Will I lose patients if I drop a PPO plan?

Posted on by HS We Do That | Category Coding and Insurance

Waiting Room 2While many dentists are extremely frustrated with the low reimbursements they receive from Preferred Provider Organizations (PPOs), they are reluctant to drop a PPO plan for fear of losing current patients who are covered by the plan. While there is a risk of patient loss associated with terminating in-network participation, there are ways to potentially avoid, mitigate or off-set patient loss.

First, determine whether there is a possibility for in-network participation through a direct contract with another PPO insurance carrier. There may be an opportunity to participate in-network with a specific PPO plan even after you terminate your direct contract with the PPO insurance carrier. Many PPO insurance carriers enter into shared network agreements, whereby a dental provider may participate in-network with multiple PPO plans through another PPO contract. For example, a dental provider may be directly contracted only with Principal and participate in-network with Ameritas insured patients. It is important to keep in mind this may only be an option in limited circumstances. A PPO carrier with whom you terminate your direct contract may not allow you to participate in-network via a shared network agreement.

Second, PPO plans often provide out-of-network benefits. It is important to understand the limitations of any out-of-network benefits; especially if a portion of your current patients work for the same employer group with limited out-of-network benefit coverage. This information can help prevent loss of patients who are covered by the PPO plan by explaining to them the extent they can still utilize their dental benefits at your practice. Identify the current patients insured by the plan you intend to drop and develop a plan to communicate with them after you terminate in-network participation with their plan.

Third, evaluate options to participate with a few other PPO plans you do not currently participate in-network with. There may be PPO carriers that offer a competitive rate of reimbursement and are seeking dental providers for their insured patients in your area. This new or additional PPO participation may allow you to off-set patient loss by adding new patients to your practice and at higher rates of reimbursement.

It is important to evaluate your PPO participation on regular basis. Your cost of doing business increases each year and it may not make financial sense to continue participating with a specific plan that will not sufficiently increase reimbursements. The potential negative impact of dropping a specific PPO plan may be much less than you initially feared after you carefully evaluate the insurance plan and develop a strategy to mitigate and off-set patient loss.

To learn more, schedule a free insurance consultation.

Previous Post:
Next Post: