The fee-for-service model isn’t a silver bullet for every dental practice. Here’s why renegotiating insurance reimbursements can be less risky and more rewarding.

By Tasha Burris

GOING FFS can seem like a cure-all for your practice’s biggest worries and frustrations—but as you might have heard, there’s no such thing as a free lunch. The allure of independence from insurance companies, the promise of better control over fees and the hope of reducing the administrative headaches tied to reimbursements are tempting. However, before making the leap, it’s important to carefully consider your goals and then evaluate whether going fully fee-for-service is really the right solution for your practice right now.

Understanding the Headaches You’re Trying to Avoid The primary motivations for moving to a fee-for-service model most often include escaping low reimbursements from insurance companies, reducing the administrative burden related to processing claims and having more control over the fees you charge and procedures you offer. However, while going FFS may eliminate some of these frustrations, it introduces new challenges that could be equally problematic.

First, patient loss is always a major concern when leaving insurance networks; even loyal patients may seek care elsewhere if they can’t afford out-of-pocket costs. Second, more-intensive case presentations are usually a must in the FFS model, and
persuading more patients to pay directly requires a high level of communication, trust and patient education, which can be more time-consuming than handling claims. Third, increased marketing demands are also a byproduct of going FFS. Out-of-
network practices often need to invest heavily in marketing to attract patients who are willing to pay more, especially
if they’re competing with nearby in-network practices.

Finding a Better Middle Ground
Rather than making an immediate switch to FFS before you’re 100 percent ready, an alternative is to renegotiate your reimbursement rates with insurance companies.

Here’s why this strategy might work better:

• It maintains your current patient relationships. By staying in-network, you can continue to serve existing patients while improving your bottom line through higher reimbursements.
• It doesn’t create operational disruption. You avoid the need to drastically change your practice’s marketing, patient education and administrative systems.
• It promises predictable cash flow. Even with negotiated rates, you’ll have the certainty of patient volume from being in-network, reducing the financial risk associated with a complete switch to FFS.

Negotiating higher reimbursements is time-consuming and challenging for dental team members saddled with other responsibilities. However, it is doable, especially if you can demonstrate your practice’s value based on high patient satisfaction rates, your track record and the availability of specialty services. Use patient testimonials and feedback to highlight the excellent care you provide. If you have high patient retention or offer services that reduce long-term insurance costs (such as preventive care), use that data to argue for higher fees. And if you provide services that are hard to find locally or require specialized training, insurance companies may be inclined to pay more to keep your practice in their network.

Bottom line: Renegotiating your fees could split the difference between what you’re earning now and what you’d hope to achieve by going FFS—without risking significant disruption to your practice. Plus, if you enlist the help of a professional dental fee negotiator, it takes most of the work out of maximizing your reimbursements. And that’s like getting money for nothing.

TASHA BURRIS is a former dental practice manager with over a decade of frontline experience. She leads sales and marketing for PPO Profits, one of the market’s leading providers of dental fee negotiations. PPO Profits is part of Benco Dental, the publisher of this magazine. Contact Burris at tashan@ppoprofits.com.