As I was gathering my thoughts on this topic, my mind was racing in many directions as to where I should start with this one. Let me first begin by saying, contrary to what we read from our dental association leadership, it is definitely not your fault doc, by you signing up with PPO plans, that third-party payers have such low reimbursement rates. It actually has everything to do with the dental insurance market, and the perceived ideologies that dental consultants have propagated for years when it comes to how we can bill the PPO patient.
Dental insurance companies use sophisticated software to calculate the needed premiums required to pay us the reimbursement rates they set, while acquiring a 24%-32% corporate profit margin. This software, which Tracy and I have seen, and navigated intimately first hand, has unbelievable information on all of us docs, average billings we send in, and average payouts their clients have in our dental offices. Once again, nowhere in their calculations on contractual reimbursement rates does sending in our fee-for-service fees affect this process in determining what their reimbursement fees are per our contracts. Honestly people, stop lies from so many out there who teach such stupid things.