Watch Intro Series

How to Optimize Your Existing PPO Contracts – Episode 314


How Do I Get a Podcast?

A Podcast is a like a radio/TV show but can be accessed via the internet any time you want. There are two ways to can get the Dentist Money Show.

  1. Watch/listen to it on our website via a web browser (Safari or Chrome) on your mobile device by visiting our podcast page.
  2. Download it automatically to your phone or tablet each week using one of the following apps.
    • For iPhones or iPads, use the Apple Podcasts app. You can get this app via the App Store (it comes pre-installed on newer devices). Once installed just search for "Dentist Money" and then click the "subscribe" button.
    • For Android phones and tablets, we suggest using the Stitcher app. You can get this app by visiting the Google Play Store. Once installed, search for "Dentist Money" and then click the plus icon (+) to add it to your favorites list.

If you need any help, feel free to contact us for support.


You know PPO insurance helps generate practice revenue, but to increase profits you need to learn how to get more out of your current PPO reimbursements. On this episode of the Dentist Money™ Show, Ryan welcomes Vivek Kinra, founder of PPO Profits. Vivek illustrates why insurance payments can get so complex and reveals ways to actually optimize existing contracts to give fees a boost.

Show notes
www.ppoprofits.com

 


 

Podcast Transcript

Ryan Isaac:
Hello, everybody. Welcome back to another episode of The Dentist Money Show, brought to you by Dentist Advisors, a no commission fiduciary, dental specific comprehensive financial planners just for dentists all over the country. Be sure to check us out at dentistadvisors.com. Today on the show, I am spending some time with Vivek Kinra from PPO Profits and Verrific, and we’re talking about, basically, how do you make more money in your current dental set-up. We’re not talking about new patients, new locations, new doctors. All those things are other questions. This is with what you already have going on, how we’re gonna make some more money. Huge, huge topic, high priority going into 2022 New Year goals. Thanks for being here, and if you have any questions for us, you can go to dentistadvisors.com. Click on Book Free Consultation link and have a chat with one of our very friendly dental specific advisors today. Thanks for being here and enjoy the show.

Announcer:
Consulting advisor conductor on due diligence when making financial decisions. General principles discussed during this program do not constitute personal advice. This program is furnished by Dentist Advisors at [0:01:04.6] ____ investment advisor. This is Dentist Money. Now, here’s your host, Ryan Isaac.

Ryan Isaac:
Alright. Welcome to The Dentist Money Show, where we help dentists make smart financial decisions. I’m your host, Ryan Isaac, and I’m here with Vivek Kinra of PPO Profits and Verrific. Vivek, thanks for being with me. How are you doing today, man?

Vivek Kinra:
I’m doing well. Thanks for having me.

Ryan Isaac:
Yeah. Well, thanks for being here. We’re gonna talk profitability, practice, ultimately, the thing you like doing. The thing I like when my clients do is when they make more money. And we’re gonna talk about how to do that in your dental practice, but first, let’s do a quick little intro. Vivek, for your two companies, who you guys are, what you do, let’s kinda start there. I’d actually… Because we’re talking to small business owners, really, in, dentists, that’s ultimately what they are, I like to hear, if you wouldn’t mind, would you explain who you guys are, what’s the origin story behind all of this? How did you guys begin? What have you battled? What have you had to do over the years of growing your businesses? But yeah, go ahead. Give us a little intro on who you guys are.

Vivek Kinra:
Yeah, sure. So I’ll start with what the companies do. I used to always say PPO Profits is a fee negotiation company, but that’s basically the large chunk of it. But recently, we branched off and created some in-office memberships offer called FFS Profits, so I can’t really just say it’s now just a fee negotiation company. And I don’t know when this will get released, but currently, we’re in negotiations to purchase a claims processing company [0:02:39.8] ____ division called RCM Profits. So the idea is that PPO Profits eventually will be a one-stop shop for all insurance-related, as well as patient election and fee-for-service patients for the membership plan, an administration type of a firm.

Ryan Isaac:
That’s really cool. Yeah, awesome.

