546: Insurance Free: Is It for Me? - Shelley DeGroff - a podcast by ACT Dental

from 2023-03-06T03:00

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Insurance Free: Is It for Me?

Episode #546 with Shelley DeGroff

Insurance is a game, and insurance companies have the upper hand. So, what can you do to win? To help answer that question, Kirk Behrendt brings in Shelley DeGroff, founder and CEO of PPO Advisors, a company that turns PPOs into profit. She shares insight into how PPO contracts work and advice for strategically dropping your PPOs. Insurance-free is the way to be! To keep more of the money you deserve, listen to Episode 546 of The Best Practices Show!

Episode Resources:


Main Takeaways:

Add and drop PPOs strategically.

Do an EOB audit on a regular basis.

Start credentialing as early as possible.

Negotiating isn't easy, but everyone should do it.

Understand how to stack and navigate your contracts.

Quotes:

“Credentialing and insurance contracts are not what they used to be. It used to be that you could sign up with an insurance company, and you were going to get a great rate, and you were going to get patients from that contract. It doesn't work that way anymore. You're signing up for a contract, or with a contract, and you're getting 50 other shared networks with that. And if you don't set yourself up into the right contracts, you're really backing yourself into a corner for successful PPO negotiations and contracting down the road. So, we really need to understand what we’re doing so the success of our practice can continue to grow.” (3:02—3:42)  

“[Credentialing is] not fast. Nothing about credentialing is fast, so prepare yourself. If you're a new doctor doing an acquisition or doing a startup, you need about 120 days to get yourself a network. So, don't wait until you take ownership. Start that process as soon as you have the letter of intent signed and you know this practice will become yours, or your startup six months in advance, if you can.” (4:08—4:35)

“As you're still building out, get your PPOs set up. You need a tax ID number, a physical address, a phone number — which, you can get a Google number and then we can transfer that somewhere else if we need to. Those are really the key things we need to get you set up with an insurance contract. So, get that process going as soon as possible. Don't wait around and think, ‘Oh, I've got 30 days till closing. I know this is in the bag. Now, I'm going to start the process.’ You're going to overwhelm your staff and you're going to overwhelm yourself. It’s hard. It’s a long process. They don't make it easy.” (4:35—5:11)

“Delta Premier is everybody’s worst nightmare. We’re to the point where now we’re seeing most states do not honor Premier status through an

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