Rob and Paul host Vivek Kinra, CEO of PPO Profits, a firm solely dedicated to increasing the PPO insurance reimbursements for dentists. In the episode, Vivek speaks with Paul and Rob about best practices for the insurance credentialing and fee schedule negotiation process (including a little-known tip for associates) and how investing in that process can yield returns down the road.

Vivek spent the early part of his career as a computer engineer leading software development teams for some major firms before helping his wife with her dental practice startup in Chicago. After building the business side of that dental practice, he realized that the biggest improvement to the bottom line can be made simply by getting better reimbursements from the PPO insurance companies and he now shares that passion and expertise with dentists around the country.

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Full Transcript:

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Intro: Welcome to the Dental Amigos podcast with Dr. Paul Goodman and attorney Rob Montgomery, taking you behind the scenes of the dental business world. All the things you didn't learn in dental school, but wish you had. Rob is not a dentist and Paul's not a lawyer, but since Rob is a lawyer we need to tell you that this podcast is for informational purposes only and shouldn't be considered legal advice. Listening to this podcast does not and will not create an attorney client relationship, as is always the case. You should formally consult with legal counsel before proceeding with any legal matter. Learn more about the Dental Amigos at www.thedentalamigos.com. And now, here are the Dental Amigos.

Rob: Hi all, I'm Rob Montgomery and I'm joined as always by the head nacho himself, Dr. Paul Goodman.

Paul: Great to be here, Rob.

Rob: Paul. It's good to see you as always and welcome everyone to another episode of the dental Amigos. Today we have a special guest Vivek Kinra, who is the CEO of PPO profits from solely dedicated to increasing the PPO insurance reimbursements for dentists across the country. Vivek spent most of his career so far as a computer engineer, leading software development teams for some major firms. However, he's transitioned to the dental field to help his dentist wife build a scratch startup in Chicago. After building the business side for the practice, he realized that the biggest improvement to the bottom line there can be made simply by getting better reimbursements from PPO insurance companies. So now he is in the insurance consulting business. And now without further ado, here's Vivek Kinra. Welcome amigo. And thanks for being on the show.

Vivek: Alright, thank you for having me a gift. I mean you guys, and I will say this, um, I actually never realized that your, your podcast, um, was called Dental Amigos. I call everyone amigo by the way.

Paul: Nice. Yeah, we're the, we're the Amigos, Vivek. We get the hard stuff out of the way first, feel free. Yeah, we've had the pleasure of meeting in person and we'll talk, talk about that. But let's say, you know, we're in, in Chicago, we're going out for nachos. Where would we go and what is your favorite toping?

Vivek: You're going to boot me out of this podcast, my friend. As soon as I said that, but uh, I don't think we'll go for, for nachos. I'm on a, I'm on a very, very strict diet. Um, and I'm not a big fan of nachos.

Paul: Oh wow. You're off the podcast. We're done.

Rob: Vivek is not the first person who has said that, that we had, we had another guest that said he didn't like, didn't like nachos. And we did, we were able to proceed with the interview.

Paul: This just shows you you've lived with. Your wife is awesome. She's just fantastic. Clearly the winner in your relationship, just, just joking. But this just shows how much dentist is inside of you because you could have just said chicken and that would've been good enough. So what would you pick? I'll give you the dentist answer. Where would we go for food in Chicago?

Vivek: Ooh man. We'll probably go to this place called Toro Sushi. The best sushi in Chicago.

Rob: Nice.

Vivek: And I'm not paid to say that I like sushi too.

Rob: We might have to rename the podcast today. Right.

Paul: There's been a whole movement online. Every time I say people want to do dental pizza, you could do dental sushi. So you know, you can start it.

Rob: And so Vivek it's interesting how you got into the dental insurance business, but tell us a little bit about what you did before you were helping your wife with her startup and specifically the, some of these PPO issues that we're going to talk about for most of the show.

Vivek: Yeah. I was a computer nerd, right? I used to write software for robotics, navigation systems. Um, my, my role was very focused on leading technically, you know, uh, technical development teams. And so, um, while my wife started the scratch practice, I was a VP of mobile application development for a major firm here in Chicago. And so I was focused on my own career and once my wife started the scratch practice, you know, in all honesty, it wasn't doing very, very hot and I was really bored from my job. Um, you know, I'm a, I'm a bit of an entrepreneur at heart and so I used to find myself, even in my corporate work meetings, thinking about the dental office and chatting with my team on Slack. We used to have a Slack team for the dental office. And so I realized, you know, my heart's actually taking me this way, the dental offices and doing that while, so I might as well actually, you know, take the leap, uh, and, and leave my position and spend time there.

Vivek: And as soon as I did that, I mean, I kinda fell in love with the industry. Um, and, and started really enjoying the business side of dentistry. Uh, got a lot of kicks off of that. And then one of the things that I realized that, you know, their insurance reimbursements that we used to get were just all over the place, right? I mean one company paying has $1100 for crown, the other company's paying $700 for a crown on another company's paying $650 for a crown. Right. And it made no sense. And so I started basically just kind of, you know, starting making to started to make some phone calls, write to these insurance companies. And I remember in October and November of 2017 I spent an insane amount of time with these insurance companies. And what I ended up realizing is that there is just this big complex web that exists with insurances that kind of piggyback off, you know, off of each other.

