GDA Action October 2021

October 2021 • 13 THEPRACTICE Tools and tips to help you manage your business. As the GDA’s Director of Health Policy, one of my roles is to provide resources and information to GDA members who have questions about third-party insurance benefits. Inevitably, one of the more common questions we receive at the GDA office from new and veteran dentists alike is about negotiating an in-network provider contract between your dental practice and an insurance company. While neither the GDA nor ADA can engage in any such negotiations on behalf of a member dentist, I am pleased to share the following resource document from the ADA on how to get the most out of the contract negotiation process. Please note that this article is for informational purposes only and should not be construed as legal advice or as a substitute for professional advice based on your practices’ unique circumstances. Why Negotiate? For in-network dentists, negotiating fee schedules with insurance carriers has never been more important as the cost of care is expected to continue to rise, especially considering the COVID-19 pandemic. In Georgia, dentists have continued to follow CDC guidelines for increased infection control procedures and the use of personal protective equipment (PPE). Because of this, many dentists may need to adjust their fee schedules to compensate for the higher overhead costs. Negotiating fee schedules generally can be done every one to two years, depending on the terms of your contract. Many dentists may not be aware that they do not have to accept what the insurance company offers, whether you are joining a new network or renewing an existing contract. However, negotiating during the initial credentialing process is probably the easiest time to potentially get a more favorable fee schedule. Although not all insurance companies will entertain negotiating contracts, some may, turning a few hours of work into a more favorable contract. Before You Get Started… As a tripartite benefit, the American Dental Association offers a ‘Contract Analysis Service’ to members who send in their unsigned contracts directly to their state associations, including the GDA. The Contract Analysis Service can provide you with information concerning a proposed contract with third party payers or certain dental management service organization contracts, excluding employment or associate contracts. While this service will not negotiate the terms of a contract for you, it can help you better understand and analyze its terms. Before you decide to negotiate your contract, evaluate what your goal is. Are you looking to increase revenue, add new patients to increase volume, see fewer patients who may be willing to pay more out of pocket, or something different? Identifying a goal can help you decide how to best plan your conversation with the insurance company. An important first step before negotiating a fee schedule is to » DENTAL BENEFITS By Emma Paris, LMSW, MPH, PMP Handling Contract Negotiations