June 25, 2021

PPO Contracts: What You Don’t Know Could Be Hurting You

Intro by Drew Hinrichs

In today’s market, practice owners are losing ground as insurance companies constantly invent new ways to reduce payments to dentists. My colleague, Shelley DeGroff, worked for years as an office manager and her experience dealing with insurers led her to launch her own business in 2013 to help level the playing field for dentists. Her team at PPO Advisors have successfully increased fee schedules for hundreds of clients. In fact, Shelley is so confident in the value she delivers that PPO Advisors is the only firm of its kind to offer a risk-free analysis with dental PPO negotiations completed upfront. I’ve asked Shelley to share a little about her work, why it’s harder than ever for practice owners to get a fair deal from insurance companies and what you can do about it. In my opinion, you can’t afford NOT to get the kind of help PPO Advisors provides.

By Shelley DeGroff, Founder of PPO Advisors

If you were walking down the street and accidentally dropped a $20 bill, you’d stop and pick it up. I don’t know anyone who wouldn’t. But if you have a hole in your pocket and a $20 bill falls through that hole without your knowing it, you’d keep walking and someone else would end up with your money. That’s essentially what’s happening with your practice, only the hole in your pocket is your PPO contract, and you’re losing a lot more than $20.

A conservative estimate would put the income lost to your practice at tens of thousands of dollars, all of which is going straight into the pockets of insurance companies. PPO contracts have become increasingly complex and packed with difficult to understand clauses, all for the purpose of disadvantaging practice owners. You may not fully understand how your PPO contract is lowering your revenue, but the losses are real, and if you do nothing the amount you lose is going to grow.

Creative Strategies for Reducing Payments to Providers

Insurances companies have a plethora of strategies for reducing payments to providers. For example, many dentists are unaware of the impact PPO network sharing has on their income. Also known as lease-share agreements, this widely held practice allows a PPO to share its network with other PPO networks as a means to expand their provider reach. A dentist who has a contract with one PPO must accept patients from the other PPOs as in-network providers. This practice is in conjunction with the most favored nation clause that most PPO contracts adhere to. This allows insurance companies to use multiple networks to bind dentists to the lowest fee among all the PPOs. For example, one PPO may have the lowest reimbursement rate for crowns while another has the lowest reimbursement rate for cavities.
Now the PPOs can use the rates of lower shared networks within your practice, even if it’s not what you agreed to in your contract with them.

That’s just one of many strategies that insurance companies have deployed to gain the upper hand with dental providers. Over the last five years insurers have pulled out the stops in their efforts to game the system and lower payments to dentists.

I started PPO Advisors after working for years as an office manager where I spent countless hours trying to understand what was in our PPO contracts. Doing that enabled me to negotiate better terms for my own office. Over time, I began doing the same for other practice owners I knew.

Now, with PPO Advisors, that’s all I do. We’ve helped over a thousand dental practice clients increase revenues by an average of 20% simply by negotiating a better fee schedule. Think about it – you do the same amount of work and get paid 20% more. We call it working smarter, not harder.

Free Analysis – See the Results Before Signing Up

Having spent years managing practices, I wanted to create a business model that made it easy for providers to see the value of what they’d get before they had to commit. That’s why PPO Advisors is the only firm in the industry to offer a free analysis with negotiations completed upfront. With our analysis, PPO Advisors does all the work to negotiate a higher fee schedule on your behalf before you become a client, so there are no surprises. You see exactly how much more money you will receive from insurance before you sign up. Our business model works because once providers see the return on their investment, it’s a no brainer for them to become clients. On the low end, our clients see an average of $40,000 as a result of higher insurance payments, with multiple providers seeing an average increase closer to $100,000.

PPO Advisors can also help with credentialing by either handling it for you or providing support to your in-house team. Whichever way you choose, we make sure you don’t experience the hassle of falling out of network because you failed to get re-credentialed.

Insurance companies go to a lot of trouble to make it hard to understand what they’re doing. It’s not realistic to expect an office manager or even a practice owner to have the time it takes to deconstruct these contracts and negotiate better terms. PPO Advisors is here to help you win the game with insurance companies. At the end of the day, we want you to keep more of your hard-earned money in your pocket, where it belongs. Contact us for a free ROI analysis and we’ll get to work!

If you’re ready to take control of your practice’s financial future, reach out to Engage Advisors. Our expert Dental CPAs and dental accountants are dedicated to maximizing your profitability. Contact Engage Advisors today and let us help you achieve financial success.