Dental Insurance: How to Build Your Personal Insurance Profile

dentist conducting dental check upNegotiating dental insurance contracts isn’t always successful for dentists. It’s difficult to prove that you deserve a higher insurance reimbursement rates from the connections and services you offer. This is why building a personal insurance profile is important – because it helps build your case. Here’s a short guide to help you:

Insurance Plan Contracts

Identify all the insurance plans you’re part of, either through direct connections or those that fall under shared networks. Trace the date you started with each Preferred Provider Organization (PPO) and list the plans you’re required to be in, but don’t have direct contract. List all the insurance carriers you’ve transacted with, including their contact information.

Out-of-Network vs. New PPO Contract

Find out if being out-of-network with specific PPO plans is making you gain or lose patients. Depending on your area of practice, it’s ideal to define customer preferences. Many patients worry about out-of-network co-pays, so you need to be sensitive about their financial needs. Applying for another PPO contract is advisable for a new practice because you’ll get new patients from major employers.

Shared Network Options

Dental insurance contract negotiations won’t always go your way. There are instances when you’ll be required to be in-network with PPO plans under shared or umbrella dental networks. Decide if you’ll join or opt-out of these indirect PPO contracts. Some dentists consider their profits before making a decision.

Dental Procedure Codes

List the top procedures you perform that gives you the most stable income. Negotiation strategies are important because insurance carriers can increase codes, even those that don’t carry much weight in your practice. In fact, they might even offer an alternative benefit to make your reimbursement even smaller. Focus only on those that make money and nothing else.

A good insurance profile is an effective strategy that’ll help you convince insurance carriers. Follow the procedures mentioned above to get your well-deserved reimbursement.


About the Author

As a psychology professor at a university in Texas. Athrun also teaches at a personality development institute in the same state.