Episode 660: Drop Insurance Plans the RIGHT Way

Dana and Kiera break down the pluses and minuses of dropping insurance in your practice. This episode includes a breakdown of why you would/wouldn’t want to drop insurance, why a membership plan does or doesn’t make sense for your practice, the difference between in-network and out-of-network fees, how to get the reimbursements you want, and a ton more.

Bonus: Hear about the hottest trends in offices across the country—what dental practices are focusing on with the DAT consultants.

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Transcript:

0:00:05.8 Kiera Dent: Hey everyone, welcome to the Dental A Team Podcast. I'm your host, Kiera Dent, and I had this crazy idea that maybe I could combine a doctor and a team member's perspective, because let's face it, dentistry can be a challenging profession with those two perspectives. I've been a dental assistant, treatment coordinator, scheduler, filler, office manager, regional manager, practice owner, and I have a team of traveling consultants, where we have traveled over 165 different offices coaching teams. Yep, we don't just understand you, we are you. Our mission is to positively impact the world of dental, and I believe that this podcast is the greatest way I can help elevate teams, grow VIP experiences, reduce stress and create A teams. Welcome to the Dental A Team Podcast.

0:00:51.5 KD: Hello, Dental A Team listeners. This is Kiera. You guys, today is a super fun day today because I have the one and only Dana with me today. Dana is one of our consultants. She travels and she also is virtual, and she's just awesome, guys. So, Dana, how are you doing today? Welcome to the show.

0:01:06.8 Dana: Hi. Thanks for having me. I'm doing good. Today has been a busy day, but a great one.

0:01:11.9 KD: Good, good, good, good. I always love busy, productive days. I think I'm more on this track of being productive rather than busy, and I think you are too, right?

0:01:24.9 Dana: Absolutely. Yep.

0:01:25.0 KD: 'Cause I'm curious, Dana, tell me, you consult a lot of offices. What are some of the hot trends that you've been noticing in office? I know I'm throwing you for a loop on this 'cause that's not what we're gonna talk about. I just wanna know, from consulting, what are some of the hottest trends you're hearing, kicking off 2023? What are they for you?

0:01:42.9 Dana: Yeah, so far right now, it's been a lot of hiring, but I feel like hiring is a trend in the dental world all the time, so maybe not necessarily a hot topic, but it's definitely coming up. And then along that same lines, onboarding new team members, but I think the thing that I'm hearing probably the most right now is, team motivation, how to show appreciation, kind of that culture, which we tie in a lot with hiring because right now, I think my biggest thing is looking for those culture fits from the beginning.

0:02:11.7 KD: Yeah, which I actually think onboarding and culture is such a unique thing because I'm starting to watch and I think corporate America is picking up the fact that employees are wanting to work in really great workforces, and I think it's just a different time, Dana. It's not what... People don't want what they used to want, benefits aren't the same. My brother works for ConocoPhillips, and he said that they just sent out a survey of asking what those people enjoy, what they like. He's like, "It was a 400 questionnaire," and I was like, "Holy cow, 400 questions." But I'm like, "If ConocoPhillips is looking to do that with their employees," and then Jason, my husband, he works at the hospital, and he said they just sent out a survey that said... And it was for employee retention, and they're doing a lot of different things, and I think that that is becoming a trend.

0:02:58.4 KD: So Dana, quick off the cusp, what are some of the things you're telling your offices to do too, maybe enhance that culture to retain team members? Any quick tips on that, that you're kind of finding?

0:03:10.8 Dana: Yeah, and I think when it's looking for those fits from the beginning, so when we are hiring and onboarding, finding out, "Do they fit what we're looking for, for team members, and is our office a good fit for them too?" We're not always the best fit for every candidate that walks in the door. So I think asking those questions, and I think too then, for existing team members, really digging into what does motivate them, how do they receive appreciation the best, what are some little things that I can ensure that I can keep consistent because that's the biggest thing with, I think, culture and morale motivation is that consistency piece, because it takes constant focus, constant drive into those things to keep it moving forward. So even finding little ways to ensure that you can keep the pieces that you're adding consistent.

