DSO Case Study – Reimbursement

Sponsored Content

Interview with CEO Dr. Alex Giannini of Blackford Dental Management:

The reason I sought out Apex is that we do not have the expertise within our organization to approach an insurance company and negotiate effectively. Prior to Apex, our best approach was to say, “Listen, we have dentists to take care of all the patients in your network, but give us a better reimbursement rate. What kind of deal can you give us?” Apex has demonstrated the ability to negotiate better reimbursement rates for our dentists.

They’ve negotiated fees for us, and they’ve done a great job. The increase in reimbursement rates has ranged from eight percent to 26 percent, depending on the insurance companies. I want to focus on 80 percent of the procedures we do. The logical thing to do is to understand the procedures and services you do the most, and then negotiate those, such as fillings, crowns, dentures and cleanings. They’ve done a great job on the negotiation of the reimbursement for us.

Apex’s maintenance of the relationships with the insurance companies saves me the time of having to build relationships with the carriers. It’s all about creating a good, harmonious relationship with all parties. We’re not partners with insurance companies, but we have in common the best interests of the patients we serve. It’s important that we both do our part to take care of patients and do it in a fashion that allows us to be profitable.

Each insurance company operates differently in processing claims and the information they need and want. Now, we have a more customized, better understanding of each insurance company and what’s required to operate with them.

Apex has the knowledge and expertise necessary to help us execute this critical portion of the DSO model to properly leverage our growth and size. We hadn’t realized or properly leveraged our collaborative strengths, with the insurance companies. Think of the amount of labor an insurance company has to invest to deal with 77 different dentists. They now don’t have to train 77 different dentists to work collaboratively with them. From that aspect, with Apex, we’re one unit, so it saves the insurance company a lot of time and money.

Apex has created a win-win scenario for both us and the insurance company. The advantage to the insurance companies is that we save them a lot of time and money, so they’re willing to work with us and give us an increase in fees which means that we don’t have any money left on the table.

After working with Apex we were able to reclaim 15 percent of our overall revenue. That translated to millions in revenue in 2015. The dentists now earn more because of the higher rates, and the organization has a healthier bottom line.

There are plenty of competitors in the market, however Apex had a fresh, new attitude about it. I chose them because they had a slightly different approach. From the beginning, they gave me the feeling that they were going to represent me as an individual, and not just another dental-management company.

So, to review: While our revenue grew, our margins swelled year over year. You win with Apex and we are very happy with the gentlemen at Apex. Great job!

To contact Apex please click here, or visit our booth #320 at the AADGP meeting in Las Vegas.

Written by Hillel Kuttler