Examining Insurance Part 2: Who Should Stay and Who Should Go

Posted on by Jim Philhower | Category Marketing, Practice Analysis

PPOs often have a much bigger impact on practice profitability than the dentist and office manager realize. When the numbers are examined, some plans may completely eliminate the profitability of some procedures. If you’re struggling to remain profitable in an insurance-driven practice, you may want to reconsider some of the plans you’re accepting. First, you need to know how many plans you’re really participating in, how many patients are being driven by each plan, and what percent of your production each plan makes up. This information is available in your practice management software. Once you have that information, use the following 3 steps to evaluate the plans you accept.

  1. Fee Schedule
    What percent of your full fee schedule is each plan paying?
  2. Administrative Hassles
    Ask the Office Manager which providers require the most time and energy to get claims paid.
  3. Quality of Patients
    Who is driving the highest quality patients into your practice?

Once you’ve evaluated all the plans, you may find it makes sense to limit participation to the top-ranked plans only. If that’s the case, make sure you have a plan in place to retain as many of those patients as possible. If you need help evaluating or eliminating insurance plans in your practice, please contact your Henry Schein representative.


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