“Should I join a dental PPO?” is a question many dentists ask. Deciding whether joining a preferred provider organization (PPO) makes business sense for your dental practice can be difficult. Understanding the pros and cons of joining a dental PPO can help you make an informed, strategic decision.
Once you sign a PPO agreement, you will be bound by the payment terms unless you can renegotiate the contract terms. Negotiating the terms before you sign the agreement is important. Speaking to a dental attorney can help you make an informed decision.
Pro: Referrals and New Patients
When a dental practice becomes an in-network provider, it will be listed in the payer’s online directory. Your dental practice could enjoy a relatively steady flow of new patients who are plan members. The costs of out-of-pocket dental services continue to increase.
As a result, consumers are more likely to look for in-network providers to minimize their costs as much as possible. Many patients will avoid dental practices that don’t accept their insurance. If you join a dental PPO, stating which insurance plans you accept on your website will help you attract more in-network patients.
Pro: PPO Contracts Can Be Negotiable
Before you sign a PPO network agreement, you’ll benefit from speaking to an attorney about the contract terms. Insurance contracts usually aren’t set in stone. An experienced attorney may be able to negotiate better terms for your dental practice. For example, you may negotiate for more robust options for appealing decisions made by the payer. You may be able to ask for rate increases every year, if not more frequently.
Pro: Easier Payment and Administration
Predictable reimbursement is another important benefit of joining a dental PPO. After you sign a contract, being an in-network provider usually simplifies the process of filing claims. For many dental offices, reimbursement has become more predictable, helping with cash flow management.
Some PPOs provide more support, especially when resolving administration issues. Many payers will assign a representative to an in-network dental provider tasked with addressing issues as they arise. If you have a small administrative staff at your dental office, easier administration can be extremely helpful.
Con: a PPO May Not Make Financial Sense
When deciding whether to join a dental PPO, reviewing the contract terms carefully and with great attention to detail is important. Joining a PPO may not make financial sense for your dental practice. For example, you may have calculated how much profit you need to make to succeed financially. If you join a PPO, your profit margin could be significantly reduced or even eliminated.
Con: Increased Patient Flow Isn’t Guaranteed
Although you may experience referrals that create a greater patient volume, the increased volume may not be enough to continue making a profit. When considering the financial pros and cons, you should analyze the minimum amount you can accept for dental services as an in-network provider to maintain profitability. You determined that joining a PPO would significantly hurt your profitability in the long run.
Contact a Dental Attorney Today
Deciding whether to join a dental PPO is an important decision. One of the best ways to understand how joining a PPO will affect your dental practice is to work with an experienced attorney. The attorneys at Mahan Dental Law will carefully review the proposed contract for you and help you determine whether joining a PPO makes sense, legally and financially. Don’t hesitate to contact Mahan Dental Law today to schedule a complimentary case evaluation.
