5 Steps to Negotiating with Insurance Companies
If you’re like most dental practices, your expenses are increasing, and
you're facing a steady stream of lower
reimbursements from insurance companies year after year. I’ve outlined some key
steps that you can take to negotiate higher fees from insurance companies that
can get you paid more without additional chair time!
Common misconceptions
about this process:
- Insurance companies
won’t
negotiate
- The PPOs don't need me
- I'm just a number
- I have no leverage
Steps to negotiating with PPOs to get paid
more:
1.) Create an
insurance profile.
- Organize a list of PPO
plans that you currently participate in, when you joined them, and create a
report illustrating your top 25 utilized codes (80-90% of your revenue and know
where the money is).
- Reasons you joined
them: New practice, need new patients, losing patients. It’s a good idea to review
the benefits of participating in PPOs.
- Find and create a list
of the network recruiters and network managers by PPO plan. These are the
people to communicate and negotiate with.
2.) Prepare to
negotiate.
- Identify your leverage: Location, Specialists/General Dentist
(do you have specific skills that set you apart?), availability (do they need
you more than you need them?).
- Create a negotiation letter that illustrates your leverage,
describes why you’re important to the network, and that you want to continue
participating with them, but the current fee schedule is insufficient. To get
the best results, you’ll need data to make your case.
- After you've completed
the previous steps, the key is to negotiate with the right person who can
actually agree to and sign off on a higher paying schedule. Send the letter
certified when possible and create a paper trail.
3.) I received a
proposal with an increased fee schedule, what next?
- Don't accept the first
offer! Compare proposed schedule versus your old one and if your top 25 codes
are not significantly increased, submit a counter proposal. Counter at least once.
- Once you've accepted a
new schedule, get an official schedule with the insurance company’s logo, implementation
date, and expiration date.
4.) After your new
schedule is implemented, what's next?
- Audit claim submissions to make sure your
increased fees are being paid for at
least two months.
- Repeat this process every 18-22 months!
Just
a quick review: The steps to negotiating higher paying schedules are to build
your insurance profile, identify and create your leverage, write a negotiation
letter and send it to the right person, review and counter offer proposed fees,
and audit for accuracy.
5.) Legalities in
negotiating that, as a sole practitioner, you should be aware
of (due to anti-trust laws):
- You cannot
call your colleagues (or band a group of dentists together) to review their
fees, boycott collectively,
or negotiate as a group, etc. with the carriers. It may sound unfair, but this is
one way that the carriers have an upper hand in negotiating.
Apex
Reimbursement is not under the same restriction, so we are able to see multiple
schedules by specialty and insurance company in order to help us create negotiating
leverage on behalf of our clients. You can see it as a sports agent who
represents multiple athletes of the same position and knows what they are
getting paid.
I’ve mentioned a few
misconceptions that may be preventing a dentist from taking the necessary
action to negotiating with the insurance companies, and outlined a number of
proven steps that will empower you to take the necessary action and positively
impact your bottom line.
Sincerely,
Harold Gornbein
Apex
Reimbursement Specialists
410-382-9164
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