Get off the insurance merry-go-round

Dec. 1, 1999
How do you create an Oinsurance-freeO practice? The author provides you with a list of do?s and don?ts.

How do you create an Oinsurance-freeO practice? The author provides you with a list of do?s and don?ts.

Chris Brady, DDS

Are you tired of fighting the Oinsurance wars?O If so, you probably will identify all too well with the following:

1. Is your front desk overworked and

overwhelmed with OstuffO ? too many statements (more than a dozen or so is too many), chasing overdue accounts, etc.?

2. Are your patients using the OI?d like to do the treatment, but what will my insurance pay, doctor?O question as an excuse to delay or postpone treatment?

3. Are your pre-authorizations allowing your patients to Ocool offO before treatment can be accomplished?

4. Is your staff spending valuable time on hold, playing the insurance game of jumping through hoops trying to get paid?

5. Are many of the daily phone calls insurance-related?

6. Is your overhead too high?

7. Is your accounts receivable total too high (over two weeks? production)?

8. Are you doing mostly one-tooth-at-a-time dentistry?

9. Do you feel like you are running between operatories checking hygiene patients, interrupting your schedule, leaving no time to diagnose what really shoud be discussed with your patients?

10. Are you doing too few ideal comprehensive restorative or cosmetic cases?

11. Are you tired of the insurance companies telling your patients that you are Ocharging too muchO and doing Ounnecessary/expensive treatment?O

If you answered OyesO to any of the above questions and are ready to regain control of the direction of your practice, you may be a candidate for creating an Oinsurance-freeO dental practice.

Where did we go wrong?

In the late 1960s and early 1970s, a new product was introduced that, in the beginning, seemed to be a great asset in helping patients pay for OneededO dentistry. For the most part, the profession embraced dental insurance. Fees at that time, coupled with the $1,000 yearly insurance maximum, allowed the patient and doctor great flexibility in accomplishing larger amounts of treatment that was in the patient?s best long-term interest.

That was 30 years ago. Things have changed. Flexibility is gone. Slowly, but surely, we have allowed the wolf into the hen house. The influence of insurance has permeated nearly every dental practice.

Our too-low fees, our too-high overhead, insurance-based diagnosis (such as the Ocrown-of-the-year-clubO treatment plans) increased stress, higher accounts receivable, insurance-driven computer software, front-desk overload, high numbers of time-wasting phone calls, seeing more patients doing Oroller-skate dentistry,O and more are all a result of insurance infiltrating, in a very direct way, the workings of our business. Quite simply, we have been handed a model that doesn?t work for most of us, but works great for the insurance companies. (Just look at the compensation received by their top people ? and they say our fees are above the usual and customary!)

Many of us have hired an extra staff member or two to follow up on all the claims processed. Technically, this person is working for the insurance company, but we pay the salary. We spend thousands of overhead dollars each year in hopes of at least staying even. But dental insurance finally has grown to such proportions that most of us recognize that we are now playing a game we cannot win. We have become the third party!

The yearly maximum is the same as it was 30 years ago, allowing today?s patient to receive payment assistance with one crown, maybe a filling, and a couple of prophies in one calendar year. Beyond that, the patient is paying 100 percent of the bill. Both the patient and the doctor have increasingly come to depend on the insurance reimbursement, resulting in a decrease in the amount of dentistry accomplished in a timely manner.

The end result is that dental professionals are working harder and making less.

Examining our options

What are our options?

1. Continue down the same road with buried heads, either complaining or giving insurance companies the Osilent treatment.O How much of your practice currently relies on insurance reimbursement? If it?s more than your net income, you may want to reconsider your position.

2. Do nothing. We could end up being Osucked inO by default and find ourselves not having enough control to choose our future. Ask the pharmacists and optometrists how well this technique works.

3. Respond reactively to the next version of insurance whims.

4. Decide on where you want your practice to be in the next two to 15 years and take action.

No. 4 sounds good, but you ask, OWhat if I lose patients?O We all have lost some patients to managed care already. Sure, some of them come back, but some don?t. You can either decide for yourself and proceed proactively, moving your practice ahead of the rest, or you can hope the insurance companies have a plan to help you. (By the way, they do, but it might not fit into your budget.)

There is a right way and a wrong way to proceed. On Page 74, you will find some do?s and don?ts I have gathered over the years to help many of my clients move their practices into a model for the next century. This is a step-by-step approach to help you get started.

Going from insurance-driven to insurance-free:



1. Change your personal dental paradigm from Oneeds-basedO to Owants-based.O (Pathology-based dentistry is on a significant decline.)

2. Get your overhead under control. You may lose some patients that only come to you because you take their insurance. These usually are the same ones who will leave when managed care becomes their only choice.

3. Stop talking about insurance.

4. Collect the money upfront using outside funding sources. What alternatives do you have in place to serve as a substitute for insurance financing?

5. Have a niche-marketing plan in place that focuses on the benefits to the patients who remain with your practice.

6. Diagnose and sell wants-based dentistry. How are your selling skills? Are you underdiagnosing because you subconsciously want to stay within insurance limits? How many large, complete cases do you do each month? Are your patients truly being served by your best efforts and treatment? Ideal, comprehensive, reconstructive treatment for many adults is a significant investment in their overall, long-term health, well-being, and quality of life. Cosmetic dentistry usually is one of the most popular and rewarding types of dentistry. Do you have the clinical and communication skills to move toward more cosmetics? How much influence do insurance companies have on the procedures that plastic or cosmetic surgeons perform to beautify otherwise healthy individuals?

7. Support the patient through this change. It is mainly a matter of retraining them. They behave the way they do because we have trained them in the insurance system. Help them understand that they are not going to lose any money in this new system.

8. Have a well-trained, highly skilled staff that shares your vision.

9. Be prepared as the leader to lead this change.

10. Make sure your facility and dental skills are state-of-the-art.

11. Focus on the benefits (faster payment and, in many cases, better benefits)

to the patient.

12. Ask the patient to pay for services rendered at the conclusion of each visit. Many will do that without questioning the suggestion.

13. Have the patient mail in the insurance form. This helps when the insurance company uses the old line that the claim form was not sent in or was lost as an attempt to delay payment. The patient now has ownership.

14. Increase your level of service. Very few patients will leave you if they rate your service superior.


1. Don?t send out a letter announcing your decision to your patients. If they overanalyze your letter, they?ll get the wrong message.

2. Don?t be rigid and inflexible.

3. Don?t discuss the change over the phone before an existing patient comes in

for his/her visit.

4. Don?t tell patients all the reasons this decision will benefit the dental


5. Don?t put down the patient?s insurance company.

6. Don?t be timid or use verbiage that communicates the wrong message.

7. Don?t ask for insurance information over the phone with new patients. What message are you sending by asking about insurance?

8. Don?t set up financial arrangements with patients that include the insurance copayment as part of the deal. (You will need to have other ways that they can comfortably pay for your services instead.)

9. Don?t use the terms ObenefitsO or Oinsurance.O Neither is accurate.

10. Don?t use electronic claims-filing. That?s doing the wrong thing faster.