Vivek: And so just kind of quickly, I realized, okay, if I did this, if I restructure some contracts, if I terminate this, or if I do this, I should be able to get better fees. And absolutely that's how it worked. And then I realized that there is a, there is a, an opportunity there because our reimbursements with some insurance companies - legitimately one day we were getting $729, and this is absolute proof story. February 28th of 2018 this particular insurance company used to pay a $729 for a crown March 1st, $1102 and now they pay $1194. Right? Such a big gap between that. And so, you know, I just basically started bringing this up. So I spent first went into a consulting role, um, where I built a company where we do insurance verifications and claims processes, et cetera, for a percentage of collections. Now if you think about it, right when we're getting paid on a percentage of collections, I have a very strong vested interest in increasing the collections off the dental office so that we make more, right? And I realized the simplest way I can do that is to just get them better fees. Well, once I started doing that, the news spread and all of a sudden this thing kind of just took a life of its own, I split that into a separate company and that's now PPO profits completely solely dedicated to just insurance reimbursements.

Paul: That's an awesome story Vivek. And we've had a chance to talk on Facebook online and in person about this as we've gone on. But just a couple of things you said that I like to just point out to our listeners because I mean you were one of the early dental notch oars and I actually always like seeing your notifications cause you were one of the few people that could argue with me but it never, you know, we were respectful and I really enjoyed the back and forth. Now we know each other but there was something that you said in the beginning of Dental Nachos. I would just like to bring to light with my good amigo who's also a non dentist here, Rob Montgomery. So we have two non-dentists and in the beginning of our time of vac I was saying, you know, it's tough being a dentist. It's stressful. You know, you work so hard, you know you're not getting paid what used to get paid. Insurance companies are tough and you said to me, Oh Paul, you know, dentistry is still a good job and you know, if you're making this amount of money, it's better than you know, another job. But over the past couple of years being with your wife, could you give us an update on your feeling on the stress level to be a dentist every day?

Vivek: Oh my opinion and thoughts and feelings on that has completely evolved. Right? Because I used to be at the dental office every single day. Right. And the level of stress that exists, just managing the expectations and dealing with people who are, you know, it's one of those things where I was thinking if there's any of the professional like this, and I couldn't think about it, right. Like legitimately it's such a fine art where little thing and cause a lot of issues patients don't like, you don't want to be there. Right. It's not like, it's not like going to a hair salon right. Where you've been, I enjoy it. Right. You want to spend money there, right. Or, you know, some other cosmetic medical procedures like Botox, right. I mean you're looking forward to that here. You don't want to go there. It's, it's little things that can make big differences.

Vivek: On top of that you deal with patient's insurance because it's such an insurance driven, uh, world where, you know, they walk in thinking that everything is going to get covered. I mean the whole thing is just so ridiculous to be stressful that now I definitely believe dentists who are also business owners, right? That combination of the solo dentist with a business owner is extremely, extremely stressful. And these folks are what their weight in gold. I actually don't know any single profession in America anymore that has that because the solo business model for most professionals is gone, right? Uh, I know Robert is a, is an attorney. The model there is still like, uh, you know, multiple attorneys forming a practice typically. Right? And then you add partners. Pharmacists got bought by uh, the corporates, right? Doctors now work for hospitals, right? So there really is no other profession professional remaining where the individual is also the business owner and dealing with some very complex situations.

Paul: I appreciate that Vivek. I know you can take this cause that's in Rob's theme of this podcast has helped me many times in life is awareness. So I was just sharing the awareness with you. So in the most nacho kind way I told you so. Right. So, you know, it's a, it's something I try to bring to light in a way that is realistic and what you're doing with your company's helpful. And just as, as I let Rob as something, I just have one other thing, can you just share with the listeners why your wife couldn't have done what you did? I mean, you know, the time that you spent prior to starting your company was labor intensive to get these new fees. Am I correct?

Vivek: Very labor intensive. Um, and I mean there's so many reasons, right? I mean, you just don't know what you don't know. Right.

Rob: Amen.

Vivek: And how do you find this out? I mean, there is no one telling you what to do here because the reality is most people don't know. Most consultants don't know. Right? I mean, and so it's just one of those things where I kind of stumbled upon it, right? And then I kept telling, digging, digging, digging until I kind of drew out this map upon all the insurances, work in the different States, claim consuming labor intensive, um, and, and with a great degree of uncertainty. Right? Uh, I mean, it's not like if you tell a dentist you can spend two months and get 60% higher fees, then they're trying to find the time somewhere. Right? But, uh, but there's a level of uncertainty there too that it might not work. So now it's one of those things. I, you know, there's so many dentists that I talk to and once in a while somebody would say, well, is this something that I can do? And I'm like, no, I mean, I, and I'm not saying it because it's how serving I'm saying it because it's accurate that there's just no way. I mean, it's just too much.