Vivek Kinra:
Thanks. And Verrific used to be part of PPO Profits, but we split it into a separate company to build some really cool dental insurance verification software. So the two very big pain points for anybody that accepts insurances are really, really poor fees, as well as insurance verification that just clogs up a lot of manpower and finance out there. So Verrific is built more like a startup. We’ve got investors, we raced around, we’ve got board members, etcetera. And so we’re pretty deep into making a really, really big dent into this really pesky problem that exists from 1990s, and hopefully in about two, three months, finally, we’ll basically crack this problem that nobody has been able to crack yet.

Ryan Isaac:
Yeah, I was just gonna ask for… Most people are probably nodding their heads like, “Yeah, the pesky problem.” But can you describe that a little bit? What’s the pesky problem since the ’90s that Verrific is trying to solve there?

Vivek Kinra:
Yeah, so it’s… Any time a patient comes over to a dental office, one of the first things that that dental office does is get the insurance information, and then it’s… You’d be surprised, but literally what happens is they call the insurance agents. Very often, especially during December, January etcetera, they’re on hold for like 40 minutes before they get someone. And they’re just calling to get information, like what is covered for this policy. Now, some of this information is on the portals but not all. And all the portals look different, so all this information still has to make its way into your practice management software. So it’s really… I’m not making this up. It’s about a 40 to 50 minute operation. So they go in there, go to the portals, punch in all this information into the practice management software manually, and then they call to get the questions answered, which you can’t find in the portal, ’cause there’s no proper way to denote it in software, so you just have to physically do that. And all across the country, all the dental offices for all the patients are currently doing this, and this is… It’s weird when I explain it to some folks, in California, where we’ve got some startup founders, etcetera, that I talk to a lot, and they’re like, “No, that’s not how it is.” I’m like, “Yeah, that’s how it is in 2021.”

Ryan Isaac:
They’re like, “No way. No way people have been putting up with this for like 40 years.”

Vivek Kinra:
Right, exactly. So yeah, that’s… Yeah.

Ryan Isaac:
A lot of people think of software development and they hear the stories on the news when young 20-something sell a software company for a billion dollars, and they think, “Man, that’s so easy. What am I doing wrong? I should just do that.” But I’ve seen from the inside, building software and what a grind it can be. What have you learned along the way, like building software, raising money, hiring engineers? You write code, and then you’re like, “Oh, that doesn’t work,” or, “That’s not what we wanted.” You gotta rewrite stuff. What have you learned so far building software?

Vivek Kinra:
Well, my career wasn’t software. I was a [0:05:52.2] ____ before I got into dentistry, so this is my war. But just to give people a flavor of what software is, I can tell you that I was… Written my CTO, up until about 3:00 AM yesterday. I’m working on a release that we had to make today, and he’s in New York, so it was 4:00 AM for him, and so… And after that, I had to still get some work, so I actually ended up sleeping today at 5:30 in the morning. So… [chuckle]

Ryan Isaac:
Founder life, it’s the dream, man. You’re doing it.

Vivek Kinra:
Right. [laughter]

Ryan Isaac:
Yeah. No, it’s funny to hear that. You always hear of the success stories, but those big multiples of sales, when people sell software companies, they are hard won. And for every one that makes it, I don’t know what the statistic is who doesn’t, but it’s very hard won. Those founders like yourself they’re pulling some late nights, man, and some long hours. That’s very cool. Let’s go back then, PPO Profits. When did this begin exactly? And it started mostly just around the insurance, but you’re adding new services now, but when did you guys begin?

Vivek Kinra:

Yeah, three years ago. As for you probably… You know, but for anybody listening, my wife’s a dentist and she had started a practice here in Chicago, and I was just really kind of almost disliked my job at that time. I was really just kind of being eager. I create a story out of it, that I ended up quitting my job. It’s like, but the reality is, I wanted to, right?

Ryan Isaac:
Yeah, right. Yeah, you wanted to get out of there. That’s fine. That’s okay. That’s fair. That’s cool.

Vivek Kinra:
Yeah, yeah. That’s right. And it just turned out to be my heart was in the dental office at that time. So I convinced my wife… Because we were living on my income at that time, the start-up wasn’t earning. And so she was a little nervous, but I got in there, but just totally got immersed. I was the guy picking up phone calls and I was… One month I was the Vice President of Mobile Application Development of a big team, and the next month I was a receptionist at a dental office. [chuckle]

Ryan Isaac:
Yeah, hey. [chuckle] Yeah. You gotta take the steps though. That’s really cool. Okay.

