The world of PPOs is confusing, and APEX Reimbursement Specialists works with both PPOs and third-party administrators to get your practice the best possible return for the procedures that you perform. What are PPOs and how are third party administrators different?
The Basics of PPOs
If your dental practice is in-network with a PPO, it means that your practice is considered a preferred provider. Through that process, you agree to a certain fee schedule that is lower than your non-insurance pricing. Why would you agree to lower fees? PPOs will promote your dental practice to customers who have insurance policies with them through listing you as a provider. Depending on the agreement that you have with an insurance company, you will have a set reimbursement amount for procedures, a yearly maximum of benefits, frequency limitations and a waiting period for certain services.
The Basics of Third Party Administrators
Third party administrators are another part of the reimbursement realm. Third-party administrators like Connection Dental are not insurance companies themselves, but they do adhere to set fee schedules like insurance companies do. If your dental practice chooses to sign up with a third-party administrator, you will be agreeing to join the network under the associated fee schedule.
The Most Common Third-Party Administrators
Some of the most popular third-party administrators in the dental space include:
- GEHA and Connection Dental
- Careington
- Guardian and Aetna
- Zelis
- DHA/Sunlife
What Should You Choose?
Many dental practices choose to partner with PPOs and third-party administrators to keep business coming through the doors throughout the year. By ensuring a steady flow of business, dentists can focus on other things, like managing overhead and patient flow.
Learn More About PPOs and Third Party Administrators with APEX
APEX Reimbursement Specialists negotiates with PPOs and third-party administrators to ensure that your dental practice is getting the best reimbursement rate possible. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.