Insurance Negotiations Simplified: For Startup Dental Practices

Are you getting your startup dental practice running, but feeling stuck when it comes to insurance contracts? Don’t let it discourage you. Even established practices run into issues with insurance contracts. In fact, insurance companies benefit greatly from keeping their contracts confusing for their provider customers. But, all hope isn’t lost. It’s absolutely possible to get the best contract deal for your business without having to stress too much — it’s just a matter of strategy. 

Maritza Duran, founder and CEO of MDent — a business consulting firm specifically for dentists and dental business owners — sat down last week to share her best tips and tricks for getting the best deal possible out of your insurance providers. For those with startup dental businesses, Maritza recommends that they seek help from a third-party consulting firm, such as hers. But it is crucial to do so with caution: you don’t want someone to simply take the reins. Your relationship with the third-party firm will be temporary, but the relationship that you form with your insurance companies will be for perpetuity. You want the third-party to guide you through the process and teach you the most important strategies. With their help, you will learn the most productive system for dealing with insurance contracts. Hire them for guidance, but learn along the way. Don’t forget to develop a good relationship with your insurance agents, either.

Third-party companies are especially beneficial for startups because those who are new to the business end of dentistry often find concepts such as credentialing versus contracting to be confusing. Handling insurance contracts without a proper understanding of how they work means. You might be unknowingly signing yourself into a contract that doesn’t keep your interests in mind. Therefore, it is best to have some level of knowledge of the process before navigating it independently. You will get ahead of the game fast if you learn the best strategies on how to deal with tricky topics such as insurance reimbursements from others who are experienced in getting the best deal. 

Finding the Best Insurance Deals for a New Dental Clinic

1) When you’re selecting the site for your practice, take a look at the demographics.

Learn about the population, as it will constitute for the majority of your patients after you open. Conduct market research ahead of time to learn about the people you will be serving. 

2) Identify the top five employers in the area, and then figure out what insurance they offer to their employees.

You want to become contracted to the most commonly used insurance in the area. 

3) Next, you should use the market research you conducted to price your services at a good market value. 

4) Centralize your system.

Take the top thirty procedure codes for your practice and map out the insurance reimbursement rates for each, as well as your private fees. Use this information

when signing your insurance contracts so that you can ensure you get the best deal. 

5) Keep the difference between direct participation versus umbrella participation in mind when signing insurance contracts.

If two or more companies have an umbrella participation contract, it will make sense to structure the ones that you prioritize in a way that fits both the main demographics of your location as well as the best deal that you can find overall. 

Keeping these strategies handy when dealing with insurance reimbursement can make a world of a difference for both seasoned and new practice owners alike. And, third-party consulting firms aren’t just for insurance negotiations: it’s a great idea to hire someone like Maritza if you need help with any business-related issue. Starting a dental business can be complicated and overwhelming, but it is doable, especially if you find the right mentorship. Finding a mentor can save you hours of time, and thousands of dollars in profit, too. 

Progressive Dental Mentor offers mentorship and online courses for professionals in all corners of the dental profession. Whether you’re wanting advice and guidance on how to best strategize for your new startup practice, or you’re wanting a comprehensive and effective training program to utilize for your new hires, PDM has the resources that support your vision. If you’d like to learn more about our options, click here to get in contact.

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Looking for help with re-negotiating the insurance contracts for your established dental practice? Click here to learn the best insurance negotiation strategies for existing practices.

About Martiza Duran

Maritza is the founder and CEO of MDent Consulting Services. After starting her career as a dental assistant and working as an office manager for over 18 years, Maritza started MDent to utilize her expertise in a way that could help dental practices flourish. Her focus is on helping startup dentists with the business planning and operational development of their new practices, including site selection, PPO negotiations, hiring and training for staff, systems, growth management, and more. She has helped with the development and expansion of 15 startup practices. She is also a Certified Body Language Trainer and Leadership Coach.