Vivek Kinra:
Yeah, I loved it though.

Ryan Isaac:
Yeah, exactly, yep.

Vivek Kinra:
Yep, so what came out of it is that I found out that these insurances are so complex that you could have two dental offices started by two different people that graduated at the same time, both going in-network with the same insurance, and both people getting different checks for the same service.

Ryan Isaac:
Yeah, insane. I mean, it’s like the definition of insanity. That’s crazy. Yup.

Vivek Kinra:
Right. But there are ways that you can increase your reimbursements from these insurance companies. So once we did that at our dental office, we had a huge impact. It’s… Sometimes I show numbers to people when I’m doing webinars on a sales call, etcetera. It’s pretty jaw dropping. And you know Paul Goodman, right?

Ryan Isaac:
Yup. Yup, Mr. Nacho himself.

Vivek Kinra:
Yep, that’s right, Dr. Nacho for me.

Ryan Isaac:
Yeah, sorry. No, you’re correct. That is very much Dr. Nacho. Yes, you’re right.

Vivek Kinra:
He’s pretty stealth. But we were having dinner in Philly with him and my wife, etcetera, and he’s like, “Vivek, stop what you’re doing, man. This is… Focus on getting dentists better fees.” And that was kind of… We’d already started, but then the focus became all about fee negotiations. And so we started about three years ago, and it was… I didn’t expect the type of… I thought I was gonna be like a solo consultant and it would be a nice side hustle, but now we are 32 people strong and over 1000 clients. And sometimes I’m like, “I don’t know what happened. It’s a dream.” But it’s one of those things where I tell people that it’s not just about me. Now we’ve got a young team that’s ambitious and driven. So I have to constantly create opportunities for them and so that’s what the genesis was to let’s start in-office membership software, simply because we’re so in the thick of it. We basically negotiate the fees, and part one is, “Okay, let’s look at what your office fees are.” Very often we say, “You need to increase your fees by 15%.” And the doctor is like, “I can’t do that, man. Cash patients are gonna like… ”

Ryan Isaac:
Yeah, they’re gonna kill us. Yeah.

Vivek Kinra:
Right. So the next step for us was, “Alright, why don’t you go get an in-office membership plan?” And they’d ask me who do I recommend? And I’m like, “Well, I actually don’t have recommendations, but there are like these seven companies, Clear, QDP, DentalHQ, etcetera.” I’m like, “Pick one. Just let us know when it’s done.” And so we just decided to build our own. And so just a very simple software that’s very cost-effective that I really think people are gonna start hearing more and more about it, and my wife turned that product called FFS Profits to go with PPO Profits. And then after a while, we liked… The one thing that we miss right now and it’s claims processing, because we’ve got a really big client network. We’ve got a lot of clients.

Ryan Isaac:
Yeah, it’s a lot.

Vivek Kinra:
And so very often, they’re like, “Can you guys just do it?” And so that then became like the genesis of, alright, there’s a company that I really like and it… Right down to legal review, but the owner of the company and I just kinda connect and seems to be a very… She wants a bigger platform. We want somebody coming in that can drive the division. So it’s turning out to be a really good… It hasn’t been penned down, so I’m hoping and…

Ryan Isaac:
Yeah, fingers crossed.

Vivek Kinra:
Right? My desk is wood. I’m gonna go sacrifice a lamb or something.

Ryan Isaac:
Yeah, yeah, whatever you gotta do.

Vivek Kinra:

Right.

Ryan Isaac:
in terms of just trying to help refer people to companies that will do those things, negotiate with their insurance companies. And not only that, maybe you could talk about this, probably, I assume part of the negotiations, when you’re going to negotiate, you have to even evaluate what insurances you should even keep, let alone negotiate. Can you talk about that a little bit, that stage of the process? And I guess where I’m coming from is a lot of people are wondering, “How do I make more money? How do I become more profitable? How do I get rid of some of these pesky insurance companies that I know I’m not getting paid enough to really do the work.” What’s the process like in just starting there and beginning to evaluate, should I keep an insurance company or should I let it go? Do I negotiate with it? How does that all work?