Rob: Well, we see this a lot where, and we have this conversation with people, you know, can they do certain things by themselves? People being dentists. And the answer is you can, but can you do it as well? And you know, if you can't do it as well, then how much less than as well are you going to do it? And then what's the cost of that? You know? And I think there are a lot of crossover in what you do and what we do in that if somebody can read an agreement or somebody can pick up the phone and call an insurance company. But as we both know that that's the beginning of the process and it's knowing what to expect and what you can ask for and what the limits are that, and it's your experience that you leverage to be able to tell people like, Hey, this is, this is an acceptable deal that's being offered to you.

Paul: But you know what's interesting to me too about your story is sort of along those lines too. You know, it doesn't make sense for a lot of times for people to do something once and for the first time and to do it only once. You know, like you've took this experience that you had with your wife and you leverage that, the time that you spent into developing this standalone business. So, but a lot of business owners in dental business owners don't have, it doesn't make sense to learn how to fix the computers or learn, you know, all the ins and outs of HIPAA on your own or learn how to all the ins and outs of insurance negotiation on your own because somebody else can do it better who's done it a number of times and you know, the learning curve, it's sort of like, it's almost for, not in some cases.

Vivek: Oh for sure.

Paul: And the reason I would just chime in and I kind of led you to this and Rob gave me a good points back is you know, I, you know, enjoyed meeting your wife, reminded me of myself, busy practice owner doing things. The other thing that we just left out is even if you could do this, there's no time to do it between 9:00 and 5:00 PM because you're seeing patients, you're checking hygiene, you're working on your lab cases, you're planning cases. So there's just this the world, there's just no time to make those - I mean, you and I have spoken at depth Beck, there's no time to make those calls or emails or figure this out during a workday. So that just adds another layer to the impossibility of it because you're, you're just engaged in patient care and if you're not engaged in patient care, you're engaged in running your circus and that's just your primary goal, your dental circus during the day.

Rob: I mean, that's when I have clients and I say, you know, who are you going to use to help you with the insurance credentialing who are doing a startup or an acquisition? And they said, we're going to do it ourselves. And they all have a full time job. I answer that is when, right? Yes, exactly. But you know, I'm curious, you know, uh, Vivek when you say you spend a lot of time, if you can kind of try to quantify that a little bit, just so people have an idea of kind of how much time you had to spend to really get your arms around this.

Vivek: Yeah, I mean, um, a lot of it was in a, now that I know, you know what I'm doing and I have, you know, planes everywhere and all this stuff,

Rob: Not now I'm not saying now, I mean obviously now you're experienced, I mean, back then when you were kind of the new, you know, sort of code dental practice owner with your wife, which, you know, our spouses are sort of guilty by association when it comes to, comes to these things. Paul's wife can attest to that. My wife can attest to that. But you, when you were just kind of figuring it out, like how much time were you spending on, on a daily basis, roughly or on a weekly basis, whatever.

Vivek: It's tough to quantify that. I would say that between October and November of 2017 the total time that I've been on with insurances is probably about 25, 30 hours. Right? I mean, it doesn't sound like a lot, but when you're on hold for 40 minutes just to get to someone, right? I mean it's, it's painful. Um, yeah. I mean I would say about 20, 30 hours of just like talking to the different folks at the different insurance companies to kind of piece together this puzzle, you know, and credentialing is, uh, the easy part, right? I mean, it legitimately, credentialing is just filling out paperwork, right? How to sign up for a contract and how to negotiate and how to, how to leverage how all the networks talk to each other. That's the, that's the secret. It took about, you know, about 20, 30 hours of just on the phone to like learn that.

Vivek: And there is, and it's funny because there was a time that in our office there was a whiteboard and a legitimately had all these insurance companies, you know, their names were come down, right? And it's just like in a detective movie, right? I mean, you had these like pins and then you'd like tie them together with treads and all that stuff, right? That's Howard was for me, right. I'm drawing this line between this company to this company. Right? And what I mean, you know not to be too cryptic, right? Like Aetna and Guardian as an example, for example, right? They, they, they share a network, which means if you sign up a contract with Aetna, you automatically become a network with DoDEA. Just dogging picks you up on echo. Same thing with, with principal in Americus, right? If you join a network with Principal, right? You are now in network or the Americas even though you never signed a contract.

Paul: I want to pause you for a second Vivek because this has happened to me in the olden days before Facebook, even before and now it's hard to be bullied before the Rob Montgomery time, when I first started with my dad. And that would happen where someone would come in and say, you take my insurance and we, we'd never heard of it. And then we asked if we could see the contract we signed and they never sent it to us. So it was like a weird movie because somehow you're in this network and now I learned from you that that's what had happened. And I mean, you know, maybe this is, you know, seems, we would know this now, but this was, you know, 2005 or six where you know, you can sign one contract and then automatically be in some network you've never heard of. Are the fees different? And we can ask her back usually. Yes, usually. I mean Vivek can tell us, I mean, we can start, I have a couple of things and I think you'll help our listeners and also what Rob and I do on a daily basis. I mean, walk us through, you know, you're, you get hired as a new associate. They say sign these different credentialing forms. Why should they ask questions first or reach out to somebody like you?

