In this episode, the Insurance Untangled host and guest explore the viability of the PPO practice model for dental practices. Ben Tuinei discusses the financial challenges that PPO plans present, including lower payments and increased costs, which lead to significant write-offs. With his years of experience, he shares his evolving perspective on PPOs, emphasizing that while the fee-for-service model is more profitable, there are strategies to optimize PPO practices. These include better coding, leveraging non-covered services, and offering quality upgrades for additional patient fees. He also touches on hybrid models and the importance of understanding insurance dynamics to enhance profitability.
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Time stamps
- 00:02:29 – It’s no secret that many dentists are going out of network these days. Is that mostly due to the fact that the PPO practice model is not working?
- 00:04:31 – If the PPO model does work, what are you seeing successful practice owners do to be highly profitable even while taking 40% write-offs as an in-network provider?
- 00:08:48 – When you assess PPO practices that are actually performing very well from a profitability standpoint, are those practices missing out on any financial or billing/coding opportunities that you want to point out?
- 00:09:43 – What’s your advice for a dentist who is busy but does not yet want to go out of network? What type of assessment should such a dentist perform in order to find new revenue opportunities as a PPO provider?
- 00:17:28 – What resources do you have for our listeners regarding “Playing the PPO Game the Right Way?
Resources
