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Are you making money by participating and being in-network with a plan?

Part 1 of 3

Dental Insurance Today — September 2021

Limoli blog

Are you making money by participating and being in-network?

If the last two years has taught us anything, it’s “be prepared for whatever you were not expecting.” Having been entrenched for the last 30 years in just about all segments of the dental benefit industry, I can confidently share that very little, both clinically and administratively, goes historically unrepeated. 

Since the initial financial recovery from the pandemic has slowly kicked back in, an entire plethora of educational plagiarists have been preaching the wonders of being as well as getting out of network. This is and can be a most noble objective – provided you don’t ignore the overall wants, needs and desires of both your active as well as potential patient in the chair. 

The two major conceptual divisions of plan participation are “when to get in” and “when to get out.” Prior to realistically addressing either of these concepts, one must first determine “where am I.”

Rather than looking with disgust at a number you are identifying as insurance write-offs, consider also looking at your appointment book and bank deposit. Participatory plans deal with (chair) time vs. money rather than procedure vs. money.

Start the process by selecting an individual participatory plan in your office. Determine first how much money the plan directly paid you. Now add to that number the total dollar amount those patients directly paid you for covered as well as non-covered services. Lastly, determine what percentage of your total gross revenues came into your practice as a result of your participation.

With that percentage number in hand, determine how much appointment time went to those participatory patients. If 30% of your gross revenues came from XYZ Dental Plan and their patients in your practice, how much chair time did it cost you? If you invested (or sold) 20% of your chair time and got 30% of your revenue – congratulations, you are making money by participating with the plan. Well done! But, if 40% of your time is only generating 30% of your revenue, you have got a problem that needs to be addressed.

You may want to first consider modifying the templates in your schedule so as to better track and forecast a more accurate “production” number. Remember that production is not a real financial number in that it has no tax consequences. Revenue “blocks” per plan per week may be the answer you are looking for. Delegate and control your time based upon your percentage of anticipated plan-driven revenue. Track your actual collectable production by both participatory as well as non-participatory plans. And remember, a well designed appointment book deals with three levels (chair, procedure and doctor) time. Clinical efficiency with doctor/assistant time comes much later in the process.


Tom Limoli
Tom Limoli
“The Nation’s Leading Reimbursement Expert”
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