Vivek Kinra:
Yeah, so that’s, I guess the… If you think about it, that’s like the core of what PPO Profits does. We get an entire insurance map about who they are in network with. And one really good thing that I don’t know if anybody else can do it right now, but we can actually pull up insurance demographic report from Verrific.

Ryan Isaac:
Oh, yeah, that makes sense. Yeah.

Vivek Kinra:
Yeah, it’s actually like… I used to always think about how can I get this and it was, I’m like, “Man, I can’t believe it,” right? Our data was structured really well and in fact, I posted on Facebook one day about what we can pull up from Verrific, and I got a lot of people messaging me, of course, we don’t have that as a separate service right now, and I don’t wanna take anything on.

Ryan Isaac:
Yeah.

Vivek Kinra:
The good thing is we can actually grab from Verrific what are the most important insurances there. The good thing is it’s real-time data from last month versus some report.

Ryan Isaac:
Oh yeah.

Vivek Kinra:
And then we just have a lot of knowledge about how in every state, the complexity that exists is that you can be in network with one insurance through another. So I’ll give you a very common thing that happens, people sign up with United Concordia because the military is through that, right? A alot of people are like, “You know what, it’s not about the fees for me, I just wanna do something good for… ”

Ryan Isaac:
Community. Yeah.

Vivek Kinra:
Yeah. That’s totally fair.

Ryan Isaac:
That’s great. Yeah.

Vivek Kinra:
Right. The problem is other insurances piggy-back on that, so even if you never signed up a contract with Blue Cross Blue Shield, right? Or Principal or Ameritas, all of the others… Yep. And they are paying the United Concordia low fees and those low fees, the doctor simply accepted because they wanna do something nice for the vets in the military, etcetera, right? And so we look at that and most of the time, the doctor’s like, I don’t know which one to cut, which one to… Right? And so very often what ends up happening is that most insurance companies have multiple tiers, so people don’t know that they take… I’m in network with Cigna, while the reality is Cigna has two different networks, one is called Advantage, the other is called DPPO. Advantage pays low, but if you sign up with that, even your DPPO patients get paid on the Advantage fee schedule. So what we will say…

Ryan Isaac:
Oh yeah.

Vivek Kinra:
Doctor, you’re thinking about getting out of network, you don’t need to get out of network with Cigna completely, let’s just drop their lower paying network, your fees, you’re gonna drop about 15% of your patients, but your fees are rising by 30%.

Ryan Isaac:
Yeah.

Vivek Kinra:
So it becomes like a perfect… It’s like that’s what I wanted, right?

Ryan Isaac:
Yeah.

Vivek Kinra:
I don’t wanna lose the whole thing, but I get a big jump and I lose a few patients that were basically kind of the threat, and in reality, very often they don’t lose those patients, some of them stick around.

Ryan Isaac:
Yeah. Well, that’s what I was saying. What seems to go so hand-in-hand is this fee negotiation or fee analysis, insurance analysis period, but with in-office membership plans, because then that’s how you can accommodate and they go so well together, and it is hard to have two different services try to interact with that, so that’s really cool. I was gonna say, I’ve found that… I’m curious if you found the same thing too, when people have dropped insurances where it’s been appropriate and it’s not appropriate for every location or every region to do that, just depending on your patient base, but when people have done it the right way, it seems to have usually reduced workload and increased margin, almost every time that I’ve seen that.

Vivek Kinra:
Oh, worked like crazy.

Ryan Isaac:
Yeah.

Vivek Kinra:
Here’s what I typically say, I get a lot of like, “Hey, is it worth it for me?”

Ryan Isaac:
Right. Yeah, I’m sure. It seems like a pain? Is there a lot of downside or what’s the pain of going through it, what do people have to give up or deal with?

Vivek Kinra:
There’s a big downside. No doubt. It is a painful process, it’s a frustrating process, and largely because a lot of uncertainty exists. And with some insurance companies, before we can get you a better fee, we almost have to take you out of network first, and that’s a pretty like… It’s not for everyone, but some of them. And it’s a very daunting thing for a dentist, largely because this kind of myth exists where the doctors feel if I go out of network, all of my patients are gonna leave.