Vivek: Yeah, I mean, I, I don't think anybody should sign any sort of credentialing because that's such a huge mistake that somebody is making in their career. It's just, I can't even stress this like ridiculously expensive mistake for their career that they're gonna make because what happens is no, uh, you know, most associates eventually wanted to start their own practice and all that stuff. Right? And then what happens is that when they sign, right, there are certain insurances that follow them. For example, United Concordia is a very prime example. This happens so often in about six different States that, you know, associates signs, you know, the contract with credentialing for, you know, with the owner and they're now in network with United Concordia. Then they will go ahead and start their own practice. The problem is United Concordia is the only company out there that ignores the different tax ID and takes that fee schedule that the owner had and applies it to the, to the different office.

Vivek: But blue cross blue shield, even though you've never signed a contract with blue cross blue shield in the new practice piggybacks off of the United Concordia fee schedule. So what happens is you send a claim to blue cross blue shield and it got paid on the United Concordia fee schedule and you're like, I never signed a contract either with United Concordia or with blue cross blue shield. Why am I getting paid at these really, really low fees? Right? So people just don't recognize that these kinds of things happen later on in the career, which is why it's always good to call them. You know what more than likely, what I'll do in a situation like this is us talked to the owner and prior to first negotiate their fees to get them to a good level before the associate, uh, signing up. Uh, because what ends up happening, this is such a common thing that happens in my, in my, in my world, right?

Vivek: We're working with a startup, right? And have submitted. Now there's a lot of AI out there where basically it's checking all the claim data. And I'm sometimes told this dentist has been accepting these little fees at this location for the last four years. We can't give him the high fees that you're requesting. Right. And so, so in essence what happens is, even though they're going to go to a different tax ID, all that claim data that they've accepted at a particular location, these companies know and they base the fees they're going to propose to you based on a lot of this knowledge. So all of us get to like call someone like me, and the best thing I can do for their career is negotiate and get higher keys for their, their boss at that time because that's going to help them in the future.

Rob: Wow. So that's amazing. So what you do as an associate greatly impacts what, what's gonna happen to you as a practice owner.

Paul: And, and to just piggyback on that for a couple of things over the back, and I have a collaborative relationship. He, when I send him someone, he sends me all those nachos. He doesn't, doesn't want to eat, but we have a collab relationship. We've done some stuff on the nacho group, but I'm so happy to have him as a resource. Cause what he shared there is, you know, you're an associate, you get hired by an office cause they need, they need an associate, want one. And you can actually bring a good idea to this practice, Vivek's service and change that practice forever. And the owner will be like, I'm so glad to have you because the owner would have never known about it. So when we had the Local Med on a person recently, uh, Tom, I suggest associates bring that with them. So why, you know, the owner has tools, why can't the associate bring tools to the owner and you know, make it really, you know, the nacho way of collaboration. So I just think it's important that, you know, Rob deals with this world a lot. And I do too, that you're what you're saying Vivek is associates can bring this idea to their owner because the owner just could be totally unaware they're getting low fees.

Vivek: Yeah. Oh absolutely.

Rob: So if, if, if an associate is in that situation and they've been accepting low fees as before, you know, while they were an associate before they're a practice owner, like is that something that over time you can help negotiate that higher or is that sort of like, Hey, sorry, you know, there's nothing, nothing can be done.

Vivek: No. You mean for if the associate then eventually moves on to a startup practice?

Rob: Yeah. Let's just say that we have an associate who's accepted low fees. They're now doing a startup and you get that response from an insurance company that says, Hey, you know, they've been taking accepting these low fees for all this time. We're not going to give you the number that you're looking for. Like what, what can you do or what do you do at that point to, to help them?

Vivek: Yeah. Like, I can still negotiate quite a bit higher. A lot of it is just built on some relationships. Right. Um, and then you know, you just have to find a way to kind of break peer from that associate position. Right now there are some companies, some insurance companies they don't care about if you were an associate somewhere else, right. They're going to treat it as a new location, a new tax ID. Right. So, so that's great. Right? Then there are a couple of companies that will basically look at where the provider has been working for. Right. And then typically very often it's just a phone call and I'm like, you know, to be quite honest and just getting his feet wet. But the startup practices opening is night and day difference between where he was associating. Right? I mean he's getting a CVCT and intraoral scanner and this is going to be a super high end practice, meaning a lot of money. So don't do this provider. Um, you know, on the, on the low fees that he had to accept, he had a daily minimum guarantee, etc. So he didn't really cared about what fees were getting paid cause he was still, you know, getting a daily, a minimum. Right. So, so those are some times you just have these conversations and you know, as long as you have the right relationships and, and you're polite, et cetera, bill understand. Right. And they'll come back and say, okay, you know, here's the fee schedule that we propose.

Rob: So you say you can fix it. However, in your world, the ideal situation is that you don't have to fix it. You can come in basically with clean hands and start from scratch and get an even better deal probably it sounds like.

