Fee Schedule Negotiations Part 1

Sitting down at the end of the month to analyze the total PPO write-offs can be so depressing it’s tempting to stick your head in the sand and not even look at the number. The first thought coming to your mind may be how great it will be when the day arrives that you can drop it totally. Until that day happens, first be sure that you are negotiating the best fee schedule possible. People often coast along with a crappy fee schedule not realizing that they may be able to negotiate.

How do you know when you can negotiate? There’s different rules depending on the plan and your location but here’s a few generalities that I’m seeing in the industry which may be helpful for you to know. Many companies will only negotiate once every 2 years so it’s important to keep a filing system to know when you are up for renewal. After you negotiate it often takes 30 days for them to make the new fee schedule effective so call them before you are due, not on the due date. Remember that you will be stuck with this fee schedule for another 2 years so look ahead to your practice goals. If you are in the process of adding Invisalign or implants be sure you focus on those procedure codes as these are often fees that get lowballed on fee schedules. Many companies also will not negotiate an entire fee schedule any more, they will allow a limited number of codes (I often see 25 as the limit) that you can focus on. Be very sure you are choosing your codes carefully! Remember it’s not just big ticket procedures like crowns to focus on but also ones that have the most frequency like prophies and exams.

I have yet to figure out why many insurance companies make it so difficult to assign a rep to your office so you have an actual person to call. A few companies still do assign a rep and I have found that by far they are faster and more accommodating with fee schedules than the ones who do not. One company in our area will only accept fee schedule increase requests by fax then they review and get back to you. In other words, it is sometimes time consuming work to track down a person so don’t get discouraged.

Some companies do not negotiate at all. If an insurance company has enough providers in your area they may give you a “take it or leave it” option only (these are the ones at the top of my list to drop). These plans are often the plans that are costing you the most.

Don’t feel bad if your first thought is “I have no idea which plans are costing me the most”. That’s what we are here for. For a complimentary phone consult just give Sandi a call at 303-204-9515 or visit our Contact Us page.