863: Want to Drop a Few PPOs? Here is What You Should Consider – Sandi Hudson

Are you overwhelmed trying to navigate PPOs? Then keep listening! In this episode of Practical Solutions Day, Kirk Behrendt brings back Sandi Hudson, founder of Unlock the PPO, to decode some of the biggest challenges when dropping PPOs. You didn't go to dental school to deal with insurance. Let the experts do it for you! To learn more about Sandi’s company and the key things to consider before dropping PPOs, listen to Episode 863 of The Best Practices Show!Learn More About Sandi:Join Sandi on Facebook: https://www.facebook.com/UnlockThePPOFollow Sandi on Instagram: https://www.instagram.com/unlocktheppoLearn more about Unlock the PPO: https://unlocktheppo.comLearn More About ACT Dental:ACT’s webinars: https://www.actdental.com/135ACT’s website: https://www.actdental.comACT’s Instagram: https://www.instagram.com/actdentalACT’s YouTube: https://www.youtube.com/actdentalACT’s Facebook: https://www.facebook.com/actdentalACT’s LinkedIn: https://www.linkedin.com/company/3137520/admin/feed/posts/ACT’s Twitter: https://twitter.com/actdentalMore Helpful Links for a Better Practice & a Better Life:Subscribe to The Best Practices Show: https://the-best-practices-show.captivate.fm/listenJoin The Best Practices Association: https://www.actdental.com/bpaDownload ACT’s BPA app on the Apple App Store: https://apps.apple.com/us/app/best-practices-association/id6738960360Download ACT’s BPA app on the Google Play Store: https://play.google.com/store/apps/details?id=com.actdental.join&hl=en_USJoin ACT’s To The Top Study Club: https://www.actdental.com/tttSee the ACT Dental/BPA Live Event Schedule: https://www.actdental.com/eventGet The Best Practices Magazine for free: https://www.actdental.com/magazinePlease leave us a review on the podcast: https://podcasts.apple.com/us/podcast/the-best-practices-show-with-kirk-behrendt/id1223838218Main Takeaways:Fee-for-service dentistry is more alive than ever.Understand how shared network agreements work.It’s not just you — this topic is overwhelming for all practices.Think about the direction of your practice before dropping PPOs.Don't be passive when signing contracts. Know what you're agreeing to.Audit your EOBs at least once a month and know what should be coming in.Be patient when trying to negotiate with reps. It may take months for a response.Pay attention to letters from insurance, even when they don't seem relevant to you.Quotes:“Delta is the only major company left where it's a standalone contract. But pretty much everybody else has multiple shared network agreements with other companies. So, it's no longer just who do you sign a contract with, or who do you want to be in-network with? It's understanding for whatever I signed, what else comes along with that? What else am I agreeing to? And the way this all should be said is, there should have to be permission given for a dentist to be opted into these shared network agreements. Unfortunately, it's the reverse. You're automatically opted in, and the burden is on you to opt out. So, you can't really be passive about it and assume that, ‘Well, I didn't know about that. I never signed anything, so it must not affect me.’ It's the opposite. Nobody is asking your permission anymore. It's, here's this new agreement. You can probably opt out of it if you want to, but you're going to have to be the one that takes the initiative to opt out if it's not the right fit for your office.” (6:36—7:39) -Sandi“I say to a lot of offices it's kind of like Jenga. You're plugging in this game of, what does this all mean? What things affect me in a good way versus a bad way? How do I agree to the things that might actually be beneficial for me, and how do I get myself out of the things that are not? That part has all changed. Five years ago, we still saw a lot of shared network agreement changes coming. But ten years ago was completely different than what we're looking at now. So, for offices who are actually trying to see patients, they didn't go to dental school to deal with all of these intricacies of contracting. So, to have the time to map this all out where you're trying to take care of patients and actually deliver dentistry, this has become its own subset to such a degree that it's very difficult to manage alongside of patient care. It's a lot.” (7:41—8:41) -Sandi“The reality is it's overwhelming for everybody, these shared network agreements. Not just the dentist’s side, but the reps on the other side who work for the insurance companies are dealing with it all on their end of things. And honestly, we've had great relationships with a lot of insurance company reps for a long time. There really are some great people on the other side of the table. But one of the things that I think has come along with some of these changes is the individual reps who used to have a lot of discretion in their market no longer have that discretion the same way. So, they're having to go up the ladder. An extra one or two percent is going to require somebody else to approve it. It's going to have to go to management. There are more layers as opposed to just being able to go directly to a person and have some resolution in a couple of weeks. We've got multiple companies right now where it's three or four months that it's taking us to get negotiations wrapped up. So, this is not a thing where you call, and if they don't call you back, you throw up your hands. You've got to be persistent and know it's going to take a few months to even get a response sometimes, to get somebody who can do the negotiation piece. It really is an ongoing project now. So, there is some agreeableness out there. It's just staying at it and being very persistent until you hear back.” (10:03—11:29) -Sandi“A lot of it will depend on your market. Sometimes, I know it's frustrating. Somebody will say, ‘Hey, I know this company is non-negotiable, but I got a great deal,’ which is awesome, and we love to hear that. The reality is that — and I speak for us on this too — it's not necessarily that we're all amazing negotiators in that. Of course, we know what we're going after. We know the market and we know what the top codes are. We're going after very targeted negotiations. But the reality is also, how much do they need you in your market? If it happens to be a time where maybe a new employer group has jumped on board and they don't have enough providers in your area, that might open up some opportunity. So, there is a piece of it that really is specific to the demographic that you're in, and do they need you more than you need them, kind of a situation. But we are seeing it loosen a bit in some markets.” (11:31—12:25) -Sandi“What's the direction of your practice? There are a lot of ways to do dentistry successfully in terms of business models. So, there's not a one-size-fits-all approach by any means. But I do think it's important for each dentist to think about things like — some dentists don't like marketing at all. They don't want to market. They don't want to think about marketing. So, PPOs may fill a little bit more of a gap for those practices where they're thinking, ‘I'd rather have a flow of patients coming in continually, even if I'm taking a little bit less for it. It takes the burden off of me for marketing externally more.’ Other practices, dentists really like that, and they are going after a different business model. We're seeing more where not everything is hygiene driven — dentists who are marketing more to say, ‘I'm not going to rely on the new patient flow coming through hygiene to feed my schedule. I'm going to go after more specialty procedures as the end result.’ So, hygiene is maybe not quite the same piece of the practice the way it has been in a more traditional business...