Managing Insurance for Higher Reimbursements
In 2024, the Health Policy Institute reported that 30.1% of dentists dropped out of some network insurance contracts. The same data reveals that 2 out of 5 dentists plan to drop out of some network insurance contracts in 2025.
Dentists consider several reasons to drop contracts:
- Low Reimbursement Rates: PPO contracts typically offer lower reimbursement rates than the actual cost of providing high-quality dental care. This leads to financial strain on dental practices. It’s common to write off 30-50% of the practice fee for participation.
- Increased Administrative Burden: Managing PPO contracts often involves significant administrative work, including dealing with insurance claims, denials, and paperwork, taking time away from patient care.
- Desire for Higher Quality Care: Dentists may feel the constraints of PPO contracts force them to use cheaper materials/labs or rush procedures to stay profitable, which can compromise the quality of care they provide.
- Greater Financial Independence: Dentists can set their own fees by dropping PPO contracts, allowing them to focus on providing the best possible care without being limited by insurance companies.
For many practices, the influx of network patients outweighs the negative impact, or the practice doesn’t feel empowered to make a change. The fear of losing patients can be overwhelming. Dropping a plan requires analysis and excellent verbal skills to maintain patient loyalty. Some practices aren’t sure they can pull it off.
Analyze Fees & Percentage of Patients on Each Plan
Before leaving a network contract, carefully analyze each fee schedule, weighted with frequency of code usage and network lease arrangements. Determine the number of patients on each plan.
Dropping a plan isn’t always the best solution, at least not immediately. Your practice must have a strong foundation that incorporates long-range treatment planning, excellent coding protocols, target marketing, and verbal scripting for the team. Practice Support Team (PST) recommends a careful analysis, evaluating restructuring and renegotiation options of contracted fees. Although network leasing isn’t typically advantageous for dentists, it can be leveraged to stay in-network by utilizing a higher leased fee schedule.
If it turns out a plan (or several) needs to be dropped, PST provides a 6-month plan designed to retain as many patients as possible in an out-of-network status.
Need Further Support?
Burkhart is dedicated to your success. PST offers a comprehensive PPO Impact Analysis for your practice. This service is complimentary for Supply Savings Guarantee and Platinum buying-level clients. For those who do not qualify, the analysis is available for $600, with an optional one-hour strategy session with one of our coaches for an additional $300 to help you achieve your personal goals.
Request your PPO Impact Analysis through your Account Manager or the Practice Support Team.
Your success is our success. Please reach out to us anytime.
To learn more, visit the Practice Support Team page, email us at PracticeSupportTeam@BurkhartDental.com, or call 1.800.665.5323.
Category: Practice Consulting
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