Vivek: Yeah. I mean if I can tell you that the best piece that I can get for anyone is in the sounds and the falling. I've talked about it as very, very counterintuitive. Oppress graduate doing a startup, right? Yeah. Graduates in may and wants to do a startup in June. That person would get the highest fees then then the provider who's been, you know, associating for 20 years and now wants to purchase a practice. I mean that's just a weird world. We live in

Rob: Warning to listeners in that situation.

Paul: Do not try, but we brought us to a good point cause Rob, Rob's us startups and acquisitions and um, I'm a transitions broker so we arm wrestle what's better, a startup or an acquisition we're tied so far, but you know, share with us the vac a little bit. You know, when you take on a new client, you know, the acquisi you can work with acquisitions starters, but share the difference in your work on that and just some of the things people should be aware of.

Vivek: Yeah. With acquisitions, uh, number one, right? The timeline. So very often what happens is a few questions I'll ask if the seller already in network, right? And, and you know, there are companies that in like Delta dental, it impacts a lot, right? I mean, if the seller is already in network with Delta PPO, right at that particular location, it becomes very, very challenging for, for the, for the new buyer to become premier. Right. Um, but you know, I typically kind of see how this, uh, the, the seller was credentialed, right. And then if they were credentialed really poorly, right. Um, then I basically just kind of stay, tear off off anything to do with the right. I mean, I almost make submissions as if this was a startup, if that makes sense. Right. Uh, it's a brand new tax ID. Here's, you know, I don't even, you know, put it in there that this is a, this is an acquisition because the moment the insurance companies are, they know that distance an acquisition, they're going to start looking at what the seller has been accepting because the buyer agreed to purchase that practice, right?

Vivek: So, um, yeah, and, and you know, once in a while what we'll even do right, is, is to see if, uh, the center is willing to terminate a contract. Um, you know, because I know I can get much better fees, uh, than what the seller has, right? And so sometimes there's just a conversation that says, you know what, I'd like to terminate this contract. Now sometimes people think that the moment they terminate a contract, they become out of network. Uh, that's just not true because what ends up happening for most dentists, almost every dentist that I come across, uh, you know, who's already in network, they don't realize, but they are in network with a company like five or six different ways, right? Just like I shared with you that blue cross blue shield will piggyback off of the United Concordia, right? The a provider may be credentialed with United Concordia and a provider and the same provider may be credentialed the blue cross blue shield of Texas for example.

Vivek: Right? And you know, let's say that thing, well we can terminate blue cross blue shield of Texas. What, don't realize that even after they terminated with blue cross blue shield of Texas, you still stay in network now with the lower fees of United Concordia, right? So I typically wouldn't look at a look at how the seller is structured and how their contracts are set up. And then once in a while I'll say, okay, the seller needs to first terminate this contract because I can get you better fees. Um, you know, with this particular company, and I'm going to structure you a little differently. So it's really just a lot of it is just, you know, it's strategic, right? And we say, okay, once this thing is terminated, then if I make a submission to the new provider through the same company, now they're not seeing that this location, the provider is already in network and existing providers already network, right? So there is no fee schedule that they can say, we're just going to add a provider to this location. Now it's a brand new provider, right. Uh, so they have to come up with a brand new fee schedule. So that's, those are some of the things that are help a lot in, in, in practice transitions

Paul: And it was interesting for that. Can I just, you know, I'll bring it back to what, you know, when Rob and I go out to this one street in Philadelphia and you know, if they said there's a wait time at Alvez on Friday night, a 40 minutes, somebody who's never been there might be like, Oh my gosh, that's a long time. But no, we'd say, wow, that's short. You know, sometimes they say two hours, so I'm just using a couple of margaritas, just a few more greens at the bar. I know under the, what I'm saying to bring this up is young dentist or any dentist when they're acquiring or starting up, they don't even know if the fee schedule is looking at as good. So they at least have a reference point. So you can tell them that 40 minute wait is not so bad, you know, that is a good fee or this is a terrible fee or this is what you should expect.

Paul: And I think that, um, it just shows the importance of interrupts as purposeful planning during that transition time where sometimes, and it's normal, you know, the acquiring dentist starts to kind of freak out and say, I'll just sign up for everything the seller had and they could be signing up for something that just got impact them for decades. So you just need a timeout. And me, I do some, you know, buyer coaching and help with, you know, doula practice coaching. If you manage the patient's expectations and you just share the why with them, it's going to be okay. You know what I mean? You just, but you need to get your team on board to say, you know, we were talking, if you're, you're going to be seeing a patient for a visit that's not in network anymore. They have to know. Or sometimes they can just wait. I mean, how long, how long, how many months does it take you to do your Vivek magic? Is it about five months you said?

Vivek: Yeah, it's for startups. Uh, right around now it takes about five months. You know, to be confident. Um, you know, and if there is a, if I'm renegotiating existing contracts, right? So there's no acquisition, but there's a dentist that comes over and says, you know, these are my fees. Can you do better? Right. I tell them eight to 12 months now because I asked them a question, are you okay being out of network for a certain time? And they say no, which is very common. Then I let them know now this is an eight month process versus a five month because it would take me about five months to get better fees through to a different contract and it'll take me another three months, uh, to terminate your existing contract. Right. So that you don't fall out of network. And so that process then becomes eight months, nine, 12 months for glitches because insurances are very glitchy.

