Don’t Let Your Employee Dental Perk Become a Headache

We recently visited with a doctor who had a long-term staff member leave due to a move. The doctor discovered, though, that through the years she had created a balance of over $5,400 for her family’s dentistry.

As with most doctors, he gave the employees and their family members a dental perk. Commonly it is 50% off and the patient pays lab. But the doctor didn’t collect the 50%! And, now it is very awkward to try to collect it. He probably won’t even try.

Lesson to Be Learned:

Go ahead and give your employees and their family members your dental perk but insist that whatever payments they have due are paid at the time of service. Otherwise, it could be very uncomfortable to try to collect that later.

There is much confusion regarding the Blue Cross Blue Shield plans that are now administered through United Concordia. If you are an out-of-network provider, here are a few things we think will help you:

The “Standard Plan” – This can be identified through a group number beginning with 10. You must click on the box of the claim form that authorizes the check but the check will go to the patient. Patient reimbursement is minimal (approximately $12 for a Prophy) have the same benefits out-of-network with this plan and the check will go to them. The patient pays your full fee.

The “Basic Plan” – Group numbers begin with 11 and there are no out-of-network benefits. However, we have heard from clients that Blue Cross Blue Shield will pay the first claim if a patient calls and complains. This is because Blue Cross did not notify patients of their relationship with United Concordia.

Credit Card Payments

Insurance companies are also sending payment via credit card such as “Quick Remit.” It is important to know that you are paying credit card fees every time you accept a payment with cards such as these. You are not required to accept credit cards and you can opt out. It seems it takes a number of phone calls to opt out, however, I recommend that you look at your credit card statements and identify how much it is costing you to accept these payments.

Three years ago there was one Pacific Dental office in the Twin Cities metro area. Now there are 12! More to come I’m sure.

Pacific Dental has over 275 practices in the Southwest U.S. and plans to add 50 practices per year across the country. Minnesota is one of their target states. Their practices are usually “Scratch Starts.”

It is interesting to note that they do lots of paid advertising through Google. And, as far as I know, most or all of the practices are located in a retail setting with good signage.

In fact, when you look at all the larger DSOs you see they are active with paid online advertising. We think there is a reason for that.

Google has basically replaced the Yellow Pages except it is a lot more hassle than writing a check to the Yellow Pages! Still, you have to have a presence there. You do not have to spend $2,000 or $3,000 per month for a “SEO” firm. It is a matter of having decent personalized content on your website and then paying Google! However, getting an AdWords campaign up and running can be complex—sort of like trying to assemble your own bicycle.

For our clients who want to experiment with online advertising, we can help you do it affordably. For $100s, not $1,000s, you can get up and running. We have seen that this can add to a practice’s online presence and new patient flow. Not double or triple it, but add to it.

A year ago we did a study in which we isolated the top 10% of practices with the highest numbers of new patients and the 10% with the lowest number. We found that those practices in the top 10% offices had facilities with high visibility in growth locations. Practices with good online presences—meaning having a decent website and positive Google reviews—were also in that top 10%.

Furthermore, the research showed that practices with expanded hours did well too. And, it helped to participate with some PPOs…but not too many!

You can see that with all of these factors, it helps to have experience\ on your side as you sort out what to do to keep your practice vital in the face of competition. That’s why we’re here.

Toward the end of 2016 Delta of Massachusetts announced that there was going to be a new, for profit Delta. The new Delta will basically offer the Delta PPO schedule only. The better paying (although still discounted) Delta Premier will fade away.

Doctors are told that if they don’t opt-in they will be out of the Delta networks and as the plans turn over, the checks will go to the patients.

For the typical Delta Premier Provider Dentist in Massachusetts this means that Delta write-offs will nearly double. I talked to doctors who will see their write-offs from Delta go from $250,000 per year to nearly half a million. Ouch! Apparently the new “For Profit” Delta will make its profits from squeezing dentists. That is why probably that at the Yankee Meeting, Delta actually had an armed guard at their booth. True!

As you probably know I have written and spoken a lot regarding PPOs. (FYI Dentaltown just released my “PPO Plays” CE: http://www.dentaltown.com/onlinece/category/2/practice-management. I also recently did a podcast with Ben Tuinei at http://advancedpracticemanagement.com/guest-audioseries/.) We are increasingly fielding calls about PPO concerns from dentists all over the country. Minnesota was one of the first to feel the sting of PPO write-offs, audits, etc. Insurance companies basically are creating a race to the bottom with their fees.

Now there are about a half dozen states that no longer offer Delta Premier. For example, if you buy a practice in California it will be considered a new “entity.” Even if you were/are a Premier dentist the practice has to now be on the PPO fee schedule. This affects practice values dramatically since the buyer will not have the same profit profile as the seller.

So the big question on everyone’s mind is . . . Will Delta PPO be the only Delta in the future?

One comfort, of sorts, is that apparently Delta is losing market share. Other insurance companies are taking a bigger cut of the market, so that is why Delta is putting pressure on their provider network. It would be good to see Delta’s “monopoly” diluted.

For many U.S. dentists, Delta is not as big a deal as it is in the Minneapolis/St. Paul area. Delta might be 20- 40% of the national market instead of 60-80%.

What Can You Do About This?

Smart management always puts the time and money where it can get the biggest return. We can do nothing about controlling the insurance market, but we will do all the things we can to make your practice strong so there is less compulsion to sign up for PPOs. Delta is not the only one nicking your bottom line.

As I said in an earlier Bulletin, it’s a matter of the right balance. Most practices will participate in some PPOs, but in my opinion very few practices should participate in all of them! Our research shows that at a certain point, additional PPOs just mean additional discounts, not additional new patient flow.

You have more power than you think. We’ve helped many dental practices successfully balance their PPO participation. If you are writing off over 25% of your production you are working the first 3 months of each year for free! It probably doesn’t have to be that way. Learn more! Contact Bill Rossi at 952- 921-3360 or bill@advancedpracticemanagement.com.