0:04:04.4 KD: I actually really love that you said, "First step first is to hire who you actually wanna hire first." That's step one. And so, no more desperate hires, guys. That's what she's trying to tell you. None of those can be desperate hires anymore. But really, I think, Dana, you brought up a really good point too, of staying consistent and having some of those fun things. I don't know, I really... I think I took this challenge on about two years ago, where I decided I'm like, "I'm gonna have a company that is the best place to work, but not for everyone. The people that I want to employ, the people that I want in my team, in my court, they're gonna enjoy the things I enjoy and the culture that we're trying to create."

0:04:38.6 KD: But gosh, I do agree. I think one hire who you really wanna have there and then to be consistent with it. So that's just a little sneak peek, guys, that's not even what we wanted to chat about today. We're really gonna talk about another hot topic, and that is dropping insurances successfully. That, I think, is another hot topic too, but I would say guys, definitely pick up one of those pearls, and if you're needing help with motivating your team, I actually think Dental A Team does it ridiculously well. I actually think we're one of the experts of team engagement, team buy-in and helping you guys create those offices where team members genuinely crave and want to work. I think that that actually is of one of our secret sauces as far as a consulting company. So if you're wanting help with that, if you're needing that accountability, guys, I have a coach.

0:05:21.5 KD: Literally, our culture, Dana knows, I do Friday five, and I look for little ways to love on our team, and that didn't come from my brilliant brain over here, guys. I've got a lot of brilliant ideas, but that actually came from a coach, and she said, "Kiera, you've gotta improve your culture," and I just appreciate one, that she calls me out on it, but two, she helped me see how to do that. So if we can help you guys, email us hello at thedentalateam.com. But Dana, let's go into this next hot topic of how to successfully drop insurance plans, another thing we're very good at. But Dana... Okay, everybody knows why they wanna drop an insurance plan. Insurances aren't reimbursing high enough, we're feeling like we aren't getting enough money for it, we deserve to be paid what we pay. But, why should you not drop an insurance plan? What's the other side of that coin? What do you think, Dana? What are you seeing?

0:06:08.3 Dana: Yeah, I think it is being prepared, making informed decisions. Being prepared in the decision that you make to drop insurance, so looking at the impact that dropping an insurance would have on your practice. So looking at how many patients are subscribers of that insurance, looking at what type of referral source that insurance company is for you, how many new patients are they driving to your practice, how much production in the last year have you gotten from that insurance company. So looking at those numbers and knowing the impact that it could have on your practice, if you drop them, and being prepared.

0:06:45.9 KD: And I think that, Dana, a lot of offices that I'm at least seeing, they... I don't think they do that checklist. I feel like it's a really quick snap decision. "I am so sick of these Delta reimbursements. That's it. We're throwing in the towel." But just check your numbers first. So I always tell people like, "Check your numbers first, let's come up with a strategic plan before we just rip the band-aids." I am not saying, don't drop insurances, however, you have not calculated the cost for most practices of how much it's gonna cost you to now market, to bring in that many patients. And are there things with your current insurance plans that you could do hashtag, adding cosmetic fees, adding specialty lab fees, there are things you can stack on insurance codes to help you get the reimbursement you want.

0:07:30.6 KD: So I would just say, really look to see how much of your population base is that going to be. Right now, I know a lot of practices are dropping Delta. Well, one man's... I don't wanna say junk 'cause it's not junk, but one man's Delta patients could be another man's treasure of Delta patients, especially... We're complaining about a $1000 a year of benefits, that's really all we're complaining about.

