A few years ago, I was in-network with quite a few PPOs (I think it was seven plans, to be precise). The general idea was I would accept a lower fee in exchange for acquiring patients. That’s the tradeoff, right? We lose some profit, but at least we stay busy.
You know what shocked me, though?
We implemented a new intake form to collect information during new-patient phone calls and it included the question, “How did you hear about us?” (Download the form here if you’d like.)
After a couple months, I looked at the numbers—only 6%–7% of patients reported that they came to us through their insurance!
Sure, insurance participation might have been a factor for patients who found us by other means (e.g., Google, postcards, word-of-mouth, etc.)—but geez, that meant I was paying for all my own marketing on top of the 30%–50% write-off from PPO fee schedules!
For all that money, a meager handful of patients directly from insurance plans sure seemed like a waste.
And then there was the skyrocketing inflation after 2020. The only way to keep up with my costs was to raise fees—but I couldn’t! It didn’t matter if my crown fee was $1,400 or $14 million. Either way, I was only getting paid the $700-800 the insurance companies allowed.
We hired a negotiator and that helped a bit with some of the plans, but they still weren’t close to our actual fees. One PPO (the biggest network, you can guess the name), refused to negotiate at all.
How I got out of the insurance grind
We decided to bite the bullet and drop all of our plans except one that was within 15% of our full fees. (I can justify 10%–15% as a “marketing expense,” no problem.) Probably 80%–90% of our patients were in PPO networks—so this was scary! But we were working with a management company that had helped hundreds of clients do it already, and they were confident, so we trusted them and started the process.
I’m happy to say that we’ve been fully transitioned for a couple of years now, and it wasn’t nearly as scary as I’d thought it would be!
The majority of our patients from PPO plans stayed with our practice as fee-for-service patients. We still accept assignment and submit claims for them, but they pay out-of-network fees and they’re okay with that. We were prepared to lose up to 30% of our PPO patients (which would work out fine financially after factoring in the increased reimbursements), and we actually came in well under that figure.
A few patients had questions or complaints during the transition, but the vast majority didn’t seem to mind. And the funny thing is, the few patients who initially left in a huff wound up coming back. I have a great Google review now from a patient stating they left when we went out-of-network but came back because we have the best hygienist anywhere.
Being out-of-network has not been a struggle at all. In fact, we’ve quadrupled our production over the last few years and added a second practice. I can’t attribute the growth to going out-of-network (we’ve implemented quite a bit of other organizational and growth strategies), but it certainly has not held us back.
It’s also much easier to grow when we have better profitability, more freedom to focus on high-quality patient care, and aren’t dependent on insurance coverage. The best part is, if I’m doing a big case, like six crowns in the interior and veneers, I’m not thinking, “Oh, I can’t send it to this lab or I’ll lose money ...” I’m just thinking about what’s best for the patient.
3 things I learned about going out-of-network
During this process, I learned some valuable lessons about going out-of-network:
Have your priorities straight.
We tend to lose sleep over the wrong things. We fret about whether we should send a letter to our patients, and should we send a letter to the insurance company? We worry about the logistics and the possibility of patients getting upset.
First and foremost, make sure you establish and maintain a great relationship with your patient base and your community. The key is having great communication with your patients and building understanding and goodwill.
If your patients love you and know that you care about them, then whether you send a properly worded letter doesn’t matter. When you explain why you couldn’t stay in-network, they’ll understand and want to support you.
We have a robust program of connecting with our patients in upbeat social ways, and we do a lot for patient appreciation. These are simple things like birthday cards, little care packages, and thank you messages after their appointments. More importantly, we have a great culture in our office. Our staff greet every patient with a big smile and are happy they’re here. When we reach out to patients, it’s not just about their dental work, but about them—things like, “It was so good seeing you! I’m excited you’re going on vacation this summer!”
We also do community work like dental days, volunteering, helping at the soup kitchen, etc. These are things to share across social media platforms, your website, newsletters, and through photos on your Google page. This builds trust and friendship with your patient base and your community.
There is no better form of marketing than word-of-mouth, but you also can’t just wait and hope your patients will tell their friends. It starts with ensuring all your providers are doing great work and you are also providing a great patient experience. People don’t rush to tell their friends about an “okay” experience.
