Which insurance carrier should I consider dropping?

As a business decision, being “in-network” with insurance carriers can make sense to increase new patient traffic into your office. Often times, practices plan on selectively dropping out of particular PPO plans once they get busy enough that they don’t need to continue to accept the reduced contracted payment schedule. What we see, though, is that often this decision is made by emotion rather than objective decision making.

For most, it comes down to two assumed factors:

  1. Dropping a plan because it is the lowest negotiated rate
  2. Assuming that you don’t have too many patients with this plan

Often these assumptions missed a much deeper understanding that should go into making this important decision making process:

  • How much did the practice produce from these insurance plans?
  • What was the exact cost to the practice for being in-network with the plan (Perhaps I’m discounting full treatment by $500/patient for this plan but 50 patients started this year)?
  • Am I dropping a plan that has highly qualified patients (are they converting at a high rate)?
  • What effects will dropping this insurance plan have on my referring doctors?
  • What geographical location are these patients coming from?
  • When given the choice between braces with the lower fee schedule and a procedure with a higher fee schedule, which option is the patient selecting?

Contact us before you are going to make a decision about dropping an insurance plan so we can help you put quantitative data behind your decision.

“Most of the world will make decisions by either guessing or using their gut. They will be either lucky or wrong” – Suhail Doshi Mixpanel CEO