Profitable PPO - May/June 2020

May/June 2020

HowMany PPOs Are TooMany?

numerous others. So if you participate with several of these other plans, not only will you likely be in Ameritas’ network, but you will have also given Ameritas the ability to choose from these various fee schedules and select the lowest fee! Often, we see offices signing with an insurance company for one or two families. It’s done with the best of intentions and is a nice gesture for their patients. The problem arises when that plan has relationships with four other companies. The office has essentially agreed to lower their fees for 3–4 different plans. Financially, it’s a costly move. While it may feel counterintuitive, the most profitable option for your practice is usually to have fewer contracts. Ideally, you’ll only have 4–6 insurance contracts with good fees, and with those 4–6 contracts you can still get widespread insurance participation. However, if you sign 20 contracts, there are dramatically more fee schedules for insurances to choose from. From an operations perspective, it’s a bit of a nightmare. The advice we always give to our clients is to reduce the number of contracts they have in place. This does not need to limit your participation, however. With only 4–6 different fee schedules, you can still participate with 40–50 different insurance plans because of all the relationships. How do you limit the PPOs you’re credentialing with and not unwittingly fall into a plan that has many affiliates? Before credentialing, ask the carrier if they have relationships with any other companies. Do some research and find out their affiliates. We spend a large part of our day at Profitable PPOs doing just this. We research these relationships extensively to reduce fee schedules for our clients because it’s something that saves practices thousands of dollars annually.

At Profitable PPOs, we have the fortuitous vantage point of working with many different practices across the United States. When a practice comes on board with us, they send us information on the PPO plans they have signed up for, and we run an analysis. What we find almost every time is that the practice has signed up for too many insurance plans. You can join a PPO network many different ways, and while this is something we study daily, many offices don’t have access to the full scope of relationships between companies. So what we see on a daily basis is that a practice has credentialed with a PPO plan without realizing it has other networks linked to it. By signing a single contract, the office has unknowingly joined a plan with 3–4 different companies, or in worst cases, over 100 other companies! When you credential several different plans without determining these relationships first, you’re effectively opening the door for all these other insurance companies to choose the lowest fee schedule. Great for them — not so great for your office. For example, let’s consider Ameritas. What you may not know is that it has relationships with quite a few companies, such as Principal, United Concordia, Dentemax, Connection Dental, and

Please, do yourself a favor and don’t credential a PPO until you or someone on your team has researched its affiliates. Know what you’re getting into so you don’t get shoved into the lowest fee schedules. You deserve better.

– Clint Johnson

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