Insurance freedom: Time to cut the chains that bind

In a previous article, I discussed the importance of making radical changes to be successful and the freedoms that allow us to build the practices, profit, and lifestyles we want. The first freedom to discuss is insurance freedom.

Get paid what you deserve

The danger of being dependent on insurance is that someone else is telling you how much your time and talents are worth. If you allow it, you’ll only get paid what they give you—not what you deserve. While getting paid by insurance may pay the bills, it doesn’t have the power to generate serious profit, and that’s what you’re looking for.

Insurance freedom

There are some key concepts that are necessary to understand to put the power of insurance freedom to work for you. Here’s the first, most important idea: when you depend upon insurance, the growth potential of your practice is automatically limited. Insurance doesn’t just mean that you have discounts or write-offs. It comprehensively impacts the way patients say “yes” to dentistry.

Because your profits come mostly from patient payments—not insurance payments—if you have patients who are dependent upon insurance, you’ll barely be able to make ends meet. It doesn’t matter whether you’re in every network in your area. Insurance caps your earning potential for each piece of dentistry that you do, so you never get beyond inflation to create a profitable practice.

Let’s take a quick look at inflation in the dental industry …

Money

How to protect your practice from inflation

Jayden Klippel

March 22, 2023

“According to the US Bureau of Labor Statistics, prices for dental services are 49.80% higher in 2024 versus 2010 (a $49.80 difference in value). Between 2010 and 2024: Dental services experienced an average inflation rate of 2.93% per year. This rate of change indicates significant inflation. In other words, dental services costing $100 in the year 2010 would cost $149.80 in 2024 for an equivalent purchase. Compared to the overall inflation rate of 2.62% during this same period, inflation for dental services was higher.”¹

Insurance hasn’t kept up with inflation. While the cost of a crown and other dental work increased significantly over the past 20 years, insurance reimbursements have remained unchanged. When fee schedules don’t match market value, you’re stuck with only making 50%–70% of what you could and should be making. Consider this as an “insurance tax”—you’re paying an extra 30%–50% on every procedure that you do.

You can put this into perspective by comparing it to the base self-employment tax rate for a small sole proprietorship, which is around 15%–20%. Insurance limits provide an “insurance tax” of around twice that amount. This doesn’t include the headaches (and payments for additional team member hours) for chasing down reimbursements, team member training for insurance handling, proper coding, and other paperwork and overhead costs.

Here’s a second key concept that I expect will strike you right in the heart: why would you delegate a patient’s health to an insurance company?

As their dentist, the dental health of your patients is your responsibility. So, what do you do about it? Ideal dentistry is dentistry free from insurance dependence. There are several ways to go about this, but here are some basics to start laying the foundation for insurance freedom.

Three foundational concepts for insurance freedom

Setting up an ideal dentistry practice requires you shift the focus from insurance to what really matters: the relationship you build with your patients. You sell yourself short when you prioritize insurance before your patients. When you do this, you never experience the joy of seeing a patient fully satisfied, confident in their smile and feeling valuable enough to invest in themselves. You can have a positive impact on the entire industry in your area if you help your patients discover their value and make the necessary investments in their dental health.

**1. Make your practice about far more than insurance.**

This has everything to do with creating an incredible experience for every patient. Consider the fact that an estimated 36% of the population experiences dental anxiety.² You won’t be drawing in customers who can (and want to) pay full prices—if they’re afraid. To eliminate those fears, you need to take time with your patients, to make friends with them, and build rapport with them. When you and your team members take the time to talk to and listen to your patients, trust grows.

People can tell whether you really care about them or whether you’re just pushing them in and out of the chair so you can see more people and make more money.

When you take the time to build trust between you and your patients, you’re not only affecting their desire to spend money at your practice, but you’re also setting the stage for customer loyalty. This can pay off tremendously over decades. (It can build word-of-mouth marketing for your practice as well.)

The thing is, you won’t be able to spend time building trust and rapport if you’re dependent on insurance.

You simply won’t have the time, because you’ll be scrambling to fill every moment with billable work. This inevitably backfires on you. It’s better for you, your practice, and your patients if you commit to improving the patient experience before you take our next step …

Overhead and Profitability

5 questions before you enter a new in-network agreement

Edward Shellard, DMD

Dec. 4, 2024

2. Disconnect insurance from health goals.

Patients who have dental anxiety aren’t typically thinking about their overall oral health. They’re thinking about dental disease, and how horrible it is to go through the process of restoration. As the dentist, you have the power and the responsibility to help your patients reframe their point of view. This starts with making their dental visits as pleasant as possible, but it also includes shifting their thinking.

Rather than restoration, the new goal becomes creating and maintaining dental health.

You can do this by having a few candid caring conversations with your patients. Help them understand they have more power over their dental health than they think they do. Train your hygienists to be kind and supportive to your patients, and to teach them, in turn, how to care for their teeth and gums properly. Keep encouraging them and stay focused on the positives.

As you empower your patients to deeply value their dental health, they will begin seeing the importance of paying for procedures that insurance won’t cover. At that point, it won’t be about what insurance will or won’t pay. It will be about the patient feeling valued and cared for, as well as how much they value and care for themselves. When they value themselves enough, they’re willing to invest in their dental health beyond what insurance will pay.

**3. Set proper expectations throughout all interactions**.

In every dealing you have with your patients, you need to have integrity. This includes following through with a treatment plan, every step of the way. This applies to your team members, as well. Anyone working with a patient needs to explain to the patient what the plan entails, and then make sure every action you said you would do takes place as promised. This helps build trust between your practice and your patients.

As you follow these three steps, you lay the foundation for taking your power back from the insurance industry. This sets you apart from other doctors and sets your business up for a radically better way of practicing dentistry.

Insurance freedom leads to a radically better way of practicing dentistry

With the foundation of a solid relationship with your current patients in place, you have the option of pulling away from any dependence upon insurance payments. This has a ripple effect throughout your business. When you aren’t dependent on insurance, you get patients from a variety of sources—not just those who rely on insurance to tell them what type of dental work to have done and when that treatment can happen. You can get more “yeses” to more dentistry, and you’re able to charge enough to make a real profit.

This liberates you to become an in-demand doctor. Some patients will seek you out because you do procedures insurance won’t pay for. Some will come for the relaxed feeling of camaraderie they feel when they have dental work done. You can pick and choose your clients, so you get the top-of-the-line patients that can pay what you want to charge.

When you’re getting the best clients, you can fill the spots that you have time and capacity for, without feeling the pressure of needing to take more patients just to pay the bills.

As you step away from insurance payments, you can finally charge premium prices for the perfect number of clients. The math works in your favor, so you make a profit, and you practice dentistry on your own terms. This enables you to deliver quality dental health, on a schedule you’ve defined.

Remember, insurance payments might cover your bills, but payments from patients result in profit.

If you can eliminate your dependence on insurance payments, you’ll never again have to practically beg insurance companies to pay you for work you’ve already done. You won’t have to justify your existence or be forced to have someone else tell you how to do dentistry. Best of all, you’ll have a practice in which you control the purse strings and how much money you make—not some insurance company.

Does that sound like freedom to you?

Author's note: Adapted from my recent book, The Four Freedoms of Dentistry. Visit Dental Success Today for your free copy.

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.

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