RANDY CURRAN
If the practice goal is at
less than $3,500 and even
to around $2,800 and
they want to consistently
treat ten plus patients
per month, I’ll advise that
going in network with
Cigna, United Healthcare,
Aetna, BCBS (depending
on state) may be a good
choice.
The good news is private
insurance carriers are
starting to see the need
for contracting with
more dental practices
in-order-to offer their
members consistency in
coverage and eliminate
the exorbitant charge
amounts by select
providers.
Also, during a September
two-hour call with
a United Healthcare
Director of Contracting,
it sounds like they are
going to revamp the
E0486 in-network fee to
an allowable amount of
between $2,100-$2,500,
depending on the region.
This is very similar to
what Cigna offers in
network. They may also
start to look using this
as the out of network
allowable as well to
combat some of the greed
we’ve seen in the industry.
Anthem California has
already moved in this
direction with teacher
and police union plans.
There are other
advantages to going
in-network. Going in-
network simplifies
the pre-authorization
process, gives the patient
an exact amount due for
treatment, speeds up
claim payments and gives
the practice a competitive
advantage when
marketing to the medical
community for referrals.
In summary, if gap
approvals are going
smoothly and the practice
doesn’t anticipate
any future in network
providers popping up
or rate changes, stay
out of network. If the
practice struggles with
gap approvals, has in
network providers nearby
or just wants to get a
jump on the trend before
contracting is closed in
the area, they may want
to look at moving in-
network.
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RANDY CURRAN
Randy Curran has helped
over one thousand dental
practices manage the
financial aspects of dental
sleep medicine (DSM) and
directly supervised collection
of over $30 million dollars
for DSM treatments. With
over 11 years billing for all
aspects of sleep medicine,
he possesses a wealth of
knowledge regarding medical
insurance coverage criteria
and reimbursement trends.
Over the past two years,
Randy has expanded his
team at Pristine Medical
Billing as they serve as
extensions of practices in 47
states across the US. Under
his tutelage, this team seeks
to maximize reimbursement
while protecting practices
from audits with proper
coding and collections
protocols.