How to say goodbye to PPO’s without losing your patients?
Updated: Oct 29
In a time when insurance companies are making it impossible to provide quality care for your patients and keeping your doors open based on their fee schedules, I would like to share with you how to say goodbye to PPO’s and hello to patients that understand the value of your service you provide to them.
Learn what to do and what not to do to ensure you will not lose the patients who value the services you provide for them. If they are satisfied and happy, they will refer their friends and family.
Things to do and REMEMBER!
1. Your patients trust you and can be your biggest referral source.
2. Focus on the quality you want to provide and finding the patients who want that quality. They want to establish a dental relationship, not just a dentist/patient existence. They want to become a part of your dental family.
3. Have all of your team on the same page, be consistent in verbiage and education.
4. Focus on educating patients, not only on the treatment you recommend but how it benefits them that you are not in network.
5. This will take some time to do correctly. I recommend only doing one insurance every three to six months depending on the number of patients per insurance company.
6. If you maintain 34% of your current PPO patients as an out of network provider, you will continue to produce your current numbers. This will allow you time to schedule new patients who will start with you as their non-participating provider.
Things NOT to do:
1. Worry that you will not be able to survive without being a network provider.
2. Assume that your patients understand in or out of network benefits and how that affects them.
3. Don’t just send a letter letting your patients know that you are no longer a participating provider.
Where to START:
1. Know what it costs to do each of the top 25 procedures most commonly used in your practice.
2. Create a spreadsheet with all PPO plans using fees for the top 25 codes.
3. Decide which plan you want to terminated first.
4. Run a report showing patients per insurance company
5. Start by verifying 20% - 25% of the patients benefits as if you are an out of network provider. Be sure you verify plans that have different group numbers.
6. Schedule and hold a management meeting and discuss findings from the above.
7. Now you are ready! It generally takes 60 to 90 days to get an actual termination date after sending the insurance company a letter letting them know you are requesting a termination date. While you are waiting, continue to get the remaining patients for that companies out of network benefits.
8. While waiting, start calling your patients personally and letting them know about the upcoming changes and how the change will benefit them as a patient. Be prepared to answer questions about why you are going out of network. It is ok to tell them that you want to continue to provide them with the quality care they deserve along with providing the services with quality products.
9. Create a letter that is to send to patients giving them the official termination date.
10. Once you have the termination date, update the fee schedule and outstanding treatment plans to your office fees. Remember you will need to honor the negotiated rates until the termination date so you will have to do adjustments for patients who are scheduled before termination. The reason you update your fees before the term date is so that all new treatment plans given to the patient reflects your office rates.
11. Beginning on the termination date, update each patient’s insurance information to reflect the out of network benefits.
12. REMEMBER TO ALWAYS STAY FOCUSED AND SHARE WITH THE PATIENTS THE POSITIVE REASONS YOU ARE NO LONGER PARTICIPATING. NOW IT IS TIME TO START ENJOYING DOING THE TREATMENT YOUR PATIENTS WANT AND DESERVE AND NOT WHAT INSURANCE COMPANIES ALLOW.
Although you will have patients who call and say I know you do not take my insurance be sure to let them know you work with all plans that have out of network benefits.
If you have any questions for Carla, please feel free to reach out to her at firstname.lastname@example.org.