A pioneer in dental insurance fee negotiations, Benjamin (Ben) Tuinei is president of Veritas Dental Resources, a Utah-based firm that helps practices realize maximum returns from procedural claims. He lends insights into the company’s proprietary processes, and how doctors can leverage its services to achieve growth and profitability while ensuring quality care.
How does Veritas Dental Resources negotiate insurance fees to help increase reimbursement rates?
Veritas has a seven-step negotiating process that yields higher payments from most preferred provider organizations (PPOs). Because this process is a bit complicated, we perform all seven steps on the doctor’s behalf. When we first meet with an interested dentist, we perform an evaluation similar to a new patient exam. In our case, we engage in a fact-finding mission to learn more about the practice and discover every negotiating opportunity that will produce a meaningful revenue increase. Next, we draft a customized plan that outlines how we will negotiate fees. Doctors receive informed consent about the process and timeline, and what fees would be involved in retaining our services.
As terms of increases, some PPO plans might offer a 5% bump, while others may extend a 35% increase. In the end, our average client sees a 7% to 13% increase in total practice revenue resulting from our services.
OUR AVERAGE CLIENT SEES A 7% TO 13% INCREASE IN TOTAL PRACTICE REVENUE
Can you also help with health maintenance organizations (HMOs) and discount plans?
Yes, but for HMOs, it’s the monthly capitation amount (per patient/per month fee) that’s negotiated. These fees are disclosed to the patient before he or she purchases the plan. As such, there are limits on what can be negotiated. But, from our experience, the monthly capitation payment dentists receive is certainly negotiable.
Discount plan fees can also be negotiated. That said, I recommend that dentists build their own discount, loyalty or membership plan and offer it directly to uninsured patients, who are most likely to purchase a discount plan. The office will capture the subscription revenue with its own plan, whereas insurance carriers do not share discount plan subscription fees with doctors.
How does Veritas help dentists join the right dental plans and assist with insurance credentialing and contract optimization?
We’ve been fortunate to work with more than 8500 dentists. As such, we have a lot of data on what insurance plans pay, how many patients (on average) our clients see per plan, and what certain employers use for insurance.
When it comes to credentialing or contract strategy, we help dentists eliminate the guesswork by using our data to recommend the best plans to join. Not all practices have the same needs when it comes to PPOs. Some can thrive with limited PPO participation, while others struggle being out of network. When it comes to contract optimization or PPO participation, we customize recommendations based upon each doctor’s practice and team culture.
What is an umbrella network, and what role does it play when negotiating fee schedules?
Umbrella networks are also called rental networks, leasing networks or network stacking organizations. They are designed to have one PPO contract and one fee schedule that governs multiple PPO plans. The advantage is that dentists are able to bypass low fee schedules that many plans would offer under a direct contract, and structure those agreements under a higher fee schedule through the network.
In my experience, umbrella networks are more likely to offer higher fees, so my recommendation is to negotiate with all PPO plans and umbrella networks, and then compare to see which provide the best reimbursement, and which network offers maximum “in-network coverage” if the goal is to be on many plans.
Why did Veritas partner with BoomCloud to offer dental membership plans?
We firmly believe that membership plans are the way of the future. As such, we endorse BoomCloud because its approach allows dentists to create and manage a membership plan. BoomCloud is also the only membership plan company that will help clients promote their plan within the practice.
What insurance coaching services do you offer? Can Veritas help when carriers deny claims?
Veritas employs a team of dental insurance experts, many of whom are actively working as office managers, insurance coordinators or treatment coordinators. This expertise can prove helpful when dealing with secondary insurance or non-covered services, and especially when appealing denied claims.
Ultimately, through Veritas’ fee negotiation and additional suite of services, we help offices safeguard the financial integrity of quality dental care.
VERITAS DENTAL RESOURCES
From Decisions in Dentistry. February 2023;9(2)26.