0:07:53.5 KD: What about the All-on-4's? What about the implant cases? What about the ortho cases? All those things. Have you maximized this patient base out before you even consider dropping. So I agree with you, Dana. Do the research first, because I don't think it makes sense for all practices to drop insurance plans. Now, I am a huge proponent of dropping, a huge proponent of membership plans, but I just think it doesn't always make sense for everybody, because it can be a lot of hard work because you have to make sure that your practice is set up to be a fee-for-service like bougie practice, you are insurance-driven guys, they're not coming to you anymore because they have a reason to come. They are coming because of you. And so I think a lot of offices get stuck on that too. Now, you've got bougie patients that are expecting top notch care, and if not, they're free agents and will go somewhere else. So Dana, if an office has decided, "I've done the checklist Dana and Kiera just talked about. I am ready to drop insurances." Walk us through this process. What does it even look like?

0:08:53.1 Dana: Yeah, sure. I think once you make the decision to move forward, then you've got to notify the insurance company and notify your patients, and I would say notify your patients prior to notifying the insurance company because they absolutely will try to beat you to it and notify your patients on their behalf instead of yours. And then I think it is really just training the team, training the team on how to answer patients questions about it, training the team on letting patients know that they can still maximize their out-of-network benefits in your practice, that they still have the same amounts of benefits available to them, that you can still submit on their behalf, that all of the processes work the same, the difference is just their member responsibility.

0:09:36.8 KD: And I really think that that's an important point to take on, guys, is like, okay, you've got the steps, we've gotta tell the insurance company, we've gotta tell the patients and we've gotta be able to handle all these concerns and these complaints, and also again, back to what I said before, it's only $1000 benefit for most insurance plans. I get it. All you insurance people, I know, I'm not dumb, I understand some plans are more than a $1000. However, the vast majority aren't really that great, so I agree. I think that one thing I actually recommend in your exact same thought process is, let's practice having these conversations with our patients first, let's practice and role play, and let's think of why are patient's gonna be angry and upset, and let's create some scripted responses, because guys, when that flood gate opens, get ready for World War whatever to break out on you.

0:10:26.0 KD: It is slashing and gashing and patients are ticked off and then you're scrambling trying to just keep these patients in play. I would also say, before you even think about dropping, make sure you have a really solid membership plan in place, because that's a great way, guys, to convert these patients into something that they're already used to doing. It's a very low cost, most are about $200, maybe $300. You can have a monthly plan for that. That's a very, very low cost to get your patients retain to your practice. So I feel like really get strategic on what you're going to do. And then also, just as another note, insurance companies are getting really sticky that if you drop and then decide you wanna go back in, they're getting more and more and more calloused at letting you back in. It's almost like they don't like to be broken up with, and so they're gonna make it hard to get back together, but just realize, those are the processes. And so I think, Dana, role-playing with your team at least is something I feel as a team member, get used to.

0:11:20.6 KD: We do coach offices on this all the time, and then just realize you're gonna rip the band-aid. I also go in waves of when I'm dropping, so I don't mass email and send letters to every person, and I also don't wanna just say like, "Hey guys, we're dropping your insurance, we wish you the best." It's gotta be, "Hey guys. So just so you know, insurance reimbursement rates are actually a lot lower and I'm sure you've noticed inflation is here, and so therefore we've made the decision to go out of network with Delta. What that means for you. One, we still accept Delta and we're still going to be able to bill on your behalf," just like Dana said. "Number two, you're still gonna be able to come here, see the exact same providers and dentist that you're going to be able to have. Number three, we actually have, if you choose and don't wanna continue with Delta, which a lot of patients are doing, we have a membership plan that you can actually swap over to that's going to give you even better benefits than what you're currently receiving. So what we'd like you to do is, we're gonna continue, everything's gonna continue as normal, we'll still be billing on your behalf, this is the only change where instead of us collecting a smaller co-pay, you'll be paying and then the insurance company will reimburse you," which will be very simple.

0:12:27.4 KD: But I think, Dana, the patient panic is that they don't think you're gonna accept their insurance anymore, so they can't see you. So Dana, how do you coach teams on how to respond to that? 'Cause I think that that's actually usually the biggest hiccup that these patients experience.

