954: Big Changes With Insurances You Need to Know About – Shelley DeGroff

Working with PPOs is more confusing than ever — and it’s by design! In this episode, Kirk Behrendt brings back Shelley DeGroff, founder and CEO of PPO Advisors, to help decode the complexity around upcoming changes and help you be an active player in the game of insurance. To stay up to date with the new changes and become less insurance dependent, listen to Episode 954 of The Best Practices Show!

Learn More About Shelley:

• Send Shelley an email: [email protected] 
• Join PPO Advisors on Facebook: https://www.facebook.com/PPOAdvisorsLLC
• Learn more about PPO Advisors: https://ppoadvisors.com

More Helpful Links for a Better Practice & a Better Life:

• Subscribe to The Best Practices Show: https://the-best-practices-show.captivate.fm/listen
• Join The Best Practices Association: https://www.actdental.com/bpa
• Download ACT’s BPA app on the Apple App Store: https://apps.apple.com/us/app/best-practices-association/id6738960360
• Download ACT’s BPA app on the Google Play Store: https://play.google.com/store/apps/details?id=com.actdental.join&hl=en_US
• Join ACT’s To The Top Study Club: https://www.actdental.com/ttt
• Get The Best Practices Magazine for free: https://www.actdental.com/magazine
• Please leave us a review on the podcast: https://podcasts.apple.com/us/podcast/the-best-practices-show-with-kirk-behrendt/id1223838218

Episode Resources:

• Watch the video version of Episode 954: https://www.youtube.com/@actdental/videos

Main Takeaways:

• Think of insurance as a game. Be an active player!
• Understand the contracts you're agreeing to, long term.
• Insurance confusion is by design. Don't just set it and forget it!
• Audit your EOBs daily. Do the math and figure out why fees are different.
• New associates cannot use the owning doctor's NPI-1 — it is insurance fraud.
• Success is not determined by the number of insurance you do or don't participate in.

Snippets:

0:00 Introduction.

1:53 Shelley’s background.

2:51 The current state of PPOs.

5:22 Why are these changes legal?

9:08 Confusion is by design.

11:07 Be an active player in the insurance game.

12:22 How often should you audit EOBs?

14:30 Is any of this negotiable?

16:16 Provider-specific credentialing, explained.

18:25 How long does it take to credential?

20:10 NPI fraud, explained.

23:12 Other upcoming changes.

27:57 The trend of non-dentists purchasing dental practices.

31:12 Lose your dependency on insurance.

40:45 About PPO Advisors and how to get in touch.

Shelley DeGroff Bio: 

Shelley DeGroff, founder and CEO of PPO Advisors, knows dentistry. After graduating from the University of Nebraska, she began working as a dental receptionist in a nearby dental office. After completing her certification as a dental assistant, Shelley transitioned to become a successful office manager. It was in that role that Shelley began noticing the need for PPO negotiations for her employing doctor. This experience began the business model for PPO Advisors, which has now become a nationwide industry leader.