Rob: To me. What's interesting too, and obviously this is a business decision that you have to quantify, and I can, I can sympathize with the people that say, Hey, I have to maintain what I'm buying here. I can't possibly risk a gap in or a loss of goodwill. But it strikes me that it's really an investment in the future. Like it may be you have a couple of Rocky months where you have to deal with some of these issues with patients and informing them that they're now out of network. But if that means that your revenue for the foreseeable future annually is going to be 25 or 30% higher, well, you know, then maybe taking a pause there or kind of dealing with some, a couple of Rocky months that becomes a kind of a cheap investment in your future.

Paul: Tell him about what I kind of talked about it. I mean this is life changing for you as an owner and we, we, you had some good numbers. I mean, and I, I've, I look at them as our practice pretty closely. I mean, how many procedures is a dentist usually bill out a year? Uh, I think we were talking about some of the live

Vivek: one dentist to two hygienists over the year. Two insurances. About $4,000.

Paul: So I mean, you know, we've, we've, you used that just a dollar per procedure and you look at 20 years and I know you can make a lot, you can do better than that. But if dentists who are listening, it's just like, this is exactly what we're trying to talk about on our podcast is to look at each aspect of your business. And be purposeful about it. And this is something, you know, they don't share it all in dental school, which I have a real issue with because it's pretty much the most important thing. But at least you know, we have resources out there now. And um, I mean I basically say to people like, wouldn't you like to get paid more for doing the exact same thing?

Vivek: You know what's interesting that um, you know, cause this is a very, very common conversation almost daily. Um, I'm saying the same thing like this. I have a lot of startups that tells me, well I'm starting in two months. It's after I write it and I'm like, you want the good news person, the bad news person, right? The good news is I can get you far better fees than what you're used to. The bad news is for the first few months it's going to be painful for you because you're going to be out of network. Right? And so, and so, you know, the next followup question they always ask, is there a way that I can be in network in 60 days? I'm like, yes. With very poor fees, right? You can just add, add a location to your existing contracts, right? And insurance. We'll be super happy to just pick that low fee schedule and apply it to your new startup. And you will be networking 60 days. But, but you know, you're three months of pain and make your next thirty years so much better.

Rob: let me say this. I mean, anybody that's doing a startup that's waiting until 60 days before they're going to open a call you like, they've, that's a huge mistake. And anybody that's listening that that is not the way to go about a purposeful and well-planned start up practice.

Paul: I mean, if we could look at here, you know, I, I have a just turned nine months, uh, drew, she's our visit today. So nine months. It's like, you know, that's the time you're waiting to have a child and people's might as well start researching strollers and cribs. You're gonna need one. So, even though to a lot of dentist, I know this isn't the exciting part to them it should be one of the most exciting because you're picking out your cabinets and your chairs, but they don't bring you any, any money. This is something that you just have to put alongside with your awareness and why a team is so important. Cause I mean, Rob deals with this life and you deal with dealt with it personally when you did your startup Vivek, it's, it's just mentally overwhelming all the decisions you need to make and think about, uh, during that process a lot. Like, you know, getting prepared to have a small human in your house.

Rob: Yeah. So if you can Vivek also walk a, walk me through what kind of like, how that would look to terminate the seller's insurance in a transition. Like what's the timing of that? And like, is that something that, you know, we should be thinking about in the due diligence standpoint and possibly incorporating in an asset purchase agreement?

Vivek: Yeah. So, and I'll, I'll try to be vague here as well, right?

Rob: No that's not okay. No, I'm kidding.

Vivek: I am talking to an attorney as I have to be very, very careful.

Rob: That's all right. But the fact that this disclaimer that you didn't hear before we got on says that none of this is legal advice. So we're free to chat.

Vivek: so I mean, you know, let's say I'm looking at the seller's contracts, right? And I see one particular insurance company that they have a contract where there's very low fees, right? And uh, the termination takes about 90 days, right? For a lot of insurance companies. So, so I let them know that I need to draft her termination letter for the seller, for this insurance company. And if we called and they're like, well no, and we're going to be out of network. And then I pointed out to them, well not quite because this company has a, has a coal leasing agreement with this other company, so you are actually going to stay in network. The seller is actually going to stay in network, but with just a different fee schedule, right? But I need to terminate this. That termination unfortunately can take 90 days. And then I stopped negotiating.

Vivek: And that really long is the process. Um, and it's, it's, it happens, they offer no, you know, uh, where I let them know that unfortunately the way it is, if you really want to get really high seas, um, I'm going to have to first wait for 90 days for this thing to get terminated. And after that, another four or five months before you get back in network and high fees, um, and, and so now it's, it's just a much longer process, et cetera. So it's, yeah, just it's case by case and which insurance company in which state? Right? Uh, the, the relationships are different than in the different States. So it really is, my first call is always very strategic. I'm, I'm trying to, and in our, in my onboarding forms that I send them, right, I need to know their fee schedules and not just that I need to have them send me all the claims because very often they'll tell me, well, I'm in New York with this company, but when I look at a claim, that claim is actually getting paid by some different company because the company was able to find a lower fee schedule.

