How To Drop a PPO Dental Insurance Plan

Dental Staff Training: Dental Insurance

Have you been thinking about dropping one of your PPO plans because you just can’t take their reduced fee schedule any Managing Dental Insurancelonger?

There is a way to handle this properly. You want to let your patients know about your decision – and you want to help them understand why you’re dropping their plan. You want to extend the opportunity to continue their dental care in your practice – even if it is on an out-of-network basis. And, you need to understand the financial and schedule implications this decision will have on your bottom line.

Reports to run in Dentrix

First of all, before you drop anything – you need to run a few reports so you can see how many patients have this insurance. Realistically, you only care about your active patients with this plan – if you haven’t seen them in over 2 years, they may have had insurance changes of their own or perhaps have moved or found a new dentist. Beyond the volume of patients, you also want to take a look at the collections you’ve received from this plan.

Insurance Carrier Report

  1.  Office Manager
  2. Reports
  3. Reference
  4. Insurance carrier list – select the insurance plan you’re considering dropping
  5. Checkmark Standard list and Include subscribers
  6. This report will show you the employer and patients with this insurance.
  7. You cannot see the patients last visit dates though- so you can either check the ledger or . . .

Office Manager List

You can run a specific lookup to find patients with this insurance plan and a last visit date within the last two years.

  1. Office Manager
  2. Letters
  3. Select a report to work with  and Edit
  4. Patient Filters: Last visit dates for the last 2 years, Dental insurance – enter the PPO you’re planning to drop
  5. In Data fields: choose Patient name & address info, Employer, Dental insurance name, Balance and recall date
  6. Run Data File only
  7. Paste into excel

From either of these lists you can see how many patients will be affected by your decision to drop this plan.

Next, you want to find out how much you have collected for this insurance plan to determine the financial impact.

Payment Summary Report

  1. Office Manager
  2. Click on the Practice Analysis icon
  3. Choose Reports
  4. Select the date range – I would look at year to date, I would also run this report for the year prior as well just to see 2 years worth of collections.
  5. Checkmark Payment Summary only – we’re looking for collections, not production
  6. Finally, select the billing types that match the insurance plan you’re considering dropping

This will show you how much you’ve collected on this plan.

Now that you know how many patients are affected and how much collections you stand to lose – do you still want to drop the plan? If so, then your next step is to create a letter to let these patients know about your decision so you can try to keep as many as possible in your practice.

Send a letter to patients

Once you’re confirmed that you’re dropping this plan, then its time to create a letter to send to these active patients. The letter should cover the following information:

  • Start out letting them know that you understand that they work for “x” employer and they have “y” insurance (maybe their employer just changed plans last week!)
  • You have decided to drop your membership in this plan
  • The patient & family are welcome to continue to come to your practice, and this will be on an out-of-network basis
  • Explain why you’re dropping the plan – you just cannot continue to offer the quality your patients expect at this fee schedule
  • Clarify how this will affect the patient – say what you will continue to do for the patient, such as filing their claims and providing excellent care
  • Share real numbers – give them the cost of a prophy/exam at standard fee, and if you can find out how much the plan will pay for out-of-network, then share that number and then do the math so the patient can see how much she will pay out of pocket.
  • Let your patients know about any financing programs you offer should they need significant treatment
  • Confirm their next due date and ask them to call in to schedule and offer to answer any questions

Be sure to provide your front desk team with a copy of this letter and encourage them to practice explaining your decision to drop this insurance plan.

Results of dropping a dental insurance plan

Expect to lose some of these patients. Hopefully, you will also retain some as well. These results will give you excellent feedback on how strong your relationship is with these patients – and do they feel you are providing enough value that they are willing to pay you some out of pocket expense to stick with your practice rather than find a new dentist on their plan?

As our patients continue to follow their insurance plans wherever they may lead, a dentist’s challenge is to provide value and communicate that value to her patients so that people will stay with a dentist even on an out-of-network basis. Starting today, ask your hygienists to begin conversations with patients about what they need and want in their dental practice – what keeps them coming back while the insurance covers the cost? Find out how you can strengthen these relationships so that if another dental insurance company continues to reduce their fees and you need to drop another plan, you have already established strong ties with these patients and you have a much better chance of retaining them in the long run.

Managing dental insurance is just one way to run a successful dental practice. If you’re interested in new ideas on running a dental practice, please subscribe to my weekly blog. One of the biggest challenges to managing a dental practice is managing dental insurance. With dental insurance handled, then dental marketing for new patients becomes a primary focus. In today’s day of online reviews, handling patient complaints well is essential. As your practice grows, hiring dental staff becomes more important. With 16+ years of dental practice management experience, I’m open to your questions to help you run a successful dental office.

Feel free to email me.

AUTHOR: Jill Nesbitt
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