Dental Insurance Plans | PMA Practice Transitions | PMA Dental Insurance Plans | PMA Practice Transitions | PMA

Are you reviewing your dental insurance plans and fee schedules? You should be, twice a year. Listen as Matt and Joe tell you why it is so important.


Matt Scherer:                    Hello, and welcome. My name is Matt Scherer. I’m with PMA Practice Transitions, and I help dental professionals buy and sell practices in the great state of Ohio, and western PA. And my colleague here is …

Joe Gordon:                       I’m Joe Gordon. I do the same thing in the great Hoosier state of Indiana, and in northern Kentucky, just because I like to bet on horses as much as possible.

Matt Scherer:                    Nice. Today’s topic is insurance policies.

Joe Gordon:                       Today’s topic is dental insurance plans, the bane of our existence.

Matt Scherer:                    That’s right.

Joe Gordon:                       For some practices out there.

Matt Scherer:                    I think in a previous segment, you put up an illustration, I think we should start out with that. I think it was good.

Joe Gordon:                       All right. One of the things I always encourage my practices when I was back in the CPA world was to at least look at their fee schedules and look at their insurance plans twice a year. And one tool, I said the simplest thing you can do that everybody never wants to do, and I said, well, I’ll do it for you. But I’ll charge you. Take a piece of paper, put down your procedures in terms of gross revenue, ten of them. But it down that length. On the top, put your top insurance plans. If you have ten insurance plans, put ten insurance plans. Then put your own fee schedule there. And then just matrix out the reimbursement you get on those procedures by plan. You’ll be shocked if you haven’t done this before, on the variances that you’re going to see with the different plans. That gives you some leverage in going back to renegotiate those fees, or to drop those plans entirely. It is-

Matt Scherer:                    I think people find that some of those plans actually pay less than Medicaid.

Joe Gordon:                       Medicaid, absolutely.

Matt Scherer:                    So why not work smarter than harder? Right? You may lose some patients if you drop some plans. That’s always the fear of dropping plans. Oh, well, Mrs. Smith isn’t on that plan. I might lose her. That’s okay. Because again, you want the plans that reimburse you the best.

Joe Gordon:                       I think if you explain to Mrs. Smith why you’re doing that, and obviously she can deal with the insurance company on her own and be reimbursed whatever they do, you’ll maintain a lot of those patients. They will continue to come see you. It happens all the time.

Matt Scherer:                    Absolutely. And I think you bring up a good point, is explaining to the patient that, listen. This is the reason why I have to drop your plan. It doesn’t reimburse me enough to do these types of procedures, so you have one of two choices. You can stay as a patient and I’d be happy to have you, and I’ll bill you out of network. Or you can move on.

Joe Gordon:                       Exactly. The other trend we’re seeing now are in-house plans. Where dental practices are moving away from insurance companies and setting up their own pseudo insurance company in-house. There’s a number of companies that are doing that. We’re seeing this as push back against some of these. We’ve just seen where Delta Dental has dropped a lot of their plans, not allowing new dentists into their premiere plans, where they get a fairly reimbursement. We just think that trend’s going to continue.

Matt Scherer:                    Yeah, and I think you bring up a good point with Delta Dental. I saw it a lot when I was in the banking world in Michigan because of the heavy auto industry. Guys and gals that were Delta Premiere, they kind of got rid of it. It’s not necessarily gone, it’s just that the fee structure is a lot different. It’s more of a PPO program now than it was before. You might have had Delta Dental and maybe wrote of 10-15%. Now it’s a 20-30% write off. That ultimately affects your value, right?

Joe Gordon:                       Without a doubt. Without a doubt. Be very cognizant of what plans you accept, what plans you continue.

Matt Scherer:                    Absolutely. Definitely need to take a deeper dive into that. There are people that can help you. Again, I think the key is, don’t be afraid. If you do this exercise and a plan just doesn’t pay, get rid of it. And let your patients know, just be up front and honest. You’re there to make money.

Joe Gordon:                       Very true.

Matt Scherer:                    We appreciate your time today. We can certainly talk a little bit deeper about this subject, obviously. But we want to keep it a little short for you, and if you like us, please give us the thumbs up. And certainly share us with your colleagues and friends. Thanks for coming along.

Matt Scherer | PMA Practice Transitions | Ohio | Pennsylvania Published by Matthew Scherer on June 24, 2019