There are many things you can do to bolster word-of-mouth.
Having lots of positive Google reviews and a high star rating is crucial. People are always going to trust real patients saying how amazing your office is much more than your own advertising. So, make sure you’re getting at least 10–20 new online reviews each month. Having hundreds (or thousands) of glowing reviews is incredibly effective in attracting people who are searching online.
Cosmetic cases or extensive restorative work can be life-changing for patients. We get permission from them to share their stories, photos, or videos on our social media, Google, our website, etc. This gives our community more opportunities to see real people having great experiences at our office.
We are also very proactive about asking for referrals. We have a Care Enough to Share program with referral cards that include a special offer for new patients. In addition to giving the cards out, we ask our patients directly about family members or friends. Statistically, most patients have family at home that aren’t currently seeing a dentist, so we always do our best to schedule them along with the existing patient.
Get your staff on board, then practice speaking to patients about it.
The transition out-of-network is only going to work if your staff understand why you are making the change and are on board with it. If your staff don’t care, then you’ll get interactions like, “Sorry, we don’t take your insurance anymore. You can check with your insurance carrier to see who is in-network in your area. Goodbye.” That’s not a recipe for retaining patients!
So, have a real conversation with your team and make sure they understand why this is going to be better for the patients, for them, and for your practice. Answer their questions and concerns. Let your staff know it’s not a big deal, so they won’t make it a big deal. Your status changed with that carrier, but you still take that insurance and accept assignment.
Then work with your team to come up with the right verbiage of how to explain it to patients and answer questions in a positive way. Make sure it’s something your staff are comfortable saying, otherwise they won’t actually do it, or they’ll say it in a half-hearted way.
Lastly, practice these conversations with your team. Roleplay as if you were the patient and they need to answer your questions.
When patients or prospective new patients ask if we take their insurance, we say (if it’s true for that carrier) something along the lines of, “Yes, we have lots of patients in that network …” then we can let them know we’re not an “in-network” provider, but the insurance will still pay their portion and we will still submit claims on their behalf. We also assure them we will go over all the details and their estimated copays before beginning any treatment.
Again, don’t make it a big deal. If you make it a big deal for patients, they’ll think it’s a big deal. Keep it casual and matter-of-fact, and your patients will think, “Okay, no problem.”
For some patients, being out-of-network might still be a dealbreaker, but for many it’s not because:
a) They’ve already seen our great office culture and started building that trust (through hearing about us from a friend or seeing our online reviews, testimonials, fun photos and videos, etc.).
b) Whether on the phone or in-person, our staff are focused on them as a person. We ask questions, we show how much we care, and we do our best to help them. When patients call around to other in-network providers who make them feel like just a number, they’re usually willing to venture out-of-network for someone who treats them like a human being.
I’m telling you, the majority of patients won’t care about your insurance status if you do a good job of building this relationship. A few patients will probably complain, and that makes it seem like everybody is complaining—but when you actually look at the numbers, it’s only two or three patients that make a fuss while the vast majority are fine with it.
Just do it.
At some point, you have to just rip off the Band-aid. You can’t wait for everything to be perfect.
Yes, do the things I’ve suggested in this article, but these are all ongoing efforts that can always be improved upon. If you wait until it’s all perfect and you have a bazillion fee-for-service new patients already … you’ll never actually get there!
So, start working on these things, create a plan, and then just do it. It’s going to be a little scary. You’re going feel unprepared. That’s okay.
Getting out of insurances is kind of like breaking an addiction. It’s not going to be comfortable, but you’re better off just doing it. It’s probably best to have supervision and do it gradually, but I went cold turkey and survived just fine.
Where should you start? Which plans should you exit first?
It depends on how much you’re writing off for each plan, how many patients are in-network for it, and possibly the terms of your contract. Before I pulled the trigger, I did an analysis to crunch the numbers on each plan and project exactly what would happen if I dropped them. You can do that same analysis here for free.
That sums up my experience. I hope it helps you transform your practice into a place where you enjoy your work more, get compensated what you’re worth, and are able treat each patient with the level of care and focus they deserve.
Best of luck to you!
Editor's note: This article originally appeared in DE Weekend, the newsletter that will elevate your Sunday mornings with practical and innovative practice management and clinical content from experts across the field. Subscribe here.