Vivek: I was there. Right. And so, and, and it's what is interesting is all of these shared networks that I talk about on your EOB, it actually says which network did the company pay off off? Uh, and so that's the most important piece of data that I got. And I'm like, Oh yeah, you know, I know you've signed a contract with this company, but they're not paying you off the ski schedule. You pink. So that's not what's happening.

Paul: I think it's thanks for sharing. In fact, I mean I do a lot with transitions as you know, and it just seems like there's so much merit, you know, cause we got listeners at all stages and ages. I know, you know my baby age, Dennis BADS and medium age, dentist MADS and season's age. Dennis says that if you're a seasoned age dentist and you're thinking of transitioning your practice in the next five years, it just sounds to me from listening to you here and there's kind of just, you know, struck me while you were talking. It just sounds to me like there's so much merit for them to also engage someone like you or find out because they could be presenting such a more attractive practice and they could say, you know, it's, you know, it's interesting. It's like if you said to a dentist, would you rather have a office with a CBCT or someone in negotiated their insurance, they'd go CBCT and you can just buy a CBCT. And in this is just such a different way for a potential seller to do that. So I think, you know, it seems to, I like what you do have accuracy really hits the whole circle of dentists in life.

Vivek: I'm going to make a statement, and I mean it, and this is, even though I'm in this business and anything I say to promote and all that stuff sounds self serving and all that stuff and you know, but I legitimately mean it. Somebody puts a gun to my head, I'm still going to say the same thing. I think every single dentist should call me it doesn't matter what situation you are in, right? Every single dentist should call me. There are, I am not sure if there's any dentist who's called me. Uh, and, and, and we've negotiated for a lot, right. Where I've said to them, sorry, I can't help you. Right. Uh, maybe there's one where, where I had told them that you're going to get a 5% increase. Right. And they were debating, right. Which even though in my, in my world, like a 5% was warranted, but it doesn't matter what stage of the practice you're in. Um, it doesn't matter if you're purchasing, if it's multi, uh, locations, right? Uh, it's rare because you know, it's mathematically, right. And I come back to it all the time, over and over again. Right. Um, and is it okay, uh, Paul and Robert, if I just share my fees and all that stuff, uh, because I want to break it down mathematically a little bit as well.

Rob: Sure. I'm actually curious because I mean, we talk a lot about return on investment and we're talking about all the, the return. So what is the investment?

Paul: I'm an open book. No one wants to read X, so just be like, yeah, go right ahead.

Vivek: So I have two different tiers. One of them is a startup, right? A startup or an out-of-network practice. So, so I have a fresh slate. The fee is lower. It's $4,200. I break it up into three payments of $1,400 each. And the second is, is existing practice practices. Practice acquisitions are multi locations and they're 5,400. Right? Then three payments of $1,800. But you know, if you're talking about about four or 5,000 bucks a often investment, right? Legitimately, you know, my, you know, sometimes people ask me, I'm gonna have to check if it's worth it. And my question always is, do you have $5,000 in the bank? Yes. Okay. Do you invest right in the stock market, et cetera, right? Yeah. Yeah. What rate of return are you looking for? Wow. 10, 15% is great. Right? And in a month, okay, so let's say you've got a 2% increase, right?

Vivek: Let's say you get a dollar more for each code. That's actually 4 or $5,000 for that year. That's a hundred percent ROI on, on your investment. Right? And, and I say that, that even though this is my business, if there's someone else that came to me, right and said, Vivek, I know what you do, I can do it better by $1. If you pay me $5,000 and for all your insurance codes that you bill out, you will get a dollar more. It's, it's not even a question. I'm like, okay, sure you're done. Sign it, right? Uh, because you know, you, you get a hundred percent ROI for that year, but then all the subsequent years, uh, you know, it's, it's the same. So that's why I always tell everyone, right, that even if, you know, there was a dentist that I was working with, he had a batty, very high fee schedule, and I looked at that, I'm like, Oh, click work.

Vivek: I mean, this is amazing, you know? And I looked up and I'm like, I could probably beat it by 7%. Right? And they're like, really? I'm like, yeah. So, so what we got for them was 6.7% higher than what they had, right? And it's well worth the money. Now there's some dentists, I give them a 60% increase, right? So, and they're over the moon, but in my view, and this dentist who got a 6.7% increase, it's still such a high ROI on what they paid that, that I legitimately believe that as much as, I mean, I can literally shot from the rooftop without any fear off, off. You know, people thinking that look at the shameless promoter crank, you know, promote business because I legitimately mean it. That any money that you spend to it is the best ROI that you can find anywhere, you know. And on top of it, just an FYI, I personally just give a money back guarantee to people, right? That if I present you the fees and you like it, no questions asked to take the money back. Um, it's never happened. But uh, but I still give that to people so that they've got some sense of comfort that, that, I mean what I'm saying, right?

