Renegotiating Dental Insurance Contracts

Thu, Dec 19, 2013

terriThis guest blog post is written by Terri Bradley, an expert in dental practice management consulting.

Imagine that you were happy with your insurance contracts. Imagine that your office had the perfect fee schedule, that when patients presented you with their insurance cards you were happy to see who they were contracted with. Imagine! The reality is, of course, that is rarely the case. What many practices do not realize, however is that it is never too late to renegotiate your office’s fee schedule, or re-evaluate your insurance contracts.

In fact, renegotiating can be both beneficial andprofitable to your practice, and is not as difficult – even impossible – as you might think. In this article, I’ll give you some tips and advice on:

  • what questions to ask before a renegotiation
  • what to look for to obtain a more favorable fee schedule
  • navigating the confusing aspects of insurance contracts/negotiation

Begin by answering some important questions about the insurance carriers your office is contracted with. For instance, when was the fee schedule last negotiated? I recommend asking for a new fee schedule annually, as it gives your office a chance to receive higher reimbursement on some of your most common procedures. However, keep in mind, you can ask at any time, and should if you feel your current reimbursement is inadequate or out-of-date.

You should also be looking at the billing guidelines for your carriers and the volume of patients per carrier, to see which are the most profitable to your practice. By answering these questions up front, you are well on your way to beginning a successful renegotiation of your contracts.

When the time comes for you to renegotiate, there are a few things to keep in mind that will ensure you receive a more favorable fee schedule. For example, if you are a specialist, or if there is not a lot of competition in your area and a carrier is looking to become contracted with your specialty, carriers may be more willing to give you a higher fee schedule.

Another factor that can help in renegotiation is your relationship to the carrier. If it’s good, carrier representatives will be more willing to participate in the give-and-take of negotiation, and ultimately agree to higher fees. When renegotiating, it also helps to focus on the most common procedures done in your office. This way, you get what you really want for your practice: a better fee schedule on the procedures that make up the bulk of your office’s income.

Understanding “rental” insurance carriers, and how to negotiate with them

It’s important, too, to examine not only which insurance companies you are contracted with but which ones you are billing. Many carriers rent out their contracts to other carriers, thus allowing people contracted with those others to use provider networks, i.e. your office.

For example, if your office is contracted with ABC Insurance, but they have rented out their contracts to XYZ Insurance, you may be billing XYZ Insurance while being contracted with ABC Insurance. There are carriers who rent their contracts out to dozens of other carriers. While the contracts are rented out, your office must accept the rental carriers and their fee schedules. Who the carriers rent out to can change frequently, sometimes monthly, thereby changing which carriers your office is contracted with and whose insurance you must accept.

The renting of contracts can be complicated, so be sure to keep track of which companies you are billing and which you are actually contracted with. If you find yourself billing one company more than the one you are contracted with, it may be beneficial to remove the “middle man” and contract directly with the other insurance carrier (in this example XYZ Insurance). Rental contracts are a key issue when renegotiating your fee schedule, so be sure to carefully examine which carriers you are billing the most in order to get the best fee schedule for your practice.

Remember, renegotiating your fee schedule is never impossible, and in fact conducting annual re-negotiations is beneficial and profitable to your practice. Understanding how your insurance contracts work, and knowing what you want out of them, gives you a solid footing to begin re-negotiation. Though it can seem complicated, renegotiating fee schedules is something every office should do and can benefit from.

Terri Bradley brings 22 years of experience – ranging from Practice Administrator of a multi-doctor specialist office to Practice Management Consultant. She is a ‘go to’ resource for comprehensive consulting, dental and medical billing and cross coding, and insurance billing and renegotiation. She specializes in consulting for Oral and Maxillofacial Surgery practices, and presents OMS coding and billing workshops and courses for private practices around the country.

Terri is a member of the prestigious Academy of Dental Management Consultants, is certified with Human Resources Specialists Bent Ericksen & Associates in both Employee Law Compliance and Integrated Performance Management (IPM), and presents to PracticeWorks User Groups regularly.

Learn more about Terri’s speaking engagements and webinar series at Terri Bradley Consulting.

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Topics: Financial Planning, business of dentistry