Unlock the PPO was founded on the commitment to add value to Established Practices by renegotiating the best possible insurance participation for our clients.  We can't stress enough how happy we are that you are here because we know you have all kinds of work on your plate running your practice. 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 immediate cash flow and longer-term profits you are already well ahead of the curve!  Most practices benefit from a renegotiation every couple of years. Focusing on this important issue as your practice changes can be the best opportunity to secure good fee schedules and we talk with far too many practices who regretted the initial fees they agreed to, often with no negotiations.

Note that it usually takes 90 days for negotiations.  Once you have accepted a contract and your application has been submitted it can take 3 weeks to 4 months to be considered in-network by the insurance company so start early! 

Plan well ahead so that you will be in-network with as many of your choices as possible we complete our engagement with your practice.  And also remember that it's better to be out-of-network for a short period of time than it is to accept an inferior fee schedule because you are making rushed decisions.

Want More Details About How We Work with Established Practices?

1. We do a third party fee analysis to help set your fees properly and discuss this with you during our first call.  We will need to submit a copy of your full fees to the insurance companies as part of the negotiations process.  If your fees are set too low it can impact negotiations.  If your fees are exceptionally high the insurance companies may assume your fees have been artificially inflated for the purposes of negotiations.  We want your fees to be set strategically to ensure the best negotiations outcome and will help you with our recommendations.

   One question we are commonly asked is if you can set your fees high at the beginning then lower them later. The answer is no, do not attempt to artificially inflate fees upfront thinking that you'll get better negotiations and then drop them later. When we are negotiating we are representing to the reps what your real fees are and reps will remember offices who tried to play the system when renegotiations roll around. Part of the reason we get good results for our clients is because we've developed a good reputation with reps for being strong advocates for the doctors we work with. This reputation always works in our client's best interest, both from a pure ROI standpoint as well as from a long-term relationship standpoint. There is too much money at state for the long run to risk putting any future increases at risk.  Start your contract off right with these carriers and then require them to live up to their end of the contract as well.

   During this first call we will also work with you to define your top codes that you want us to focus negotiations on.  We will provide a template to help guide the process but want to be sure that your top codes are a custom reflection of your new office so it will be tailored specifically to your practice.

2. We'll be doing a demographic analysis of your area to pinpoint largest employers and what corresponding dental insurance companies are tied to them.  What is an important insurance company to consider in one market will be different from another based on local employers.  Strategic decisions need to be made to choose the best mix of participation for your specific area.
3. We'll get you the credentialing paperwork to begin working on right away.  We want to get all of your documentation at the front end of the process so that any non-negotiable companies can be started right away and so that we can immediately submit your applications when you accept an offer.  This will keep the process moving as quickly as possible.  Remember to plan on 90-120 days to be in-network under your new tax ID number.
4. Let the renegotiations begin!  If you are currently an associate and your current office is in-network, that's ok.  Your new fee schedules will be tied to your new office and your tax ID number, not your associate position (with the exception of United Concordia which is tied to the dentist's name).  We will negotiate a customized fee schedule wherever possible so that we focus negotiations on the codes that will be the most relevant.
5. Once we have the best offers, have made our recommendations and you have made your final decisions we'll coordinate the paperwork, have you sign off and then we will let you know your effective dates to be considered in-network with each plan.
6. Copies of all final fee schedules and contracts will be placed in a permanent online account for you to access at any time.  We'll also send you a reminder of when you are eligible for the next round of negotiations so that you don't miss out on any future increases.

We have had many of our Established Practice clients tell us that our services went smoothly from beginning to end.  Our process is transparent and our goal is to share as much of our knowledge with you so that your Established Practice continues to thrive!

We are project-based so we charge a flat fee and do not take a percentage of the increases we obtain for you. We typically work with a practice for about 6 months, depending on your goals, but our process and fee includes everything from beginning to end.

Interested in learning more? Visit our Contact Us page and we’ll be happy to send you more details and pricing by email.