PPO Insurance Write Offs – Your Biggest Revenue Leak!

Every business has revenue leaks! In other words, expenses or even systems that allow more outgoing money than necessary. Would it surprise you that your PPO insurance contracts are likely your largest revenue leak? Did you know that PPO Negotiations & Optimizing your contract structure can substantially slow that flow and allow you to collect an additional 10%-20% or MORE on the insured side of your practice? 

Whether you’re just opening a new practice or have been established for quite some time, negotiating your insurance contracts is a must! Insurance companies try to keep their fee schedule flexibility a secret, but anyone can negotiate their fee schedules prior to signing up OR every two years after contracting.  

PPO participation makes sense for growth. Being in network with insurance plans allows for your practice to appeal to patients with dental insurance. It also can be a marketing tool to attract new clientele to your practice through online insurance directories.  

On the other hand, dentists that are in network with many insurance plans tend to have a full chair and a backed-up schedule. Although the “busy-ness” means collections, of course being an in-network provider cuts into those collections greatly. By contracting as an in-network provider, you are agreeing to a set fee schedule of maximum allowable fees. Most carrier contracts require a 40%-60% write-off. Each carrier typically has a separate fee schedule, and some plans may pay better than others.   

If the patients in the chair are taking up x amount of your time and you are only able to collect 40%-50% of your fee, this is where the plans you take start to matter a great deal. 50%-60% of your fee is being written off or in other words, leaking through the cracks. 

Your time is extremely valuable. You spend your time working on patients and have the claims submitted to only come back with a payment that is at times less than half of what your UCR fee is. At the end of the day, it’s questionable if that payment allowed by the insurance company will even cover the cost of your time, supplies and operation of your practice.  

What can be done about this? Being in network with PPOs will always require a write off, but there are ways to improve your situation on the insurance side of things. At Beacon PPO Solutions, we take steps to help our clients collect more and write off less. Negotiating and optimizing your PPO contracts is the solution!  

PPO Negotiations & Optimization 

Negotiating your PPO contracts isn’t as simple as it may sound. Yes, you will have some success if someone in your practice reaches out to companies and asks for a fee increase. Some companies will say no, some will say OK and offer something standard and say it’s the best they can do (with hopes and crossed fingers that you will accept and lock in those slightly less garbage fees for 2-3 more years).  

Without proper leverage and knowledge, your negotiation success will be minimal. The main leverage insurance companies care about when negotiating is leasing leverage. Did you know you can be in network with each company through other companies and their fee schedules? This is called PPO leasing. It allows insurance companies to process claims on your other fee schedules and of course, they will choose the lowest option that they see.

Leasing can potentially be the worst OR best option for participation. Because all carriers overlap and intertwine, it is important to look at the big picture of all carriers in relation to each other. This takes an in-depth process that is specific to your combination of PPO contracts. There are over 3,000 ways to configure your PPO participation. The odds of you currently having the best combination is very (very, very) low.  

Here are the important steps to a successful negotiation process:  

• UCR Evaluation – Make sure your UCR fees are not falling below the market average. This can cause companies to cut into your fee schedules and only pay what you are asking. They often will not increase a fee schedule where they are already (in theory) paying close to your billed UCR fee.  

• PPO Evaluation – Confirm participation with all carriers, identify whether you are in network directly or leasing through a different company’s fee schedule, obtain all current fee schedules and analyze. After PPO Evaluation, all of the leverage needed to negotiate is identified and recommendations can start being made and then implemented.  

• Negotiations – The best negotiation strategy is not held only in a good relationship with the carriers. Although we know this is important, the most tactful leverage is in knowing all of your participation options. This is leasing leverage.  

• Optimization – There are plenty of ways to be in network. Through optimization, contract changes can make a low paying contract into a high one depending on your options. Optimization is when you add, re-structure or change the way you participate with an insurance on the fee schedule side, while remaining an in network dentist on the participation side. 

In summation, you are likely doing MORE work for LESS money while that revenue leak can be slowed. PPO Negotiation services are extremely beneficial for many reasons. The number one takeaway is increased reimbursements, which automatically applies to your bottom line. The knowledge of how your plans pay can also help you select marketing strategies that increase patient visits within the highest paying networks you are participating with.   

Is your practice a good candidate for PPO Negotiations & Optimization? 

 Contrary to what many other consultants in the industry will tell you, not every dental practice is a good fit for PPO negotiation services. Here’s a quick quiz for you to know if your practice needs Beacon’s PPO negotiation & optimization expertise. You should consider talking to Beacon PPO Solutions IF…  

•  You are opening a new practice and need to negotiate and know your options before credentialing  

• You are in network with the majority of PPO carriers  

• You are in network with any third-party administrators or leasing umbrellas (Connection Dental, Dentemax, Careington, etc.) 

• You feel as though your fee schedules pay very low  

• You have a very busy office with a backed-up schedule  

• You are out of network with insurances but want to grow exposure through adding some profitable PPO  

• You don’t know where to start with evaluating your participation or the profitability of your contracts 

• Your office is noticing companies using lower fee schedules for claims (default leasing)  

• You want to make more money for the work you are doing.  

If any of these sound like you…give us a call or schedule a free PPO consultation through our website. The consultation is FREE, and we will also provide a complimentary evaluation of your PPO participation/ contracts and an Insurance Revenue Analysis. Worst case scenario — you endure some fun small talk and gather important knowledge of the PPO industry; your practice’s potential and some simple solutions to quickly improve your practice’s systems or participation. 

You can book your complimentary consultation through our appointment scheduling link here:

Schedule Now!

You can also call us anytime at: 385-888-3161 and visit our website at: www.beaconpposolutions.com.

We assist offices in all situations to understand how their insurance carriers work and ensure maximum reimbursements for the work they are doing. Feel free to call in to have a conversation about your situation and what your options are to increase PPO revenue in 2025. 

Talk to you soon!

The Beacon Team