What has changed is that dentists are participating in more networks than ever before, and payers are using more and more networks at the same time. For example, Guardian has its directly contracted network as well uses 7 other networks. Guardian’s objective is to use the network contract which provides the greatest discount from your practice. How can we use this to our advantage?
Below is the Dental Basket for GPs. The most frequent 15 services accounts for 76.6% of all services performed by GPs. By converting the “% of Services” column to 100% in the “Adj %” column, we can use it to make a weighted average of each fee schedule. For example, Schedule 2 has some fees higher and lower than Schedule 1, but the net impact is a 5% increase.
If you can move your Guardian’s members to the Connection Dental fee schedule, it will increase the revenue on those members by 27%. The challenge will be the participation with Aetna and Ameritas. If you are not ready for the one year of punishment from Aetna (will not recognize a practice under a leased network for one year after terminating a direct contract), you must opt-out of Aetna’s leased relationships and term Ameritas.