We hear it every day. Dentists are frustrated with dental insurance. The delay, deny, and down-code tactics. The “lost” claims. The “missing” or “incorrect” information on the claim form. Above all, we’re frustrated with the low reimbursements. Being treated like a commodity and getting paid the lowest possible fee is not why most dentists went into the profession. Increasing patient volume, while shopping for cheap materials, equipment, and lab services, is a recipe for a low standard of care. So, what can you do to minimize your involvement with dental insurance?
As frustrated as you may be, it is highly risky to make an emotional decision and drop all insurances. You could lose a majority of your patients and you could even lose your practice. But there are some steps you must take if you want to minimize your involvement with dental insurance. And let’s be clear; long term, it’s riskier to stay with insurance than to go out-of-network.
How to set yourself apart from the average insurance practice
Continuing education: There are a number of clinical procedures that are either not covered by insurance or have limited coverage. Your strategy is to master one or more of these services so you can become the go-to dentist in your area for those services. These include sedation, implants, veneers, full-mouth reconstruction, gold work, Invisalign, TMJ, whitening, and sleep. In the real world, dentists who don’t want to deal with certain cases, such as sedating phobic patients or satisfying discriminating veneer patients, often refer their patients to dentists who are better trained in these areas.
Facility: Making your office look nicer than the average insurance office is a tangible statement that every patient notices the moment they set foot in your practice. If your office looks like every other office, that also makes a statement, just not one you want to make. You don’t have to create a Taj Mahal, because that costs a lot of money better spent elsewhere. Your money would be well spent with a skilled decorator who can guide you toward beautiful surfaces, paint, carpet, and furniture. A clean, uncluttered, nice smelling facility goes a long way for very little cost. You also don’t need to invest in all the latest and greatest technology based on the false notion that this is the golden ticket to practice success. It’s not, despite what the sales reps tell you. Don’t get me wrong, technology is great, but until you can afford the toys, many of them can be outsourced. One of my mentors told me, “The dental sales reps have solutions to problems that don’t exist.”
Staff: You absolutely must have a staff that is 100% on board with your practice vision. If your goal is to become less dependent on insurance and you have a staff that is too insurance-oriented or doesn’t believe in the insurance-independent services you want to offer, you will need to make some changes. Coach them or fire them, but don’t struggle with a poor performer who is working against your vision.
Customer service: Volumes have been written on the importance of outstanding customer service. It’s one of the easiest things to implement, yet many practices drop the ball in this area. Patients who are willing to pay out-of-pocket for services not covered by insurance are spending a lot of money. They expect and deserve a high level of customer service. What does this mean? It means running on time; taking the time to talk to them about their treatment, concerns, and fears; promptly returning their calls and emails; being genuinely friendly, honest, and professional about fees and treatment risks; offering painless dentistry; and checking in with them after a procedure. A culture of excellent customer service will go farther than just about anything else in building your practice.
Communication: Along with customer service, nothing will help you succeed in minimizing your involvement with insurance as much as outstanding communication. This is the main reason we developed a master class to help dentists back away from insurance. You can be the best dentist in the world, but if you and your staff can’t effectively communicate with patients, it will be hard to reach your goal of minimizing insurance. Communication begins with a clear marketing message. This includes the initial contact by email or phone, which must be genuinely helpful and professional. When a patient arrives, they should be greeted by name and graciously welcomed. The dentist should be prepared for the meeting by reviewing the new-patient forms in advance. During the consultation, the dentist should truly listen to the patient to find out their concerns. After the exam, x-rays, and clinical photos, the dentist should have an informed consent discussion with the patient. Because a picture is worth a thousand words, the clinical photos should be an integral part of the informed consent discussion. Once the treatment is decided upon, the financial coordinator should step in and be friendly and honest about the fees and financial options and then get everything in writing. Treatment plans outside of insurance coverage are typically high-dollar and, depending on the patient’s urgency for treatment, they may need time to think about their decision. It’s OK to follow up, but only in a helpful way, not with sales pressure.
Marketing: In the insurance-based practice model, patients contact your office to schedule because you’re on a list of dentists. Insurance is a form of marketing, and a very expensive form of marketing. In exchange for agreeing to deeply discounted fees and restrictions on treatment options, the insurance company provides you with a steady stream of patients. This works if all you want to do is dentistry that is covered by insurance. If you want to do dentistry that is not covered by insurance, you will need to effectively market those services so that a steady stream of patients will schedule treatment that is not covered by insurance. But the devil is in the details. Effective marketing methods change regularly. As a small business, your marketing budget will not be able to compete with large businesses. On the bright side, the internet provides various ways to gain the market share and thrive. Word-of-mouth used to be our number one source of new patients in our practice, and then SEO took over. At the time of this article, laser-focused social media marketing is delivering the bulk of new patients to our practice. What’s next? Who knows? A successful marketing professional can help you wisely invest your marketing dollars to deliver a constant stream of new patients.
