Ask the Experts: Insurance Reimbursements
Practical advice for the most pressing practice management questions
April 1, 2025
Volume 21
,
Issue 3
,
April 2025
Page(s): p. 10
What should I be doing with my insurance companies in order to get higher reimbursements?
In recent years, dental insurance companies have not increased reimbursements for many practices in many plans and, in some cases, have even lowered them. And even if a practice's reimbursements have stayed the same, their value has continually dropped due to increases in inflation. Although there are no guarantees, dental practices can take specific actions in order to maximize their potential to acquire a higher level of reimbursement, including the following:
1. Hire an insurance negotiation company. In some cases, these companies are able to negotiate increased reimbursements for practices. But because there are no guarantees, you may or may not see a return on your investment to engage one.
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2. Raise your fees every year and send your new fee schedule to all insurance companies with whom you participate. Showing higher fee schedules may prompt dental insurers to increase reimbursements to match them.
3. After you've submitted your new fee schedule, call each insurer on the phone to request a review and an increase in your reimbursements. If you don't hear back, which is quite common, call repeatedly. Sometimes the squeaky wheel gets the oil.
4. Appeal any cases that are rejected by your insurance companies.Take time to make the appeal, and let the insurance company know that you will not simply sit back and allow them to reject certain cases for no obvious reason. If you do not appeal, there will be no further opportunity to receive any reimbursement from the insurance company.
5. If you have colleagues in your area who are comfortable sharing information, compare your reimbursements to theirs. If yours are lower, contact the insurance company, ask them why, and insist that your reimbursements be increased. You don't have to threaten to leave, but you want to let them know that you have comparative information and that your reimbursement should be brought up to the level of others in your local dental community.
Roger P. Levin, DDS, is the CEO and founder of Levin Group, a leading practice management consulting firm that has worked with more than 30,000 practices to increase production. A recognized expert on dental practice management and marketing, Levin has written 67 books and more than 4,000 articles and regularly presents seminars in the United States and around the world.
Questions can be submitted to asktheexperts@conexiant.com
