Going Out of Network with Delta Dental Insurance
Transitioning our office out of network with insurance and Delta Dental was a huge decision. They are the “big bad wolf” so it’s a scary thought.
I have experienced firsthand the challenges and benefits that come with it. We had a lot of patients that were hesitant at first, most patients were very insurance driven and so when the process changed, there were a lot of questions.
Clear communication, proper education and the right systems helped our office make the transition easier for us and our patients. Here are the five lessons I’ve learned along the way.
1. Clear Communication with Patients is Crucial
If you are not working with insurance daily like most of us are, insurance is confusing for patients. Many assume that if they don’t stay in-network, then they will have no coverage, but that is rarely the case.
Our office made the decision to be proactive when going out of network, which meant we sent out letters to all our patients, posted it on social media and gave a one point contact with any questions. We also were upfront about patients’ costs at time of appointment and how reimbursement works and addressing their concerns made a huge difference in retention and trust.
During check-in, we asked patients if they had any questions, which were more effective in person than over the phone or via text.
2. Being Out of Network Allows Us to Focus on Patient Care, and Not Be Bound by Delta Dental
Being in-network often dictates what we can and can’t do for patients, sometimes limited our quality of care. Since going out of network, we have seen firsthand how our dentists are able to spend more time with patients and create treatment plans based on what is best for the patient’s oral health, not just what Delta Dental allows.
3. Many Patients Will Stay if You Show Them the Value
We were worried about losing a lot of patients going out of network, but again communication help retain a lot of patients.
We had a lot of patients that went to other offices that were in-network, but returned to our office as they didn’t receive the level of care they received at our office. We have a strong relationship with our patients as we have been in business for over 10 years and are a viable part of the community.
Most patients still had out of pocket costs but offering to submit their insurance claims on their behalf also helped ease the transition.
4. Strong Financial Systems Need to Be in Place
Without Delta Dental dictating fees, we’ve had to be more intentional on how we set pricing and structure financial policies. We set in place financial options through Care Credit, and we also use Kleer In-Office membership plans which helps make care more accessible and encourages patient retention.
5. Insurance Reimbursement Can Still Work in the Patients’ Favor
PPO plans often offer surprisingly high reimbursement for out-of-network care.
We charge patients our full fees at date of service and will submit their claims on their behalf. This extra step we offer reassures patients and makes their experience smoother.
Patients are then reimbursed by Delta Dental directly (if the state allows). We have seen that the reimbursement rate is higher than even our in-network contracted rates.
My final thoughts: Going out of network with Delta Dental has been a learning process, but it has ultimately allowed our practice to provide higher-quality, patient-centered care. While going out of network requires strong communication and patient education, we have learned that many patients are willing to stay when they see the benefits.
If your practice is considering going out of network, being proactive and transparent with patients will be the key to long-term success.
About the Author
Erika McAuliffe, MAADOM
Erika has over 7 years of experience at SkyRidge Dental in Lakeway, TX. Before transitioning to dentistry, she spent more than 10 years in the medical insurance industry. Erika and her husband relocated from Minnesota to Texas in 2017, where they quickly fell in love with the Texan sunshine and vibrant community.
Erika’s commitment to professional growth led her to attend her first AADOM conference in Orlando and then received her FAADOM distinction in Las Vegas. She has currently achieved her MAADOM distinction, a testament to her dedication to improving dental office management and enhancing patient care.
Erika’s journey reflects her unwavering dedication, adaptability, and enthusiasm for elevating the quality of patient care through her contributions to the field of dentistry.
