Insurance Contract Class Results
Here is what the class thought important aspects of an insurance contract would be to negotiate:
fees for service, services covered
The price for a specific treatment or the frequency of appointments patients can make within a year.
fee for procedure
No time limits on benefits, and more flexible coverage options such as if a patient is determined to benefit from a fixed prosthesis over a removable one.
% required by the patient to pay vs % of the procedure covered by the plan
Prices
How much reimbursement for specific procedures or what procedure codes are reimbursed.
when you get paid for treatments that require multi-step appointments, such as a crown, would you be paid upfront, on seating, or a hybrid of both?
percentage paid
Benefits, non-competition clause, compensation and salary, dispute resolutions
how they categorize different procedures and what procedures are covered.
Fee Schedule and Reimbursement Rates
The cap of the payments for procedures would be something to negotiate.
the amount reimbursed!
Important aspects of an insurance contract that you must consider as a dentist include the amount the dentist will be paid for each procedure, the number/types of procedures covered by the insurance company, and the frequency at which each company disperses benefits to their members. Knowing these things will allow the dentist to better accommodate their patients while also ensuring that they are being paid sufficiently for their efforts.
when you get paid
Times at which the insurance company pays the dentist. Such as, immediately as the code is applied to the treatment plan. Or will the insurance company wait until the month's end or some other arbitrary timeline they create?
Dentists should be able to negotiate the price of the procedure and the types of procedures covered.
What percent you would receive for patients with PPOs
How much each code is reimbursed for
The limits for each treatment.
the limit
maximums
Reimbursements
I think it would be important to determine what insurances will cover for different patient needs and if the treatment you as the provider deem suitable.
reimbursement fees
How quickly they will pay me. How they will communicate with me.
fees
how long it takes for dentists to be reimbursed
Prices for codes
You should negotiate fee schedules and payment options as the dentist.
Prices, how often a patient can come in
Reimbursement for treatments and time frame allotted for these reimbursements
How much you get paid, how often/how many times insurance will cover care, under what circumstances insurance will pay for a procedure.
amount reimbursed for a procedure
Price
Prices for services- incentivizing preventative treatments.
The fees, and percent of return of fee
The ability for the insurance company to dictate your treatment. You also need to negotiate the fees they are willing to pay. If you will be doing work at a loss or at a low profit margin, it is not advisable to even work with that insurance company.
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