News |7 min read

How to Win the Game of Patient Retention While Playing Dental Insurance Whack-A-Mole

Tamara Whitley, FAADOM. Text: Real-world insights from AADOM authors.

Six years into our marriage, in the spring of 1996, my husband Bill graduated from dental school.

I would often fantasize about us working together during his dental school years. When I finally verbalized my fantasy, Bill’s exact words were, “Over my dead body will you ever work in my office.”

At this point, I decided to stick with growing my career in Corporate America with such notable companies as Cigna, CVS, ADP, and Medco Health Solutions.

After dental school graduation, Bill became an associate dentist in his childhood dentist’s office.

Keep reading to find out tips on making your dental practice stronger – with great patient retention!

Two major issues

Let’s fast forward to January 2018, when my job moved from Dallas to El Paso. While we were waiting for my non-compete period to end, Bill asked me to bring my 27 years of experience to our dental office that we opened in 2009.

I assure you that he was most definitely alive and not dead when he asked me that question.

But he was quick to reiterate that this would only be TEMPORARY until my non-compete period was over.

While working full-time in Corporate America, I managed our S-corporation financials while Bill was an associate dentist. My goal in this temporary assignment was to discover why our practice wasn’t as profitable as Bill’s associateship.

Did I say this would be a TEMPORARY assignment?

I quickly discovered 2 MAJOR issues:

  1. 504 claims over 500 days old aging, which is another article for another day
  2. 34 separate dental insurance fee schedules

As I began the ten-and-a-half-month effort to clean up the aging claims and input reimbursements, I noticed names of companies I had never heard of in dental insurance.

Bill told me that he never signed a PPO contract with these companies. The more I loaded EOB’s, the more I realized we were underwater on ALL of the reimbursements/contracts with these companies – meaning the amount we were being reimbursed wasn’t enough to cover our breakeven hourly cost to provide dental services.

Even with 27 YEARS of experience in the insurance/benefits world and knowing the acronym soup of PPO, HMO, HSA, U&C, U&R, MAC, OOP, OON, AOB, HIPAA, OSHA, ACA, ROI, Lifetime & Annual MAX, I knew I needed dental management help.

The next steps

I went to a trusted advisor in the dental industry and told him of my discovery. After hearing me say, “I don’t know how to “undo” this nightmare,” he pointed me to Craig Dreiling at Solutions 101.… This text opens a new tab to the Solutions 101 website…

Before our first meeting, Craig instructed us to gather several items for him to review at our first meeting. I couldn’t imagine why he would need this information during our first meeting. Still, I quickly learned the answer when “Rainman” walked into our office.

After exchanging pleasantries, Craig sat down and flipped through the documents like Dustin Hoffman did while counting cards in the 1988 movie “Rainman.” Craig spent MAYBE 2-3 seconds on each piece of paper, flipping through the entire stack in a matter of minutes.

Craig looked up at us and declared that he would help us. He guaranteed that he would decline to take our case if he didn’t deliver a significant ROI (return on investment). We had nothing to lose and a TON to gain, so we dove in head-first.

After a six-month deep dive of our own office data, S101 analyzed, clarified, and developed a strategic plan for our office.

The S101 team… This text opens a new tab to the Solutions 101 website… is dental insurance re-engineers with a deep, analytical process that educated us on:

  • Which networks to keep
  • Which networks to exit
  • How to play dental insurance Whack-A-Mole with leased networks
  • How to accurately set our fees
  • How to communicate our strategies with patients and insurance companies
  • The order in which our practice should execute the plan for patient retention while playing the game of Dental Insurance WHACK-A-MOLE

Do you remember that childhood game of WHACK-A-MOLE?

It was a game where the player would use a mallet to hit the toy moles, which would appear randomly, back into their holes.

I quickly learned that I was the player, the 34 fee schedules were the moles, and S101 was my mallet.

Our S101 insurance roadmap allowed us to make informed and data-driven decisions, with S101 doing the heavy lifting for us.

NOW we were READY to play Dental Insurance WHACK-A-MOLE!

7 rules for patient retention while playing dental insurance WHACK-A-MOLE

  1. Meet with S101 to develop your custom strategy, complete with a targeted patient communication timeline.
  2. CORRECTLY assess your fees. “Percentile” lists are irrelevant and can skew revenue and patient experiences. Be precise and efficient.
  3. Determine if the insurance company denies the patients the right to assign their benefits for out-of-network (OON) plans.
  4. Determine your patient’s open enrollment period: If your exit date is January 1st, most companies have open enrollment in October/November; however, some government entities or school districts have open enrollment in June/July.
  5. Create a comprehensive patient letter to include the answers to these questions:
    • Why is this change necessary?
    • What is NOT changing?
    • What is changing?
    • What options do you offer to keep your patients?
  6. Extend your patient communications timeline if the insurance company does not allow AOB OON.
  7. Watch the money roll in.

Sample patient communications timeline WITHOUT AOB OON

June 1st – December 31st begin in-office patient meetings

  • Front office puts insurance company initials on schedule to flag DDS/DMD.
  • Front office creates network status change packets to include: cover letter, in-house membership plan, patients specific eligibility, which includes OON %, Deductible, and Annual Maximum, and HSA enrollment instructions.
  • DDS/DMD reviews schedule for insurance notation and informs patient chairside of the non-preferred status change effective date. Avoid words like OON!
  • Front Desk meets with the patient to review the network status packet, including contact information should the patient have questions during open enrollment.
  • September 15th, make personal phones for patients who have been in the office for the past 12-18 months, followed by a detailed email to include all items listed above.
  • October 15th email, or snail mail, the cover letter, in-house membership plan, and HSA enrollment instructions to all patients/guarantors who have been in the office 18-24 months.

January 1st – June 1st

  • Verify insurance 3 days before the appointment
  • Make an outbound text, phone call, or email to ask the patient which option they will use to stay with your practice.

Patient retention is a game worth playing

I won’t lie.

Dental insurance WHACK-A-MOLE is a ton of work, but trust me, it’s a game worth playing when the leased networks have been WHACKED out of your practice and the money rolls in.

As for Rainman? We have now changed Craig’s nickname from Rainman to Jerry Maguire.

Why?

Because Craig SHOWS ME THE MONEY!

Disclaimer: I haven’t received a dime from S101 to promote their unique company that quite literally saved our dental office.

And as for the dentist who said, “Over my dead body, will you ever work in my office”?

He is now the dentist that says, “Over my dead body, will you ever leave the dental practice!”


Meet the Author

Tamara Whitley, FAADOM. AADOM author.Tamara Whitley, FAADOM, is a co-owner and dental practice administrator at Whitley Family Dental… This text opens a new tab to the Whitley Family Dental website… in Dallas, Texas. She brings over 30 years of proven business and insurance administration experience to her role from notable companies such as Cigna, CVS, ADP, and Medco Health Solutions.

Tamara found AADOM in October 2020 when she went “all in” with a lifetime membership. She was inducted as an AADOM Fellow (FAADOM) in 2021 and is a member of her local AADOM at the Dallas/Fort Worth Chapter.

She holds her Black Belt in Six Signa Process Methodology as well.

Tamara has been married to Dr. Bill for 31 years. Together, with their son, they enjoy traveling, reading, and cooking.

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