Cliff's Notes

The Business of Dentistry

In-House Dental Insurance Plans May be Illegal …


The in-house dental insurance plan may be illegal in your state. Here in New Jersey the “good intent” may cost you hundreds of thousands of dollars. The fact is simple, you are offering insurance and you are not a state licensed insurer. BANG! You just broke a whole bunch of laws. Also, the higher your UCR the higher your reimbursement, that is pretty much a fact, but offering a special (i.e. $69.99 Cleaning, X-rays, Exam) may re-adjust your reimbursement to a lower rate and may require you to refund any patient that paid a higher rate during the promotional period and that includes insurance companies.

Healthcare providers are subject to additional consumer protection laws. If you are a PPO provider you are subject to insurance company rules and regulations. However, the rules keep changing. It is almost impossible for a dental office doing less than $1M/year to have the resources to understand and manage the ever changing landscape. Insurance reimbursements are fluid and constantly shifting and require continuous monitoring . Now is the time to think about “Out Sourcing”.

Simple economics … Out sourcing your PPO management program may cost $400.00/month. A team member may cost $600.00+/week. A PPO management company has multiple resources and can react quickly to changes in rates and law.

This past week I attended an outstanding presentation on PPO management and how to navigate and monitor the insurance system. I was amazed at the data the insurance companies compile to determine your reimbursement rate. Do you do “write-offs”? Maybe you should do “insurance adjustments”. Understanding the insurance market and managing it correctly could amount to thousands of dollars per month.

Another thing I noticed was the lack of interest in learning about such an important topic. Most dentist do not understand the insurance market and leave it to the office manager. The office manager does not attend quality seminars and the dentist assumes everything is being done correctly and legally.

Seminar attendance for the new generation of dentists is down and that is not good. They get there information on line but the interaction of a live session really brings things home. For a dentist, practice management sessions are not interesting but they are essential. A good business owner does not have to know how to do something but they need to know what can be and has to be done and then hold team members accountable.

As the cost of operations continue to rise, outsourcing is a very viable option. Outsourcing is nothing more than “shared services” and the only down side is having to pick the best company to work with. Get recommendations and interview several dental orientated companies and calculate the best ROI. The investment in third party specialists can be very rewarding. Would you ask a PPO management company to do a crown prep? Why do you think you can manage PPO’s? After all, you don’t know what you don’t know! Please contact me at any time with any questions or concerns.

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October 30, 2016 - Posted by | Uncategorized

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