Among the various dental insurance options, three of the most popular ones are the PPO (Preferred Provider Organization), HMO (Health Maintenance Organization), and indemnity plans. As your practice considers whether to accept these types of insurance, you should speak with knowledgeable legal counsel about negotiating the most favorable terms.
Mahan Dental Law is ready to work with you. We help dental practices understand the implications of different insurance plans and work to negotiate the most favorable contracts. Learn more about how we can assist you with PPOs, HMOs, and indemnity plans.
Comparing the Three Options
There are many insurance options available to dental practices, and even non-insurance plans that may serve the needs of your patients. Three of the most popular types of insurance are:
- PPO (Preferred Provider Organization): Dentists who participate in a PPO agree with the insurer to reduce their patient fees in return for joining the insurance network. This gives the dentist access to a potentially large pool of patients who have the flexibility of choosing their providers.
- HMO (Health Maintenance Organization): The typical HMO arrangement provides dentists with a fixed monthly capitation payment for each patient that is enrolled in the HMO, regardless of the number of services that are provided to the patients.
- Indemnity Plans: Under an indemnity plan, a patient will pay for services upfront and receive reimbursement from the insurance company. Meanwhile, dentists set their own fee schedules without network restrictions.
How We Help With Drafting Your Dental Insurance Contracts
Many dentists don’t realize that they can negotiate their insurance contracts, a process that you should undertake to ensure you reach the best possible deal with your insurer. Our law firm can assist you with the following matters:
- Reviewing your existing operations: You will not be able to understand how to negotiate the best possible insurance contract if you don’t fully understand your existing operations and how insurance may play into them. For instance, you need to know about your practice’s UCR (usual, customary, and reasonable) and office fees so you can compare them to the insurance company’s proposed fee schedule.
- Examining the details of the policy: Do your homework on the proposed policy from your insurance company, and be prepared to negotiate. Having an attorney is vital for this step because you will likely encounter terms and clauses you do not understand. Far too many dentists overlook the details of contractual language, only to have their lack of understanding cost them money in the long run.
- Drafting and negotiating with the insurer: Your lawyer can help you draft a suitable insurance contract that represents your best interests and protects your finances. As you negotiate with the insurance company, you will want to present a strong case for each of the terms and clauses you request. We can help you determine which terms you must have and those which are negotiable.
- Discussing your ongoing legal obligations: After successfully drafting and executing your insurance contract, you can begin accepting patients who participate in the PPO, HMO, or indemnity plan. However, you will want to ensure that you do not unintentionally breach the contact and that you hold the insurer liable if they breach. We can explain your legal rights and duties moving forward.
Count On Mahan Dental Law for Your Insurance and Legal Needs
Dental practices throughout the country rely on Mahan Dental Law to help them effectively negotiate and draft insurance contracts that allow them to maximize profits while minimizing legal problems. We’re ready to assist with your PPO, HMO, or indemnity plan contract today. Call us or complete our online contact form to get started.