Ryan Isaac:
Yeah.

Vivek Kinra:
In reality, I’ve never seen that actually materialize, and what people don’t realize is that when you’re out of network, you actually get paid more.

Ryan Isaac:
Exactly.

Vivek Kinra:
And it’s a bigger price to dentists.

Ryan Isaac:
Yeah, I’ve seen that and a lot of feedback I’ve heard too, which is the by-product of this, which is what a lot of dentists really truly want, that’s non-financial, is they have more time to spend with patients, they’re not rushing as much, they’re not as frantic and yeah, they reduce workloads, they can spend more time or quality time with patients, and they get paid more, they get paid more money, profitability, income, like every time.

Vivek Kinra:
100%. And I think my wife is the classic example for that, when she got started, and she was like hustling like working really hard on her assistance, it was extremely busy every day, sometimes she’s always coming really, really late because the patients got backed up, etcetera, and so in her practice we just saw a huge distance. First year, we just saw a very high increase in our collections and that increased quite a bit, but now the good thing is that now we have two kids. And what we’ve said is slow down, so there was a time she was doing five days a week, then went to four, and today was the first day when she went to three, like today is Monday, and she took it out. So from now on when she’s no longer working Mondays, so now she works Tuesdays, Wednesdays and Thursdays, so for us now it’s like, “Okay, we can give up some income, but it’s still higher than, way higher than what we had before we did this process.” So now I was like, alright, no point like getting ourselves, we’ve got two young kids, enjoy life a little bit. Fortunately, my companies are doing fine, so take a step back and everybody is kind of happier with that.

Matt Mulcock: On The Dentist Money Show, we teach dentists how to make smart financial decisions.

Ryan Isaac:
You’re correct.

Matt Mulcock:
I mean, is that all it takes, Ryan, to make smart financial decisions, listening to our show?

Ryan Isaac:
Matt, it’s a good first step. But to put your financial future on the fast track, the next smart decision is to go to dentistadvisors.com. What you do there is you click on the Book Free Consultation button right in the middle of the home screen and then you schedule a time to talk with one of our very friendly dental specific financial advisors today.

Ryan Isaac:
What are the cases where that just does not work for people, where dropping insurances or going out of network, is not… Just it’s not a good business option for people?

Vivek Kinra:
I have not seen that, and it’s funny.

Ryan Isaac:
Okay.

Vivek Kinra:
Because even folks that say, I mean, as you can imagine, right? The most common hesitation is, “Vivek, what are you talking about? You don’t know my patients.” Right?

Ryan Isaac:
Yeah.

Vivek Kinra:
Like I am in a place where there’s a Starbucks and a dental office at every corner, and everybody is in network. And you’re telling me that I’ll need to go out of network with Aetna for a few months. All of my patients are going to go to the practice that’s on the left and the practice that’s on the right.

Ryan Isaac:
You’re right. Yeah.

Vivek Kinra:
But in reality, it doesn’t work like that because we manage it well, right? Like I’m never dismissive of this concern because I’ve lived through it hundreds of times now.

Ryan Isaac:
Yeah.

Vivek Kinra:
Leading with our practice.

Ryan Isaac:
Yeah.

Vivek Kinra:
And now we just have ways to mitigate it and we write the letters for them, to send them out as an email to the patients about what they can expect. I re-coach their teams, right? Just verbally on how to look at which policy it is, on how to handle that. So it becomes a very much like, handle each patient and each insurance policy as it comes and what dentists find out, it’s completely opposite. It’s so strange, because what ends up happening is, once they’re out of network and they’re seeing their cheques that are their full fee, I get a question saying, “Vivek, why do I have to go back in network now?” Right? And I’m like, “You don’t?” And like, “Yeah, excellent.” Nobody is…

Ryan Isaac:
Yeah. Yeah. We don’t want to. Yeah.

