Dental Insurance Contracts

When you started your career as a dentist, you may not have known just how much you would be required to learn about dental insurance plans. As a private practitioner, you not only are responsible for providing quality care to your patient to ensure their oral health, but also managing a growing volume of insurance companies and their preferred provider organization (PPO) networks. Becoming a member of these networks can help you build and maintain a larger volume of patients, but it also means you have to negotiate dental insurance contracts that stipulate how much you will make on each procedure.

Learning How Insurance Companies Set Fees

One of the first lessons to learn is how dental insurance companies set their fee schedules for reimbursement rates. When you set your fees, you probably determine how long the procedure takes, while taking into account all the expenses you have to run the office, including staffing costs, equipment costs, and other overhead costs. You may also look at what other dentists in the area charge for the same procedure, and set your fees accordingly.

With insurance providers, there is no standard that they all follow to determine reimbursement rates, which means they can vary significantly from one provider to another. They often employ a very subjective evaluation tool called “UCR”, which stands for usual, customary, and reasonable fees. Generally speaking, this breaks down into:

  • “Usual” fees are the amounts that an individual dentist charges for a specific procedure that is commonly performed in the dental offices in your area.
  • “Customary” fees are an amount the insurance company calculates based on actual fees submitted for the procedure by one or more providers. They use this number to identify a maximum amount that they will pay for that procedure.
  • “Reasonable” fees are one that strays from customary or usual fees because of complications, special circumstances, or unique needs of the patient.

Often the insurance company will review the UCR fees for any given procedure, then determine your actual reimbursement rates based on whichever is lowest. They also take into account the area where you practice, the cost of living, and the population size. When negotiating dental insurance contracts, it’s important to understand the role of UCR fees so you can effectively increase the amount you are receiving for specific procedures.

Once you know how fees are set, the next step is to work with Everest Advocates to identify ways that you can increase your individual rates in your dental insurance contracts. We can help you go through an exhaustive review of your existing contracts, and help you discover areas where dental insurance providers might be willing to increase your reimbursement rates. We have assisted hundreds of dentists in finding ways that they can negotiate dental insurance contracts that are more favorable and provide a better income to the dental practice.

If you are ready to find ways to make your business grow, and improve your bottom line, contact Everest Advocates today to find out how we can help. You can reach us by calling 844.GO.4.APPS (844.464.2777), or request more information online with our simple form.