0:12:39.8 Dana: Absolutely, and I think it really it is, one, making sure that your team understands the fundamentals. So do they even know what out-of-network versus in-network means in your practice? Do they know how a patient can utilize out-of-network benefits when they come to your office and then how we explain it to patients? Because yes, patients are so used to hearing preferred provider or participating provider, and they're used to hearing that from their insurance company as that that's what they want to look for, because that is a way that insurance company, right? We want them to... They want them to go to preferred or participating providers. But, what we want patients to understand is, they aren't the only providers they can see and they get fantastic care in our office and can still use their benefits.

0:13:22.1 Dana: So I think it's making sure team members know the difference, one, and then to know how they can explain to patients very clearly, very simply, that their benefits are just as good in their office as they were prior to the transition and that they can utilize them and we're happy to participate with all PPOs, we're happy to bill any PPO, and you can be seen in our practice, and we have patients that have your plan that are seen here, and great news is, we have the best doctors, we give the best care, and you will always, always love your experience in our practice.

0:13:57.1 KD: So Dana, I wanna get more tactical with you, let's pretend... And guys, I would do this if I was even freaking thinking about dropping insurances, I would use this resource. So Dana, explain what the difference between in-network and out-of-network is. So if this office who's listening, who's genius and they listen to the Dental A Team podcast and they've left us a review of five stars on how much they love us. Guys, that was a subtle... Not subtle hint. Go do it right now, if you haven't done it, 'cause that helps us help more practices. So if you're that office and you've left us a review and you love us and you're using this as a team training, Dana, explain what is the difference between in-network and out-of-network, so offices even have a starting place of where to start.

0:14:38.5 Dana: Yeah, sure. So in-network, you're obligated to your insurance contract fees. So those fee schedules that you get and you update every year, and we attach to our patients, that is the maximum allowed amount by that insurance company, and when you are in-network, that is what the patient is ultimately responsible for, is that fee schedule. Okay? So there is an adjustment that happens and we collect our agreed upon contracted rate with insurance company when we are in-network. When we are out-of-network and the patient has benefits, out-of-network benefits, they are instead of being attached to the contracted rate, they are then responsible for your UCR fee. So if they have that 80% coverage, let's say for Perio, they've got 80% coverage in-network, it's 80% of the adjusted rate. When you're out-of-network, it is 80% of your usual on customary fees.

0:15:36.8 KD: And that's like if they're really nice. Sometimes they don't even do 80%, sometimes they do, they get to make up the rules of whatever they wanna do. But I agree. So in-network means we're bound by the insurance's rules and pricing. It's kind of like... I wanna use the Costco example. When you go there, you get the Costco benefit, but you also have to pay the Costco membership fee. Okay. That's more of a better membership example, but what it is, is you are bound to have to pay that amount. That is what we're allowed to charge. That's what we have to ask, because we are bound by that. I feel like the Costco membership wasn't my best analogy, guys, that will come later for another one, but it's just you are bound by these rules that the insurance company sets and you can't go outside of it, otherwise, you're in violation of the contract. Benefit of being in a contract, patients flock to you, that cost that we're losing is coming as a marketing fee. So that's number one.

0:16:27.8 KD: Number two is, when you... When they're no longer in network, okay? So we've decided we're breaking free, we're not gonna be a part of Costco's membership, we can go freaking shop anywhere. We can shop anywhere, we can go anywhere, and yet, if the patient wants us to still bill on their behalf, they can do it. I really feel this Costco membership is not my best analogy, guys. So cut that analogy, just go on. You have to either be bound by the rules or you can be a free agent and go anywhere, but we can still bill on your behalf, you won't get the discounts and the benefits. I guess, let's keep this Costco analogy running. You could take your Costco card to say, Smith's, Albertsons, Raleys, they could send to Costco and Costco will decide, "Yes, I'm gonna pay for it," or, "No, I won't." They're probably not, 'cause we didn't go to that store. Dana, this is the worst analogy, and I feel like I need to cut it. Back it up, guys.

