In Network or Fee for Service? Staying Profitable With Dental Insurance | Dr. Ryan Walsh

Should your practice stay in network, go fee for service, or something in between? With Jeff away, endodontist Dr. Ryan Walsh joins Dr. Chad Duplantis and Dr. Jennifer Bell as guest host. Together they cover three practice models (fee for service, mostly PPO, and an out-of-network specialty office), what really happens when you drop a plan, how to negotiate with insurance companies, and how to handle a patient who wants a gold crown the plan won't pay for.

In this episode:
- Fee for service, PPO and specialist: how each practice model stays profitable
- Why the PPO playbook from 2010 is harder to make work today
- What happens to patients when you drop an insurance plan (sometimes the difference is $2)
- Dental insurance maximums haven't changed since the 1970s, but a crown went from $100 to about $1,460
- Fewer than 6% of patients use their full benefits each year
- Out of network doesn't mean patients can't use their insurance
- Negotiating fees: the reports to run on every plan, and why you should only threaten to leave if you mean it
- How groups like Dental Advocacy Group help private practices get better fee schedules
- The gold crown problem: when the plan pays less than your lab bill

📰 Plus dental news from July 2024: a study linking tamoxifen to early tooth loss, Ohio joins the dentist and dental hygienist licensure compact, and Ohio passes a non-covered services law.

🎉 Congratulations to Dr. Jennifer Bell on earning her Mastership in the Academy of General Dentistry (MAGD)!

Dr. Ryan Walsh is an endodontist in the Dallas-Fort Worth area. His practice left its last insurance network a few years ago and is now fully fee for service, while still filing claims for patients.

This is general information, not billing or legal advice.

Chapters:
0:00 Intro
1:22 Meet tonight's guest host, Dr. Ryan Walsh
3:11 JB's MAGD, and stuck in the airline meltdown
7:09 When a canceled trip feels like a gift
13:41 Ryan's week
15:36 News: tamoxifen linked to early tooth loss
18:01 News: Ohio joins the dentist and hygienist compact
19:05 News: Ohio passes a non-covered services law
21:44 Tonight's topic: staying profitable today
22:56 Three practice models: fee for service, PPO and specialist
24:51 Building a PPO practice from scratch
27:34 What happens when you drop an insurance plan?
29:36 Insurance maximums haven't changed since 1970
32:06 Fewer than 6% of patients max out their benefits
33:06 Out of network doesn't mean you can't use your insurance
34:07 The pressure on specialists to be in network
37:38 "Do you want the best, or someone in your network?"
39:46 Negotiating fees with insurance companies
42:08 The reports to run on every plan
44:08 Getting outside help with your fee analysis
46:41 Dropping a plan over bad customer service
47:36 What is Dental Advocacy Group?
52:03 The gold crown problem
53:43 Passing on the cost of gold
57:52 Why insurers pay less for gold
59:57 When a procedure is cost prohibitive
1:03:09 Closing
1:04:29 ADA education resources

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Spotify: https://open.spotify.com/show/2Elfj6LX0hCUyp0AgdTsij

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