Practice Management |6 min read

Three Steps To Insurance Independence

Real World Insights from AADOM Authors - Jessica Martin

Your office needs to increase your new patient numbers and demand for the practice, but not in a discount or insurance-driven way. Those methods are difficult to sustain and are a race to the bottom in terms of being able to provide quality dental care. Instead, try these three steps.

Step 1 – Create Value

Increasing new patient numbers can be achieved by providing people’s desired experience. The office needs to attract ideal patients who can withstand changes in fees and network relationships.

Dental anxiety is a serious barrier, and most practices aren’t doing enough to address it, creating the perfect opportunity to stand out. People without anxiety are simply provided with a better experience! Having an office that looks and feels different and a team that knows how to be “sensory sensitive” reduces patients’ fight-or-flight feeling because of the dental environment and vulnerability to treatment.

An office can create a brand identity with this concept and begin networking in the community to create visibility and credibility, which ultimately leads to profitability. This sets the stage for the office to be a magnet for new, ideal patients, and demand increases. The office gets “too busy” as a result. Yay!

Step 2 – Utilize the Right Systems

All the systems the patients experience as they travel through an appointment need to be cleaned up to create an optimal experience. This includes phone conversations, the check-in process, seating of the patient, consent forms, the actual dental treatment, and the walk-out process. There are also behind-the-scenes systems that a patient experiences indirectly, such as recall, collections/billing, insurance claims, processing, scheduling, and referral thank-you notes, to name a few.

Most practices have basic systems for all of these functions. However, they often don’t consider how their way of doing things may be impacting patients’ feelings and anxiety levels. All of these details matter, so it’s important that the systems of the office mirror the same calming, relaxing feeling the patient gets from having a sensory-sensitive team and a beautiful office to visit.

Step 3 – Education and Preparation

Once the practice has achieved an elevated experience and value that patients can’t get from switching providers AND has the demands of a full schedule with their ideal patients, it becomes even more necessary to start educating patients about what insurance is and what it is not. A dental practice can still be insurance-friendly and be an advocate for the patient to help them maximize their insurance. The front office team can do the legwork of understanding the patient’s policy and helping the patient achieve the most out of their benefits while also not letting insurance dictate their treatment. The patient starts to make choices about what is best for their oral health versus what their insurance will cover.

Here is where alternate payment options become even more important. If a patient has an insurance policy that isn’t serving them and covers very little based on what they need or what they are paying, a membership plan with the office might be the best option. The more patients that can be moved from insurance to a membership plan before dropping insurance networks, the better because they don’t need to wrestle with any decisions when their network relationship changes. Having payment plan options, extended credit, etc., is also helpful as the practice may ask patients to pay more out of pocket or for services before insurance reimbursement.

Educate the team well in advance on the unified office verbiage once you’re completely out of network with insurance. It’s imperative that these conversations include everyone from the front to the back. The team needs to feel confident in encouraging patients not to panic and to stay with the practice. There may be fear on all sides about how the practice will survive this decision, so getting ahead of them with a well-thought-out plan eases everyone into the idea.

Other Things to Consider

There are many logistical details to consider, from timing, verbiage, and disbursement of a letter to patients, all the way to supplies needed (letterhead, brochures, stamps, etc.). Often, there is a 90-day span from letting insurance know and when the actual drop occurs. Two different letters may need to be sent as some patients may have out-of-network coverage with the office, while others’ policies may not offer an out-of-network option, meaning the patient will have no coverage. The team should research those policy nuances beforehand so the doctor knows how many patients this impacts.

The time of the year is also important to consider, as open enrollment for individual policies is a narrow window. Patients may wish to modify their policy for the next year or get off their insurance altogether to stay with the practice. Or the patient may wish to see what their out-of-network coverage will be. The more the practice can assist, the better.

Again, the dental team is the advocate for the patient, and they feel more connected to the office than to the insurance policy. I suggest the office take a proactive approach to answering patient questions. Creating a FAQ for the team to share with patients as needed can be helpful.

Considerations such as network contracts for newer associates need to be reviewed as they may have signed up to be in the network for a certain length of time before being able to drop. Understanding how the payment process may change is also important, as the insurance company may choose to pay the patient directly, which may necessitate a change in the collection process for those patients.

For offices with several network relationships, I recommend first dropping those insurances with the fewest patients. Be aware of roughly how many patients are on each insurance and create a plan for how/when the drops will occur as the practice is building demand. As patient numbers ramp up, take the opportunity to raise fees, let them stabilize, then drop another plan, and so on. This process will take longer for offices heavily dependent on insurance, but following these steps will move the practice closer and closer to independence.

Don’t do this alone! Work with a trusted advisor for each of these steps. There is planning to do and strategies to make this process as painless as possible while still retaining patients. Along the way, you’ll move the practice into achieving higher production and collection goals, help more people, and become known for the experience your team provides. These are all positive moves that can ultimately lead to creating the out-of-network practice of your dreams!

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About the Author

Headshot of Jessica Martin

Jessica Martin owns Martin Management Consulting and is co-owner of Martin Dental, a successful dental spa in Eau Claire, WI. She is a licensed school psychologist and helps medical professionals understand why patients feel anxious. Jessica has created strategies for dental offices to remove some of the most common barriers to dental care and has assisted 90+ business professionals to thrive and become more successful.

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