Insurance Negotiations Simplified: For Established Dental Practices

Whether you’re preparing to launch your startup dental practice, or you’re a seasoned practice owner with multiple, well-established locations, you’ve probably felt overwhelmed by insurance negotiations. Insurance companies make it difficult for those under their contracts to understand how to get the most profitable rates. This can prove to be challenging for dental professionals.

This is a problem that Maritza Duran understands well. Maritza is the owner and founder of MDent, a consulting firm that specializes in helping dentists to build their successful practice with ease. Recently, Dr. Kathryn Alderman sat down with Maritza and talked about this particular issue in depth. She shared several great strategies for handling this issue effectively, no matter where you might be in the process of achieving success for your dental practice. 

One of the most common questions from dental business owners is how to negotiate insurance fees. The answer depends on whether you are still in the startup phase of your practice, or you own an established practice and are simply looking to get a better deal. This post will target those who already have an established practice.

Learn More about insurance contract negotiation advice for startup dental practices.

Maritza recommends, for those with established dental practices who are seeking to increase their reimbursement potential, to follow a five-step plan in order to get the best deal for your practice.

Maritza’s Five-Step Strategy
for Increase Insurance Reimbursement for Dental Offices:

1) Run a report in your practice to understand which are the most commonly used insurance companies that are bringing the cash-flow for your practice.

You can use your software to run this report, called the “Insurance Utilization by Report”. This will help you rank your insurances from the highest used (by number of claims) down to the lowest one. Focus on the top five insurances on this list. 

2) Find out how you’re currently contracted with these insurance companies. Is your contract direct, or does it follow an “indirect contract”?

An indirect contract is a new model that insurance companies follow, and signing an indirect contract will put you into both of their networks. Sometimes, dental practices may not know that their indirect contract with one set of insurance companies may overlap with another contract, or maybe even could be re-situated in a way that gets you a better deal. 

3) Find out what your top ten procedure codes are.

Based on these top ten codes, you can look to see what your reimbursement and fee schedule for each of the ten procedures. Map it out and create a flowchart or spreadsheet to help you put it all together. 

4) Find out the contact information for insurance agents who are in charge of negotiating PPO fees.

Evaluate if you already have a relationship with the insurance agents who advocate for your practice for any of those top five companies.

5) Start developing a relationship with your insurance carrier agents, if you haven’t already.

Doing this can help you to get better advocacy for your business. If you have a solid relationship in place, you may be able to negotiate your reimbursement directly. 

Of course, all is not lost if you don’t already have a relationship built. And maybe you don’t want to take the time to build it before you attempt to negotiate for a better deal. Maritza recommends that in those cases, it is best to go with “option B” — using a third-party company to help you negotiate for the best deal. But, if you do exercise this option, be careful — insurance companies stay one step ahead of the game. They often develop policies or methods to avoid giving third-party companies like MDent the necessary information that is needed, or refuse to work with them entirely. 

Make sure to approach third-party help as working “with” you, rather than “for” you.

Stay directly involved with your insurance company. Use the third-party to help with negotiations, but don’t rely entirely on their service or use them as a middle man. The communications should still come from you.

No matter which route you decide to take, there are two very important factors that you must keep in mind. Maritza warns that forgetting to account for these two things will make the transition period much harder to deal with, not only for your patients and your bottom line, but also your staff too. 

Keep these things in mind when negotiating fees with Insurance

1) Keep patient experience in mind.

Know that some insurance companies penalize practices for trying to leave a direct contract and rejoin under an umbrella or indirect one. Warn the patients affected by the contractual changes ahead of time, especially those who are returning patients to your clinic. If you don’t, the insurance company might send them a letter in the mail, urging them to choose a different clinic instead. Keep one step ahead and communicate clearly with the affected portion of your client base at the start, so that they have the right information and aren’t scared off by this tactic. 

2) Keep your team’s experience in mind, too.

It is crucial to support your team through transitional periods, especially one that can be as hairy as insurance contract changes. You, as the business owner, understand the bigger picture — but your team needs to understand it as well. Communicate closely with them, and make sure they are committed to the same big picture outcome that you are. Involving them with decision-making, and ensuring that they are correctly supported and encouraged will prepare them for the transition as well as keep them motivated, even during the most hectic phases.

In conclusion, the process of negotiating insurance contracts can definitely be simplified

And you can come out with a better deal for your business and your client base, too. Follow these steps to do-it-yourself, or hire a professional like Maritza with MDent. 

Many established practices can greatly benefit from the help of a mentor or business consultant, and not just when it comes to insurance negotiations. Progressive Dental mentor offers mentorship and online courses for professionals in all corners of the dental profession. Whether you want advice on honing business strategies, or you want to save time and money by training your new hires with a comprehensive and effective training program, PDM has the resources to support your needs. If you’d like to learn more about our options, click here to get in contact.