Vivek Kinra:
Right. Right. And it’s really strange. We had a doctor out in, I think, Pennsylvania. She was really, really upset about being out of network with Aetna, and it was taking really, really long. And then like, doctor, to be perfectly honest, a lot of our doctors would say, “Stay out of network. See how it goes.”

Ryan Isaac:
Yeah.

Vivek Kinra:
And now she’s like, “Keep me out.” And in fact, we sent her an email saying, “Hey, I think you’re about to get back in network with Aetna.” She sent us an email back, “Absolutely not.”

Ryan Isaac:
No way. Yeah.

Vivek Kinra:
Make sure. And she was very, very, like precise.

Ryan Isaac:
Yeah.

Vivek Kinra:
Like, I’m not getting back in network.

Ryan Isaac:
Yeah, and it’s, I mean, how fascinating is that, you know, I… And you hear this, too. Everyone wants to grow their practice. Everyone wants to do more revenue… People just wanna earn more money, whether that’s more locations or partners or whatever it is, right? I’m constantly surprised at how many ways you can grow the revenue and profitability and so income of a practice that have nothing to do with new patients, new locations, new doctors, I mean, there’s so much to do, that’s not even new marketing.

Vivek Kinra:
That’s right.

Ryan Isaac:
And that’s one… This is just one of my favourite places to begin because it feels like one of the most obvious. Let me ask you this. How often should people be going through a process like this, whether analyzing what’s working and what’s not working, what do we do with insurances? How frequent should this be on their minds?

Vivek Kinra:
Yeah. I mean, a lot of people think it’s like two years, etcetera.

Ryan Isaac:
Okay.

Vivek Kinra:
Not really, right? I mean, it’s all dependent on how good of a job do you do, and how well you’re structured and stay on top of it. So for us, what happens is, we’ve had clients since the company’s been open for three years now. Now the clients that we got started, earlier on, who are coming back and saying, “Hey, Vivek, time to redo it again”. Right? And I’m looking at them, I’m like, “Don’t even touch it. Because what you’ve got, nobody can get right now. You can’t even increase it. The only thing you need to do is… ” So we eventually came up with a support agreement, which is basically a monthly support thing, where we just like keep track of it to make sure nobody screws it up. And we constantly negotiate with any insurance as soon as we see that’s possible. So and the reason why that’s so important is because what ends up happening is, people are like, “Okay, I’ll go in six years, or five years, to redo this process.” Right?

Ryan Isaac:
Yeah.

Vivek Kinra:
I mean, network with 15 insurances. Well, the thing is that they could have gotten an increase for two of them, four years ago.

Ryan Isaac:
Yeah.

Vivek Kinra:
Like those increases for four years on those two insurances…

Ryan Isaac:
Maximizing, yeah…

Vivek Kinra:
It goes like tens of hundreds, right? Like…

Ryan Isaac:
Yeah.

Vivek Kinra:
And so it’s like don’t even… So this is now become for us the constant process. And so with us right now we’ve seen we could make a big change in like Aetna and United Healthcare, right? And so the folks that are, kind of on our support services agreement, we basically send them a message saying, “Hey, this is what we should do.” Right? So the good thing is it’s only two insurances, but we’re tackling them now versus five years down the road when they feel that they’ve got enough insurances that they want to reevaluate. So there’s no hard and fast rules for me.

Ryan Isaac:
Yeah, okay. Yeah, that makes sense. And that’s actually really good to hear. We get similar questions as investment advisors like, how to monitor stock markets and like move in and out of stocks, when things are good and bad, and we’re kind of like, well, that’s not… That’s probably not the place you should spend your time and effort and money trying to monitor daily or monthly, but, man, monitoring the insurance companies that are or are not paying your practice enough money is 100% worth monitoring with time and attention and money like totally. And is that service… Not a lot of people are doing that kind of constant monitoring, right?

Vivek Kinra:
I don’t know that. Actually, I do know of one company that does.

Ryan Isaac:
Okay. I’m just trying to think… I don’t think I’ve met anyone that’s gone through this process, but they’re also like, “Oh yeah, we’re monitoring this all year long just for changes,” and it totally should be done.

Vivek Kinra:
Somewhat unique for us, right? Because we throw in a lot of other stuff as well. We also, at that time wanna see how your in-office membership plan is doing. So on this agreement, we just meet once a month, right?

