July 28, 2020

Many offices are rethinking their involvement with PPO dental plans. Are you one of them?

You may be an office that has a sign “We accept ALL Dental PPO Insurance Carriers,” or you may accept only a few PPO plans. Whatever the case may be, this article will help you know what to do with your dental platform if you choose to end your involvement with some or all of your carriers.

Dentrix Ascend offers you many sources of information if you are thinking about eliminating your practice’s involvement with dental PPO insurance carriers. You can run reports based on PPO insurance carriers and plans, new patient numbers based on these insurance carriers, and, perhaps most importantly, what collection numbers these carriers produce. This article focuses on what you should do after you choose to eliminate these carriers.

Notify the Patients
Call patients or send letters to inform them of your decision to no longer be a participating provider with their dental insurance network. Be very cautious with how you convey this information to your patients since many insurance carriers offer an out-of-network benefit that may not have a downside to the patient if they continue services with you. This is another topic for a later date.

Rename the Carrier
Insurance information once attached to your patient should remain with the account. Dentrix Ascend allows you to end coverage with a certain date cutoff; look at the insurance carriers/plans to see when coverages start and end for your patients. Once you attach an insurance carrier to a patient, even if the coverage has ended, you will not be able to delete the carrier in Ascend. You can, however, edit the name of the plan. I would choose a name that would indicate to your team members that the plan will no longer be used; for example, Do Not Use Dental Plan Name.

Rename the Fee Schedule
Fee Schedules once attached to an insurance carrier also remain in Ascend. This will have no effect in other areas once you are not using the insurance carrier to which the fee schedule is attached, but you should rename the fee schedule so it doesn’t accidentally get used. Edit the fee schedule name to something like “Z (PPO Dental Plan Name)”. Placing the “Z” in front of the name sorts it to the bottom of your Fee Schedule list.

Remove the “Contracted With” Connection
Update the location record (billing entities) and user accounts of the providers to remove their connection to the PPO insurance carriers.

Keep Notes
Record any correspondence you have with the patients whose PPO carrier you eliminated. You may choose to scan a document to the Document Manager, record a patient note, or include a notification to alert other team members of this interaction with your patients.

Involve the Team
Choosing to eliminate a PPO from your practice does not come lightly. There can be many issues and complications associated with this decision. Educating your team is key to making this transition successful. Their education should include a script for talking to patients and new SOPs at the least. Set aside time for distraction-free training and allow some time for hands-on practice. Let team members ask questions to ease their mind regarding this new way of not accepting a PPO insurance carrier.

 

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