0:17:15.8 KD: Basically, I hope that that made sense for you guys. It's not the Costco membership. Alright guys, I was trying, I was trying on the fly, but it didn't work out. So really, it's you're either in-network and you're bound by those rules or you're out-of-network and we can still send on your behalf, but they're just not guaranteed to pay for it. And even in-network, guys, they're not even guaranteed to pay for it, which is why insurance is just a joke anyway. So with that said, when you go out-of-network, the only big no-no is, they can't have a membership, here's my Costco membership coming in, they can't have a membership and bill to insurance at the same time. That's a big no-no. We either bill to insurance on their behalf and take the discounts and the benefits, or they have a membership plan and we do not bill to insurance anymore, they can't do a double dip. See? I know it sounds really awesome, but we can't do that. So hopefully, Dana, that was one of my worst analogies, guys, so I hope you followed along.

0:18:03.6 KD: No, it's not a Costco membership. Don't think about it, you can kind of think about it. But bottom line is, in-network, follow the rules, can only charge and pay and have that. Out-of-network, we could charge our own fee, but this is where it gets really funky, 'cause trying to guess and estimate their insurance estimated portion versus ours, I usually recommend estimating about 20% lower. So for cleaning, come about 20% off. So they're gonna pay 20%, insurance hopefully will cover about 80%. Sometimes they'll still cover 100% of your office fee, but that means, guys, if your cleaning now is $200, they only have $1000 max. More of that max will get eaten up faster than if they were in-network, 'cause in-networker cleaning is only what, $75. Now we're charging $200. If they pay on $200, more of that max will get eaten up. So I don't think that was my best work on that one, Dana, but hopefully that makes sense to you guys, hopefully you guys can chat about it. Don't worry. I promise we're super experts on this. Dana, you should take it from here.

[laughter]

0:19:01.0 Dana: I think the Costco membership, we all can understand the rules that you're bound by your membership. Right? So I think that that was decent analogy, Kiera. I wouldn't get yourself to...

[laughter]

0:19:13.7 KD: I think that there... I'm like, I know there's something in there where I'm like, okay, I think it'd almost be like going to your primary care physician, I think is probably a better analogy. You go to your primary care physician, you use your insurance there, but guess what? You can go to other places. I don't have to just go to a physical therapist within my network. They can still bill on my behalf, but just because they're not a part of my network, I still get to utilize the benefits if the insurance company chooses to cover it. So that's kind of the difference. Now, if I go to, say, a physical therapist within my network, I'm probably gonna get a discounted rate. But right now, I go to a physical therapist that I'm obsessed with, and she is not contracted with my insurance, but they still bill on my behalf, whatever insurance covers rock on, and I'm responsible for the outside. That's how your practice will become.

0:20:00.1 KD: These patients are just used to insurance covering a little bit more, but for some offices, what I actually recommend that they do is to just charge what the insurance charges for preventative. 'Cause that's where your patients are gonna see your biggest hiccup is, just charge the preventative rate. So if I know that the insurance company is only gonna reimburse $75, you can charge $75 instead of 200, 'cause then your patients don't really see a difference when they're out-of-network. They're not gonna notice a difference really on crowns, they won't notice the difference on fillings, it's just that preventative. So some offices who have successfully dropped it, they decide, "Well, yes, we could charge $200 for our cleaning, but if insurance is only gonna reimburse us $75, let's change that." That's sometimes an easier transition for those patients to have.

0:20:43.5 Dana: Yeah, and I think this is unknown territory for a lot of our patients. So when we can ease them into it or transition them into it, I think it's always fantastic. And I think too, a membership plan is a really great way to kind of ease them into that transition too. Oftentimes, patients don't realize how much they're paying out-of-pocket for those benefits, and insurance benefits really are a coupon, it's like a discount. It doesn't work like our medical insurance, it's very frustrating and confusing for patients because they oftentimes don't understand that and they're not really aware how much it's costing them, out-of-pocket, it just comes out of their paycheck, it's one of those line items, and they don't really dig in.

