The Gold of Going Out of Network with Insurance
A while back, our dental office decided to no longer hold contracts with many of the insurance companies we were working with.
Many practice managers have asked how a dental office could go out of network with all insurance plans except two. This topic does not have a simple answer.
Many vital points must be considered before deciding to go out of network. Reimbursements, the number of active patients with insurance, and insurance fee schedules are all data that must be taken into the equation to make an informed decision.
In addition, three key points can be summed up that may help another practice decide if dropping insurance plans is right for their practice.
Insurance Analysis
The first step is to conduct a complete insurance analysis. This will give you the information you need to decide which insurance companies an office collects less on.
Based on that information, the office may want to start with one or two companies. This is a lengthy process. It will take planning and further analysis to decide if this action will succeed in the long term.
After going out of network with one of the two companies, the practice manager should evaluate the office’s collections and budget.
Timeframe
Working with a nine-month timeline is essential when an office decides to leap. The doctors talked to each patient at their next appointment. They always explained why, such as discussing that we can no longer give quality care on low reimbursements from insurance.
Having a timeframe also allowed patients time to decide what their options are. In addition to a timeframe, we created an in-office discount plan to act like dental insurance. This plan was developed and tailored to our office. It saved the patients and committed them to staying with our practice.
Dental practices that are out of network with dental insurance should plan on creating a reimbursement program.
Emotional Journey
Going out of network with insurance is an emotional process. The practice was initially scary, but our feelings changed after seeing the results and the numbers.
Naturally, patients will be upset when their insurance is altered to out-of-network. This is why it is essential to have the doctors sit down face-to-face and explain why this change is occurring. Our dentists explained that we first want to keep them as patients.
Secondly, they explained why we decided to go out of network with their plan. Many patients understand that their insurance dictates treatment, and the doctors want what is best for patient care. It is also important to expect to lose patients. However, many patients who choose to leave initially may decide to come back.
When the office provides a red-carpet experience for your patients, many will immediately go to another office and decide to return and pay higher fees with out-of-network benefits because they value and recognize the difference the office makes as providers. I cannot stress enough the importance of setting your office apart from others.
Overall, this change has benefited our practice tremendously. We now do not have to let insurance dictate treatment. Our patients are trained to understand how dental insurance works, which helps during treatment planning.
Dental clinicians and patients feel their treatment is the best option because it is what they truly need, and everyone values it. In hindsight, we wished we had decided to go out of network sooner. It has been a win-win for us.
About the Author
Melanie Keesee, FAADOM
Melanie Keesee joined AADOM in 2021. She is currently a member of the Tri-State DPLN. Melanie’s background is primarily in Business Management, Human Resources, and Finance and Accounting. She received her BSBA in Management from Sullivan University.
Melanie and her husband, Michael live on their farm in Custer, KY, along with their 2 adorable dogs, Chopper and Copper. When she isn’t working, she visits the beach as much as possible.
