PRACTICE PERSPECTIVES Participation In Managed

Care Dental Insurance Plans An interview with Lois Banta, dental practice consultant

Practice Perspectives is a new offering in the Focus, contributed by Dr. David Thein, who is a periodontist and associate professor at UMKC School of Dentistry. Dr. Thein is director of the UMKC Somers Clinic, which houses the Dental Faculty Practice and AEGD residency programs. He also is course director for the practice management curriculum.

This idea germinated after Dr. Thein participated in the Focus survey sent to members in 2018, shortly after Dr. Wyckoff became editor. Dr. Thein approached the MDA, inquiring about providing this column geared to both pending and new graduates as well as seasoned veterans who wished they had picked up more practice management advice while in dental school.

The column will provide a Q&A style interview with industry experts on the following topics: Managed care dental plans; Dental practice valuation and transition; Motivating/compensating/ evaluating your staff; Minimizing the risk of getting sued; Practical retirement planning over your career; and Corporate dentistry. Do you have something you’d like to see covered in this column? Let us know!


here are very few issues in dentistry today that are as

misunderstood as managed care dental insurance plans. Some offices have learned to deal with them quite effectively. But most, if they participate at all, consider them to be necessary evils in doing business in today’s dental environment. Our discount-minded consumer market often turns to PPO dental plans as vehicles to “pay for” their dental care. Many of us have experienced the pros and cons of being a preferred provider for a particular dental network at some point in our careers. To help bring some clarity to this topic, we’ve asked Lois Banta, a dental practice consultant, to tap her vast experience in all things dental manage- ment to help us navigate the tricky waters of managed care. Regardless if you are new to dental practice or have been in the trenches for years, her practical advice can offer some guidance to the question, “Is managed care right for your practice?”

Following is an introduction from Lois and then her responses to questions Dr. Thein has asked:

Lois Banta: Choosing to participate or not to participate in managed care PPO plans is a deci- sion of major importance. There are hidden costs—potentially compromising decisions to be made—and calculations required to determine if the practice can handle the influx of new patients in a manageable way without affecting the quality of care. Additionally, participating in a PPO plan requires the practice to reduce their fees in exchange for adding new patients to the practice. Careful research and consideration are necessary to determine if participating in man- aged PPO care is truly cost effective or cost prohibitive.

As a general rule, run a fee schedule report first on your dental software to verify what your cur- rent practice fees are. Next, find out from the PPO insurance company what their allowable fees are or would be. This will help you determine the percentage of adjustments you will agree to accept. Finally, there will need to be an analysis done to estimate the dollars it will take in future production minus adjustments to achieve similar net practice collections without the reduced fees of managed care. This gives you a fairly accurate picture of how much more you will need to produce in order to realize the same net.

8 focus | JAN/FEB 2019 | ISSUE 1

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