What if you want to get out of the insurance model? How can you minimize your risk? Very carefully! It is very risky to get out of the insurance-based model if your practice has depended on insurance patients for income. Patients will leave, so you absolutely must be prepared for that loss. The million-dollar question is: will the fees you collect from your fee-for-service, out-of-network patients equal or exceed the loss from the insurance patients you lose?
Minimize your risk
Here are some tips to minimize your risk rather than jumping headlong into a 100% fee-for-service, out-of-network practice. Disclaimer: Discuss your business plans with a t professional advisor before you implement any of these strategies so you don’t lose all your patients, suffer financially, and lose your practice.
1. Spend six to 12 months talking to each patient and explaining why it is to their benefit for you to become an out-of-network provider or an unrestricted provider. It really is to patients’ benefit because you can spend more time with them, give them your undivided attention, take the best continuing education, and better afford the best techniques, labs, materials, equipment, and staff. Patients do not want to hear a sob story from their dentist about how the insurance companies are cutting reimbursements and you’re having a hard time making a living.
2. Drop the plans that provide you with the least annual revenue first. If there are some plans that don’t bring in much production/collections, the financial risk of dropping them is lower. In most areas, one insurer is the biggest provider, so that would be the last plan you to drop, and only if you’re producing enough to compensate for the loss of your insurance patients from that plan because you will most definitely lose some patients.
3. Take care of your existing patients. If you drop a plan, you don’t necessarily have to ask for payment in full at the time of service. You can still estimate the insurance coverage, accept assignment of benefits, and ask the patient only for the copayment. This makes for a more seamless transition in patients’ experiences, and your existing patients are less likely to leave. If you’re trying to transition away from billing, you may want to offer a 5% bookkeeping courtesy for payment in full at the time of service.
4. Make the biggest changes with the new patients, who are the easiest patients to train about how things work in your office. If they ask, “Do you take XYZ insurance?” your staff can respond with, “We’re out of network with XYZ insurance, but that doesn’t mean you can’t come here. A lot of our patients have XYZ insurance. Here’s how it works.” You can even train your new patients to pay 100% at the time of service and help them with making monthly payments by directing them to financing companies such as CareCredit.
5. Offer a membership plan at your office. For patients who don’t have insurance, a membership plan is an excellent way for them to control their out-of-pocket costs. You can set up a plan that includes x-rays, cleanings, and a discount off procedures. A membership plan also provides you with a steady stream of income.
How do you drop the plans?
Many dentists are angry with insurance companies and feel the need to write a poison pen letter to each company when they drop one. The insurance company is a business. Their job is to collect as much money as possible in insurance premiums and pay out as little as possible in benefits by lowering allowable fees, denying and delaying benefits, asking for more documentation, and telling dentists that they will only pay for a lower fee service. It’s not personal, so don’t go away mad, just go away, and feel good that you’re no longer subject to their whims and restrictions. Write a letter stating your intention to go out-of-network at the earliest possible time and send it with a return receipt requested. The company will tell you when your contract ends.
Minimizing your dental practice’s involvement with dental insurance is a difficult but worthwhile goal that is very risky and can put you out of business if you’re not careful. But with proper planning and management of the risks with strategic implementation, you can work toward this goal and provide your patients with an improved treatment experience while providing yourself with a more gratifying professional life.
Editor's note: This article appeared in the November 2021 print edition of Dental Economics.
The Bernsteins have a private, fee-for-service, out-of-network practice in Oakland, California, focusing on cosmetic dentistry, sedation dentistry, and Invisalign. Josh Bernstein, DDS, is a clinical instructor in cosmetic dentistry, full-mouth reconstruction, and IV sedation, as well as a conscious sedation evaluator for the Dental Board of California. He lectures nationwide and is published nationally and internationally. Allison Bernstein, RDA, is a practice management professional with expertise in teaching patient communications to assist dentists and their teams on becoming less dependent on insurance. The Bernsteins host a podcast called Dental Suite 903 and have a Master Class by the same name. You can reach them at [email protected].