If you’re going to accept dental insurance in your office, there are things you need to have in place BEFORE you start seeing your first insurance patient.
Dental insurance is another important element in your dental practice startup checklist.
I wanted to bring this information to you in a video format, so I’ve created a three-part series on Getting Started With Dental Insurance – Before Opening the Doors to Your Office!
Continue to read forward for the video Transcript:
Welcome guys, This is Nilay Shah, your host with Dental Startup Academy.
We’re going to start off with our first topic, which will be a series of videos on Getting Started With Dental Insurance.
This is NOT going be a nitty-gritty detailed video on how to calculate copays, how deductible works, how maximums work, etc. –
But don’t worry, I will bring you those videos in the future, so be sure to tune into our channel.
For the first video in the series, I’m going to go over the very basics of dental insurance.
Specifically, we’re going to discuss what in-network vs out-of-network means. And how is it that you decide whether or not you should participate with certain plans and should opt out of certain plans.
For the second video in the series, we’re going to get into the credentialing process.
- When should you start enrolling with the plans?
- How does the process actually work?
- What documentation do you need to have together to get everything done?
And for the last video in the series, we’re going to get into all the things you need to have in place in order to start seeing your first set of insurance patients when you open the doors to your office.
So before deciding on enrolling with certain plans, let’s discuss the basic definition of what in-network and out-of-network means.
In-network means that you as the provider are agreeing to accept the allowable fees of the insurance plan and not charge the patient the difference between their fees and your private office fees.
So, basically when you decided to become an in-network provider, you are writing off the difference between what you charge and what the insurance has contracted with you for a particular service.
Out-of-network, on the other hand, means you can charge the patient the difference between what the insurance fee is and your private office fee is.
Why don’t we discuss this with an example.
Let’s say patient comes in and you’ve treatment planned him for a crown and let’s say they have MetLife and you are in-network with them.
So you’ve decided to accept the MetLife insurance fee for a crown as a full fee and not charge the patient the difference between your fee and their [insurance] fee.
Let’s say the MetLife in-network fee for a crown is $800. But your office fee non-insurance patient, or a UCR (Usual and Customary Fee) for a crown is $1100.
As an in-network dentist, you’re not allowed to charge the patient the difference which is $300.
So, you’re essentially writing off the $300.
As an out-of-network dentist, you are allowed to charge the patient the difference.
So, for example, for that $800 crown, if the patient has out-of-network benefits with MetLife and let’s say the insurance pays 50% of that $800, insurance will contribute $400 towards that crown and you are allowed to charge the patient the difference between $1100 (which is your fee) and what the insurance reimbursement is ($400).
So essentially, you are allowed to charge the patient the $700.
How do you decide which plans to enroll with?
So now that I’ve gone over the difference between in-network vs. out-of-network, let’s go into the discussion of how do you decide which plans to enroll with.
You have to look at your competition.
Now, wherever your office is, look at the nearest offices around you and figure out which plans they accept.
When I was going through the startup journey while my office was being built, what I did was I called up the ten nearest offices.
And I basically pretended to be a potential patient, and I found out that some of the offices did not accept some of the major PPOs such as Aetna, Delta and Cigna.
Now, two and a half years later into my startup, I cannot imagine not accepting those plans.
In fact, I added on other well paying Unions that we had not heard of when we started out.
So what plans should you start enrolling with?
My advice would be to start with as many PPOs as possible just to get yourself busier to buildup that initial patient base.
Eventually as you get busier, you can analyze your numbers and opt out of plans that don’t work for you.
Initially I accepted an extremely low paying fee schedule, but after being on that plan for one year, we made a list of all the patients that were referred by those patients and we realized that majority of the patients that were referred had relatively well paying plans.
So I was glad to stay on that low paying plan for that period of one year.
The amount of production that was written off by staying on that low paying plan was well worth the number of new patients we gained in that period.
Now that I’m busier, we’re no longer opted-in to that plan.
So, it is a decision that you have to make for your office as you get busier.
So, I hope by now you kind of understand what plans you need to start enrolling with.
By looking at your competition, calling up the offices around you, going through their websites –
And that’s what we’re going to get into as part of our second video in this series of Getting started With Dental Insurance – Before Opening the Doors to Your Office.
So in the mean time, leave any comments or questions you may have below this video and we’ll see you next time.
Thanks for watching guys. Take care!