Letters: PPO leasing networks
September 03, 2018
I recently read your June 18 article by David Burger "PPO-Leasing Networks Can Lead to Confusion, Consternation," and was concerned with the tone of the article being negative on the topic.
I, for one, am happy to see preferred provider organization leasing occurring. And I will tell you why.
Until early spring of 2017, I was a fee-for-service dentist with only one contract: Delta Dental. I practiced for nearly 25 years under that arrangement. Many large envelopes showed up in my mailbox asking me to "join our fabulous network of (underpaid) dentists." I declined. As low as Delta Dental reimbursements have become recently, almost all the large envelopes had fees 40-75 percent of the fees Delta is paying today. Why would I discount my fees that much? Just to keep a warm body in my hygiene chair, or place a crown at 33 percent of my usual, customary and reasonable fee? No, thanks. I can't make a profit doing that. I was already wondering why I was continuing to accept Delta Dental fees that haven't been increased in many years. Are you listening, Delta?
As the dental insurance benefit climate has been changing over the last few years, I realized far too many patients were making choices to transfer to in network offices based upon the propaganda insurance companies send along with their explanation of benefits statements and meetings during benefit open enrollment periods. My best option was to join select networks that offered reimbursement at or above Delta Dental, but below my usual, customary and reasonable fees. They do exist. Honest. I'm proof. I joined just two networks as a contracted provider, with (negotiated) fees about midway between Delta and my UCR fee.
How does the PPO leasing benefit my office? Simple. When a low-reimbursement plan leases one of the two networks I participate in, my office is paid based upon my (higher) contracted fees from one of the two networks. And I can still maintain a doctor-patient relationship with that family with the poor plan, because to them, I am an in-network option through the lease. The patient is happy to be in a great office and I'm happy not being reimbursed at 50 percent or worse of my full usual, customary and reasonable fee through a low reimbursement plan that I could have signed trying to maintain patient flow.
If this plan of attack is working for me, it can work for you. Do your research, employ some experts on the subject. I did, and figured out how to walk away from low reimbursement plans. They only exist because a dentist is willing to sign a contract. You do have a choice, provided PPO leasing exists. So, please don't throw the baby out with the bathwater; PPO leasing works very, very well for some of us.
Ernest Johnson, D.D.S.