Have You Been Victimized by Your PPO Contract – You May Not Be Aware!
UNCOVER THE SECRET PPO Plans Do Not Want You to Know!
It is preventing your practice from collecting 24% – 43% more in your claim reimbursements.
Dental insurance companies are beginning to add amendments to their provider agreements to include provisions not previously incorporated into the original contract. That is if they have not already done so.
Some of the amendments cover a variety of subjects, such as the following:
Benefit companies are now including language that indicates they may engage in a rented network in the future; even though, they do not presently engage.
A requirement to report all other contracts paying a lesser fee schedule than this specific company.
A suggestion that if one dentist of a multi- dentist practice participates with a dental benefit company, all the other dentists must also be participating with that same company.
A requirement that the dentist must notify patients if they choose to terminate its participation with a particular benefit company. They must also refer those patients to another provider who does contract with the said benefit company.
What does this mean for dentists that PARTICIPATE with such groups?
It means that dental providers could be paid on a lesser fee schedule and writing off 24% – 43 % more that they did not need to do before. This drastically cuts into a practice’s bottom line.
The sample fee schedule illustrated on Chart 1.1 shows how a dentist can engage with a PPO plan that promises a pool of patients in exchange for higher write offs. This becomes attractive to practices that need to increase their patient base and they feel they will make up the write offs by doing more in volume, after all, it is only one PPO plan. However, that PPO plan in time has added amendments that now include 7 other PPO plans that honor the same fee schedule illustrated on Chart 1.1; thereby, preventing the practice from obtaining a higher fee reimbursement from these 7 insurance companies.
Are you currently a Victim? You already may be a Victim or a potential victim if you can answer yes to any of the questions posted below.
Is your practice currently in network with various PPO plans and writing off over 32% from your standard fees?
If you are a single provider, are the EOB’s being paid on a different fee schedule that you anticipated?
If you are practice with multiple providers, are the EOB’s being paid differently for each associate from the same dental benefit company?
Already in a variety of plans and not certain if your practice has been affected?
Are you looking to purchase a practice signed up with a variety of dental benefit groups?
Are you a dentist looking to join a group that is signed up with a variety of Dental benefit groups?
What Should you do if you feel you are a Victim or potential Victim?
Review the dental benefit group contract carefully and see if there are any provisions cited before you join.
Identify the type of contract the providers are in- network; direct, rented or 3rd party payor.
Review every EOB and make sure it is being paid on the fee schedule you expected it to be paid on.
Check patient’s eligibility prior to their visit and ask the insurance representative what fee schedule the patients plan will be paid on.