Ryan Isaac:
Cool.

Vivek Kinra:
And the big thing is, we just kinda stay ahead of it, and sometimes what happens is you have an office manager that believes that they really know what they’re doing, and I mean, I’m… I tell the doctors, I’m like, “Doctor, to be perfectly honest, what you’ve done is phenomenal, what you’ve got is phenomenal, the risk is somebody screws it up.”

Ryan Isaac:
Yes, yeah. Right, it’s set up, it’s ready to go, if it doesn’t get messed up along the way, but keeping something not messed up for years and years requires constant focus and someone’s gotta pay attention to it.

Vivek Kinra:
Right. And unfortunately, what happens is you’ve got an office manager who says, “I know how to credential, I know how to re-credential.” They just fill out some forms that they think and… Right? And all of a sudden, they just reduce fees for like… Just like this example of, “Oh, you know what? I’ll just sign up with United Concordia,” not realizing now you’re gonna drop fees for four other companies that we’ve got really high fees. And then we’re like, “Oh, no.” Because… And they’re like “I don’t know.” I’m like, “Yeah.” That’s the reason why we’re here, it’s because you don’t know what you don’t know.

Ryan Isaac:
And the insurance companies know it though.

Vivek Kinra:
Right, exactly.

Ryan Isaac:
Yeah, they definitely know what’s going on with that. And so, is it true also that even once you’ve negotiated the proper rates and network and all that kinda stuff, that insurance companies can still… I’ll give them the benefit of the doubt, that it’s totally accidental, but they can still mess up your contracted rates or just not pay what’s been contracted, and if someone doesn’t notice it in your office, then it just goes unnoticed? Is that common?

Vivek Kinra:
No. They typically will send you a letter saying, “Hey, just so you know.” And this year has been like a crazy number of companies that are just saying, “Hey, just so you know, in 2022 we’re paying you less.” And it happened with Cigna, it happened with United Healthcare, it happened with Aetna. And so, it’s been a challenging year in that regard, but generally, they wouldn’t automatically do it but if you do have it where let’s say you’ve got United Concordia, that a doctor just signed up with and there’s a contract with Ameritas. Ameritas has full right to pay off the lowest paying network they can find. So now if they see United Concordia, they’ll just start paying off United Concordia at a lower fee without telling anybody.

Ryan Isaac:
Yeah, and this is not… This seems like something a lot of doctors are probably not aware of, the logistics, the details of how this is really working, right?

Vivek Kinra:
Right.

Ryan Isaac:
They’re just seeing income or no income coming home and they’re maybe wondering what’s going on, we’re collecting but… Or we’re producing, but we’re not really collecting and we don’t know what’s going on.

Vivek Kinra:
Common. And honestly, it’s gotten so complex, insurance companies no longer know it.

Ryan Isaac:
Oh, yeah, okay.

Vivek Kinra:
Yeah.

Ryan Isaac:
Yeah, that’s probably true. Man, I feel like there’s probably so many ways we could dive into this, but let’s give people some actionable things to do here, if they’re listening to this and they’re wondering about which insurances to keep or not keep, how to negotiate, how to set fees, in-office membership, insurance verifications processing, all that kind of stuff, where do they begin with Verrific and PPO profits? How do they reach out and what are some good first steps that people can expect?

Vivek Kinra:
I mean, so the first… I maintain a pretty public Facebook profile, so most of the time people just kinda reach out on Facebook or message, etcetera.

Ryan Isaac:
Let’s do this, yep, okay.

Vivek Kinra:
Where I direct them is the ppoprofits.com website. So on there, I do two webinars a week, and these are live interactive webinars where many doctors come over and they ask questions, etcetera, and the good thing is that when you’ve got 20 doctors on a webinar, when one doctor asks a question, I can answer it for the rest of them, and very often, we end up answering questions that a doctor never thought about it yet, but it was very pertinent. So these are the right assessments, so if you’re gonna register for it, go to…

Ryan Isaac:
Twice a month, ppoprofits.com, and you’re running those…

Vivek Kinra:
Twice a week.

Ryan Isaac:
Oh, twice a week? Yeah.

