Reducing managed care (PPO) fee discounts is one of doctors’ biggest management concerns. Since Delta Dental has the largest dental network by far, your practice’s status with them is critical. Below, practice management expert Bill Rossi* outlines how you can potentially add thousands in increased profits by making the right moves.
Over 85% of general dentists participate with Delta Premier, which is still Delta Dental’s largest network. Over half of the dentists in the United States are also with the Delta PPO. They are “Premier/PPO Providers,” and the fee allowances paid to these dentists default to the lower PPO rate.
If you are a Delta Premier/PPO provider, you need to seriously evaluate your situation. You may be able to gain tens of thousands of dollars per year by dropping your Delta PPO participation and becoming a “Regular” Delta Premier Provider.
Most of your Delta PPO patients will still have the same benefit set (100% coverage on preventative, 80% restorative, 50% major, etc.) because their plan will default to the “Premier” level of benefits. Making this change means you can collect 10%-20% more for treating the same patients.
For example, in our area the average fee for a D2740 crown is about $1,300, while the Delta Premier Provider fee allowance is $967. The Delta PPO reimburses providers for the same crown at a fee of only $864, over $100 less!
While there’s approximately a 25%-35% fee discount for “Regular” Delta Premier, the discount for Delta PPO is in the 35%-45% range. Our experience is that the additional PPO discounts don’t translate into proportionately more patients attracted or retained.
Most doctors assume Delta is phasing out its Premier program and, therefore, its providers. That’s true in some areas, but in many states it isn’t over yet! It’s been our experience that transitioning from Delta PPO to Delta Premier is a relatively smooth process and can add tens of thousands of dollars per year to your bottom line. So make the switch while you can!
You may not be clear on your Delta status or options, so take the following steps now:
- Contact Delta Provider Relations to confirm your Delta status. If you’re only with “Delta Premier” that’s good. If you’re participating with Delta at all, that’s where you want to be.
- Are you both Delta Premier and PPO? Then you likely can add substantially to your bottom line by switching to Premier only, as described above.
- Compare the PPO to Premier benefit sets for the largest employers in your area. You’ll find that in most cases, the benefit sets are the same. However, in some cases, the PPO to Premier benefits vary (for example, from 100% to 80% coverage on preventative).Some PPO plans have no Premier benefits. You’ll likely lose those patients. However, many times patients have the option to upgrade their Delta plan so they can go to the “dentist of their choice” – you! Or, they have the option to choose other dental insurance through their employer which offers better coverage in your office.
PPO decisions should only be made in the context of your particular practice situation. In any PPO transition, there will be some loss of patients. So prepare yourself psychologically for this loss in advance. However, if you handle it correctly, the loss will usually be far less than you fear.
It’s interesting that when we make a consulting visit to an office participating with Delta Premier, they usually have plenty of Delta patients, even when they are surrounded by other practices that participate with the Delta PPO. Many doctors are unaware that their patients have incentives to go to a Premier/PPO office.
This confirms that once you’ve made the transition to a regular Delta Premier Provider, it’s pretty easy. While the transition may seem scary, it won’t be if you plan for it properly.
* For more information on managing PPO participation and other practice management services, contact Rossi at 952.921.3360, or online at Advanced Practice Management.