, and insurance companies get another provider to add to the network they offer to their subscribers. Everybody wins, don’t they?
“Insurance reimbursement rates have gone down consistently, even through the pandemic, even when costs are rising. So the dentists are getting less money coming back from the insurance companies and yet patient premiums have gone up. And so, where's the money going?”
The operating expenses of owning a dental practice have skyrocketed in the past three years. Materials, supplies, and PPE are more expensive due to supply chain issues and inflation. And as the demand for good hygienists has grown sharply, so has the cost of your office’s payroll.
There are many factors contributing to the revenue and cash flow issues many dental offices need to overcome this year. Materials and supplies are more expensive, payroll is higher than ever, and inflation is affecting the entire economy. But the problem at the front of many practice owner’s minds is likely the low reimbursement rates they’re receiving from insurance carriers.