Vivek Kinra:
Yeah. Yeah.

Ryan Isaac:
You’re a busy man. And no wonder you’re not going to bed til 4:00 AM.

Vivek Kinra:
Yeah.

Ryan Isaac:
Okay. So reach out, PPO… And then what’s the process like of just kind of investigating what insurance is like and margins are like and fees and that kind of stuff? What’s the process like once they engage with you guys?

Vivek Kinra:
We don’t get started, we don’t actually… So once a client gets started with us, unfortunately, we don’t have a pre-analysis method.

Ryan Isaac:
Yeah, sure.

Vivek Kinra:
And also because we’re kinda, knock on wood, again, I’m gonna like… It’s a second lamb I’ll have to sacrifice but we have a very high backlog right now, so we’re about two and a half months behind with the waitlist so what happens is when doctors get started today, in about 10, eight to 10 weeks, we start the process, and then at that time, we’ll start collecting all the information about their current insurance map, we’ll start negotiating and then in three to four weeks, we’ll basically present everything to them about what we can do, etcetera. By the way, on the same website, at PPO Profits, if you go there, you’ll see Help with Insurance Patients and, Help with Cash Patients, and if you’re looking for a in-office membership plan, there’s a… You can schedule a private demo there.

Ryan Isaac:
Cool.

Vivek Kinra:
Same thing with Verrific. If you go there, you can schedule a demo.

Ryan Isaac:
Yeah, these days, I think if a practice is running without a membership plan, there’s just money sitting there left on the table, it should be… It’s a must in everybody’s practice these days.

Vivek Kinra:
Yeah, yeah.

Ryan Isaac:
100%. I feel like that flew by our time together but anything else you’d like to leave people with? Any parting words of wisdom and experience that you’ve seen people go through?

Vivek Kinra:
No, I mean, the most important thing really is that, I think, what we’ve put together overall, through the two companies, I’m obviously incredibly proud of what we’ve built. And our main thing that, I talk a lot about it as well, that our internal focus has always been being best in class. I didn’t care about the 15, 20 companies that exist in fee negotiation or in-office membership plan or even more in insurance verifications, our main thought process has always been the best in class, to be best in class, and I really believe that. But I think fee negotiations, if anybody said, “I’m gonna do one thing for my dental practice in 2022, that’s all I’m gonna do. I don’t wanna do anything, I’m gonna take the bare minimum Cs to keep my license.” That one thing I believe should be fee negotiations, it’s like a win.

Ryan Isaac:
Okay. And I like… And then ultimately, that’s what people are looking for. It’s like, “How do I just do what I’m doing, just make it a little bit more efficient and earn a little bit more money?” And from a net worth perspective, increasing your income by 25 grand a year, 50 grand a year, some people it’s six figures, you’ve seen this, I’ve seen this, that amount of money increased, or lost, left on the table is a massive difference over decades in a career in terms of net worth, it’s huge.

Vivek Kinra:
Absolutely, absolutely. But, I tell people, this is, in their course of lifetime, this is a million dollar problem.

Ryan Isaac:
I agree.

Vivek Kinra:
Yeah.

Ryan Isaac:
Yeah, I totally agree. There’s things worth like in a dentist’s life, there’s things worth stressing about and being obsessive about, and these details of the practice and their profitability basically, is top of the list, top of the priority, I totally agree with that.

Vivek Kinra: You’re right.

Ryan Isaac:
Well, thanks for spending some time and being with us, we’ll probably… We should probably do like, maybe do like a webinar or something, get into a little bit more detail, take some live Q&A one of these months coming up in 2022, but thanks for being with us, again, ppoprofits.com, that’s where we’ll link everyone to, and thank you for your time, thanks for being with us today, thank you all you listeners for joining us again, and reach out, get in touch, ppoprofits.com. Again, 2022, that’s a high priority list for your practice and your net worth, do it, so Vivek, thanks for being with us. Thanks everyone for listening, we’ll catch you next time. Take care, bye-bye.

Practice Management

Get Our Latest Content

Sign-up to receive email notifications when we publish new articles, podcasts, courses, eGuides, and videos in our education library.

Subscribe Now

Related Resources