0:21:22.2 Dana: So another thing I would say is, when we're having these membership conversations, challenge patients to really look at what they're paying out-of-pocket for those benefits versus what they're getting from them. If they've got $1000 and they're out putting a lot out of their paycheck, is it even really as beneficial as they thought? And something like your membership plan, where they see instant savings, where they see that they still get that same care, and they see that what they get to save in their paycheck as well, having those conversations from the beginning really helps them see the value of something like a membership plan in your office.

0:22:00.5 KD: And I think that the membership plan is, I feel, the antidote to going out-of-network. But when you're looking at dropping these insurance plans, I think, let's go back to the beginning and let's look to see, number one, like Dana said, check your numbers and let's see how much production is coming from them, how much are we truly writing off. I don't believe that negotiation really helps. Sometimes you can get into umbrella plans, which can often help, and so you're getting reimbursed a higher amount for seeing the same patient. So maybe look into that before you opt to completely vacate. After that then, role play with your team, help them understand what in-network and out-of-network is. In-network, we've got to play by the rules of the game, they dictate what we can charge. Out-of-network, we get to dictate what it is and we can still bill on their behalf, 'cause if you guys understand that differentiator, fantastic. Then there's a membership plan option, which can't be used in conjunction with insurance. But yet, like Dana said, most people don't even know, so especially around open enrollment time, getting them to leave their insurance plan, move over to a membership plan, that's better for you, better for the patient, it's a win all the way around.

0:23:01.5 KD: So then from there, we role-play this, we explain what it's gonna be, we look at all the things that people are gonna complain about, "Well, how much is my cleaning gonna be? Is my cleaning still free? Well, what happens if I want to come and see you guys? What if I wanna have... I have to now pay for this out of pocket?" How do you answer all of those questions as a team to make the patient feel really great? Dana dropped some good verbiage in there, like, "The great news is, you're already here, we're gonna bill on your behalf, we're gonna maximize your benefits for you."

0:23:28.3 KD: And at the end of the day, you can always adjust your outbound cleaning fee guys. So that way, their preventative work still feels like it's covered by insurance. Just remember, even if the insurance covers it, at the end of the year, they've eaten up all their max, Profi is still not free. So then from there, having that membership plan, getting more and more patients to convert over to that membership plan really starts to be a way to retain patients to your practice. So I think that there's a lot of key pieces in there guys, there's a lot of ways of what is in-network, what is out-of-network, what are the common issues, and then role play it.

0:24:03.1 KD: Once you determine like, "Okay, perfect, we're good," next step is make sure we truly are a fee-for-service practice, that we really can have that type of culture, that kind of morale. And then after that, contact the insurances, have it ready to go, have the letters, half the calls, have the emails, have the texts ready to go to your patients and let them know you're still accepting it, and this is the only change for them. Make it as smooth and honest as possible, and you will lose less and less and less patients. So Dana, that's kind of my pretty bow on the end of this. Any last thoughts that you've got on your side, that you wanna add in?

0:24:36.5 Dana: I think you wrapped it up and summed it up really well. I think just make sure that you're making the right decision for your practice.

0:24:43.1 KD: And dropping insurance doesn't always mean that that's the right decision. So really assess that, guys. And then if you want help, if you need help navigating this, I know a lot of team members get scared of this, so if you guys need help with that, be sure to email us hello at thedentalateam.com. We have lots of our practices who are starting to transition and drop insurance plans, just 'cause I think it does... It is nicer. You can work smarter, not harder. Less patients and still see the same amount, but you've just gotta make sure you figure out those marketing pieces and how to generate more patient flow if you opt to opt out. So email us hello at thedentalateam.com if we can help you. Dana, thanks for being on the podcast today. It was super fun to have you.

0:25:18.7 Dana: Always love being here. Thanks for having me.

0:25:21.5 KD: Of course. Alright, guys, as always, thanks for listening, and we'll catch you next time on the Dental A Team Podcast. And that wraps it up for another episode of The Dental A Team podcast. Thank you so much for listening and we'll talk to you next time.

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