Negotiating with PPOs can feel like arm wrestling a grizzly bear. Dental insurance fee schedules are notoriously restrictive, leaving many practices with slim margins and mounting frustrations. But what if you could reduce your dependency on PPOs while increasing revenue and loyalty?
Here’s a roadmap to negotiating better PPO fee schedules, cutting ties with low-paying plans, and scaling your BoomCloud™ patient membership plan to create predictable, recurring revenue.
Why Negotiating Dental Insurance Fee Schedules Matters
Fee schedules dictate how much you’re reimbursed for each procedure. If you’re stuck with rock-bottom fees, your profitability takes a hit.
The Challenges of PPO Contracts:
- Low Reimbursement Rates: Often below the cost of delivering care.
- High Administrative Burden: Insurance billing eats up time and resources.
- Loss of Control: You’re stuck playing by the PPO’s rules.
Negotiating better terms or transitioning away from PPOs can help you regain control of your practice and finances.
How to Negotiate Dental Insurance Fee Schedules
1. Analyze Your Current PPO Contracts
Before negotiating, understand where your pain points are.
What to Evaluate:
- Reimbursement rates for your most common procedures.
- Volume of patients from each PPO.
- Administrative costs of billing and claim management.
Pro Tip: Use analytics tools to determine which PPOs are costing you more than they’re worth. You can also hire Veritas Dental Resources to do the negotiation for your practice!
2. Gather Data to Strengthen Your Negotiation
Insurance companies won’t raise fees without a compelling reason.
What to Prepare:
- A breakdown of your overhead costs to justify higher rates.
- Data showing patient volume driven by your practice.
- Benchmark comparisons to other PPO rates in your area.
Tip: Present your case professionally and emphasize your value to their network.
3. Negotiate Strategically
When it’s time to talk, approach negotiations with confidence.
Negotiation Tips:
- Start with your highest-volume procedures and request higher fees.
- Be ready to walk away from unprofitable PPOs.
- Offer to maintain a limited relationship with the PPO for specific services.
4. Phase Out Low-Paying PPOs
If negotiations don’t yield satisfactory results, consider cutting ties.
Steps to Phase Out a PPO:
- Notify the PPO of your decision to terminate the contract.
- Communicate the change to your patients early and often.
- Offer alternative solutions, such as an in-house membership plan.
Example: Dr. Dan Nelson of Wood River Dental successfully transitioned away from multiple PPOs by implementing a BoomCloud™ membership program, ensuring patients still had affordable care options.
Scaling a Patient Membership Plan with BoomCloud™
Membership plans provide an ideal solution for patients who lose PPO coverage or lack dental insurance altogether.
How BoomCloud™ Helps:
- Automated Billing: Simplifies recurring payments and renewals.
- Customizable Plans: Tailor memberships for different demographics, like families or seniors.
- Analytics Dashboard: Monitor your MRR (Monthly Recurring Revenue), ARR (Annual Recurring Revenue), and patient retention.
Benefits of Membership Plans:
- Predictable Revenue: Membership patients generate consistent income.
- Higher Patient Spend: Members spend 4x more than PPO patients.
- Loyalty: Membership plans build stronger patient-practice relationships.
Case Study:
7 to 7 Dental used BoomCloud™ to scale their membership plan to 2,000 active members, generating $85,000/month in MRR and significantly reducing their dependence on PPOs.
Benefits of Reducing PPO Reliance
1. Financial Freedom
With fewer PPOs dictating your fees, you can set your prices based on value, not constraints.
2. Better Patient Care
Fee-for-service and membership models allow you to focus on quality care without cutting corners.
3. Administrative Efficiency
Say goodbye to the time and stress of insurance billing.
FAQs
How do I know which PPOs to negotiate with or drop?
Evaluate reimbursement rates, patient volume, and administrative costs. Focus on PPOs that bring the least value to your practice.
How does BoomCloud™ help with patient retention after cutting PPOs?
BoomCloud™ makes it easy to offer affordable membership plans, ensuring patients remain loyal even without PPO coverage.
Is it risky to drop PPOs?
While there’s always some risk, practices that offer a well-structured membership plan often see improved patient satisfaction and revenue stability.
Final Thoughts: Take Control of Your Practice with Smart Strategies
Negotiating PPO contracts, reducing insurance dependence, and scaling a patient membership plan are transformative steps for any dental practice. With tools like BoomCloud™, you can create predictable revenue, attract loyal patients, and regain control of your financial future.
Ready to Take the Leap?
Schedule a BoomCloud™ demo today and discover how a membership plan can empower your practice to thrive without PPOs.
