Established Practices Tour

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PPO Contract Negotiation & Credentialing FAQs for Dentists

Unlock The PPO was founded on the commitment to add value to the privately owned dental practice by negotiating the best possible insurance participation for our clients with a focus on PPO strategy in a fast moving industry. Understanding the difference between direct contracts and shared network agreements is now an important part of your insurance strategy. Education on blending the best fit for your office, as well as knowing when it’s time to get out of plans, is critical. We will help you quantify the impact of improving the performance of your PPO contracts. By looking ahead to the impact insurance participation will have on your cash flow and longer-term profits, you are already well ahead of the curve. We talk with far too many practices who regret the initial fees they agreed to, often with no negotiations. The good news is that by reviewing strategy changes, you have the ability to re-evaluate your contracting for better positioning.

We work with privately owned practices with no more than one location and we do not work with practice purchases/transitions or large group/DSOs.

Want More Details About How We Work with Established Practices?

1.

We do a third party fee analysis so you can evaluate your current cash fees alongside of average fees in your area. This allows you to make any fee adjustments at the beginning of the process before we begin negotiations.
2.

We have a personal “Analysis Call” to review all of your current PPO fees on your top codes. We review the impact the insurance companies are having on your practice currently as our starting point.
3.

Negotiations will be underway where we are working on trying to get your current contracts increased while also getting new offers that may provide higher alternative fee schedules.
4.

We have a second call to review final offers where we run a side by side comparison on new offers and yearly profit increases with all of your options so you can make final decisions.
5.

We will coordinate or supply any necessary paperwork and save a copy of all final paperwork and fee schedules in a permanent online account for you to access at any time.

Testimonials

For more feedback about our services

Dr. Robert Davis – Greenville

North Carolina

Great service and attention to detail. The Unlock team was fabulous in every way and helped to navigate a generally confusing part of starting up a dental practice. I would have been lost in the insurance world without them!

Dr. Jennifer Lumbley, Flowood

Mississippi

Sandi and her entire staff at Unlock The PPO have been so wonderful throughout this journey. They have given me a wealth of information about how the insurance negotiating process works. We have received amazing results. The only thing I regret is not contacting them years ago. ”2024”

Dr. John Lee Jr. – Chino Hills

California

Sandi and her team are pros. They are extremely knowledgeable, efficient and excellent to work with. Their services were worth every penny and I’m so glad to have had their help.

Dr. Levon Sukiasian – Massapequa

New York

The entire team was knowledgeable, efficient, extremely helpful and made the process stress free. They were always available to answer my questions and give their advice. I would highly recommend their services and would definitely work with them in the future.

Dr. Haitham Wehbe & Dr. Ahmad Muhieddine – Manvel

Texas

Dealing with insurance companies can be very challenging. Unlock the PPO helped make this challenge less daunting.” 2024

Dr. Chad Biggio – Baton Rouge

Louisiana

Unlock the PPO was a great experience. They are very knowledgeable and helpful throughout the process. Their negotiations helped me get close to 25% increase in fees with certain plans. Highly recommend.

Dr. Earl Spader – Tucson

Arizona

The team at Unlock the PPO met all of our expectations and more! They made the whole process very easy to comprehend and we are very glad we chose them for our insurance navigation and negotiations.

Dr. Michael Lysonski – Edgewood

Minnesota

Working with you exceeded expectations-great timelines and attention to detail… and results!

Dr. Yamini Gollapudi – Oak Point

Texas

We have a start-up and Lisa was very helpful to set up UCR fee and negotiating with insurance fee schedule. I would highly recommend. ”2024”

Dr. Justin Tarver – Monroe

Louisiana

We worked with Unlock The PPO beginning in January 2022. They were great to work with and helped us significantly improve reimbursement from insurance companies. I would highly recommend them.

Frequently Asked Questions

Although it varies, most companies that negotiate will allow a fee review once every 24 months. This does not guarantee a fee increase at that time but you should attempt negotiations every opportunity you are allowed to submit for a review.

The negotiation process typically takes about 90 days after submittal, but we work with most clients about 6-8 months in total. The process includes a cash fee analysis for your zip code, the initial PPO analysis, negotiations, presentation of final offers, submitting the paperwork and confirming the effective dates.

We globally look at all of your PPO strategy. Fee schedule increase requests and negotiations are a part of that process but understanding shared network agreements, education about the ones that are beneficial or harmful and guiding overall PPO selection is where our bigger value is at. Understanding the impact insurance companies are having on your practice and guidance to get the right fit for your situation is where our expertise goes beyond just negotiations.

If your insurance reimbursements don’t cover your overhead, you may be losing money on key procedures. Our analysis compares your current contracts, as well as all new offers, to your cash fees to easily see what fee schedules may not be workable and help guide you on the right mix of PPOs for your practice’s chosen business model.

We have a money back guarantee that states we’ll find you yearly increase estimates options with your current contracts that would cover the cost of our package the first year or we refund the difference. This applies to established offices that are doing our renegotiation package (not FFS/start up packages adding plans for the first time).

It depends on several factors including how many providers there are in your area, how badly the insurance company needs to retain you and volume of production you may be doing with that company. We assume Delta to be non negotiable. We can prepare a request to be sent for Delta as there can be rare exceptions but we do not want anyone to specifically hire us to negotiate with Delta.

We can often help identify renegotiation opportunities to improve fee schedules before considering termination. If you are too busy and are considering reducing PPO participation, we provide all necessary termination and opt out paperwork to remain out of network.

It’s common for offices to reach out to us after being overwhelmed about their current contracting, mainly due to the expansion of shared network agreements. If you are not sure how you are getting paid currently, we’ll have you send us sample EOBs in a HIPAA compliant format to help map out our starting point and get you to a place you can understand your contracting going forward.

Each office we work with is unique. Some offices may be too busy and need to trim some PPOs. Other offices are looking for growth through potential added insurance participation. We want to find the best fit for your office by carefully analyzing your current participation, giving profit estimates if you were to drop plans or new write off estimates if you were to add plans. You’ll be able to see hard numbers before making any decisions about changing participation so we find the right options for your practice.

We work exclusively with privately owned dental practices (no large groups or DSOs), offering one-on-one strategic PPO planning. You work directly with experienced industry professionals, not automated systems or junior consultants.