Paul: You know, your people, the dentists you live with one and I have a couple of, I mean, I do this, you know, I'm sharing all kinds of ideas. I know Robert's with these clients too, but I'm with dentists all the time and I say, just find out, right? I mean, you have a conversation, you talk about it. You should just find out about new things and a lot of things in life. I mean, your example there Vivek I feel like there's a no lose situation for both of those clients because the person who got a 60% increase, I know that they're thrilled, but in my mind, I think that you probably know that they were getting some pretty bad fees for years. Right? And then the guy who got the 6.7% for should really in my mind is he is an, is a bigger win or a great win because he or she was probably getting solid fees and then you made them even solider. That's a word. Um, so it's why it's just such a win win. And that's why I just, I just think you have such a great, great tool for dentists because in a time where there's just some challenges that we face are many challenges, it's just a great, great tool that they could use to really change their everyday happiness, which is my a whole, whole, whole thing.

Rob: Yeah. And I don't think that you said shameless. I don't see it as shameless plug at all. I mean, it is what it is. And I think a lot of times people are just reluctant to spend money on the things that really matter, you know, and he could probably find somebody that could, might be able to submit applications for cheaper, but cheaper is not always better. It's all about ROI as you said. And so just so I'm clear too, like with a startup, are you also, you're completing all the paperwork for that $4,200 to write this is, you're negotiating, you're doing the whole thing.

Vivek: Yeah, we do the credentialing as well. Now the, there, there are a couple of firms out there, um, that negotiate but don't credential. And I don't even know how that works because the credentialing is where everything gets screwed up. And so now obviously we don't, there are some applications where you need, you know, the dentist have to print it out and fill it out and sign it, et cetera. Right. Those are things that obviously we can do for them. Right. But we don't allow anyone to hand, uh, any documentation directly to the insurance company. Right. We basically tell them these are the things that you gotta fill out right now. So we, you know, so, so I mean, they're not, we're not actually competing their applications for them. They still have to unfortunately printed out and complete it. But, uh, we're basically guiding them and we're not letting them send them everything to them.

Vivek: And very often what happens is, you know, each insurance company has Moto plans, like PPO plans, right? Cigna has advantage and DPO or MetLife has, you know, PDB, PDB, plasma bib, a charcoal. So we let them know, these are the plans that you're going to sign up with. Um, and then they send us the paperwork, could be your computer to view it. And then we send it over to the insurance companies. And then we follow up with the insurance companies to see the process says, uh, and as soon as we start with a client, I let them know any recredentialing informs any paperwork, anything that the insurance company is going to ask you to send to you. You don't sign anything. You have to forward everything to us. And the clients have been very, very good about it. As soon as they get something that forwarded to me saying, what do I do with this? Sometimes I'm like, do nothing.

Rob: Yeah. Frankly, I mean, what you charge for that service alone, it's worth it, you know, before you even get into the money savings. So, you know, it really, it does seem like a kind of a no brainer from, from an investment standpoint. Hey Vivek, it's been great having you on the show today. Thanks for sharing this. There's a lot of stuff, great content here and some great ideas and some things for our listeners to think about. If people want to get in touch with you or learn more about your firm, how would they do that?

Vivek: Yeah, I mean, a few things. You know, obviously my company's website, it's PPOprofits.com, right? Um, on that, there's a phone number for contact. That's actually my cell phone number, right. The best thing to do is send me a text. Right. Uh, I usually text back with the link to my calendar. Uh, Facebook is the second, I would probably say most people find me on Facebook, right. Uh, on, on a lot of Facebook dental groups. Right? Uh, if you just search for B, that can run, send me a message. I typically get messages on Facebook almost daily. Um, right. And then my cell phone number. You know, I actually don't mind people just calling me on myself or, or sending me a tax because that's, that allows me to just send a text.

Vivek: I, uh, I maintain a public calendar, right? And then the whoever wants to set up some time with me can just set up a time based on whatever's most convenient. And very often I either do these, uh, you know, introduction calls either in the morning at 8:30 or even as late as like 10:00 PM. That's the time, you know, around 8:30 PM to 10:00 PM late at night. My daughter's gone to sleep and, and sometimes since also they convenient time for the dentist because their day is over, et cetera. And they can just kind of freely discuss without patients disturbing them.

Rob: That's great. What is that a phone number? We'll put it up on the show notes too, but if somebody is just listening what, what's the number they can text you?

Vivek: Yeah, it's area code (219) 309-9383

Rob: All right, so (219) 309-9383 you could text Vivek and schedule a meeting and thanks so much for being on the show. We got off, we were kind of got off to a slow start with the whole nacho thing, but I think you absolutely more than redeemed yourself.

Vivek: Thank you for having me guys.

Rob: Well thanks for listening to another great podcast with the Dental Amigos and don't forget to tune in next time to have the dental business demystified. If you're looking for more information about today's podcast, you can find it on the dentalamigos.com. If you're looking for Paul, you can find Paul at drpaulgoodman.com and if you're looking for Rob, you can find him at yourdentallawyer.com. This podcast has been sponsored by Orange Line Media group, helping dentists and other professionals create content people love. Find out how we can help you take your business to the next level www.orangelinemedia.com. Until next time.