Should I take dental insurance or not? Part 1

Dental Insurance

Have you ever wondered what it takes to be dental “insurance free?” Or why it makes sense to be “blended” with a mix of dental insurance and fee for service revenue? If so, this two part discussion will be of interest to you.

Before we get into the subject matter, a few insights today from the New York metro market as I’m wrapping up two weeks of setting up a satellite office in midtown Manhattan roughly a block from the Empire State Building.

While getting ready for this week’s session in the live course “Getting 5 Star Reviews for Your Practice”, I spent time digging through patient reviews of a dozen Manhattan practices with significant numbers of reviews (50+) within a mile radius in what is a hyper-competitive market.

Here are three things that NYC patients universally report via reviews that really are not much different than what I see when I’m working in Miami, LA, Chicago, Dallas, Seattle, Montreal, London, etc.:

1 – They don’t like pushy sales spiels. Hard selling simply doesn’t work yet it seems that many practices still haven’t read the memo. When patients report this it is also a dead giveaway that the practice lacks a non-confrontational/ethical sales process like this one that our members use.

2 – They hate pain of all types and I don’t mean just physical pain although that is a biggie. They list out the various types of pains for the world to read about routinely in their reviews and to either act upon or not.

3 – Patients report in their reviews on who they trust and don’t trust. Other patients want to read those stories AND those reporting are blunt about whether one can or can’t trust a particular practice, doctor, front desk, hygienist, etc.

The take home? Whether you live in a competitive market or not and whatever your goal is related to dental insurance, fee for service, basic, or niche cases, “ground zero” for how patients inspect and decide on who they trust as a practice is now via online practice reviews.

Practices have two choices. Either address this seriously or leave it up to chance. You can do it all “analog” via check-lists OR you can do it digitally using  new software tools that allow you to garner a hundred or more reviews in a year.  If you want to have a frank discussion about how reviews fit into marketing and sales and even your service mix (e.g. fee for service and/or insurance) go here.

Now onto “Should I take dental  insurance or not?” Part 1

Personally, I’ve seen both sides of the dental insurance question/equation having seen 80%+ dental insurance participation in my general practice followed by 0% dental insurance participation/100% fee for service in my niche practice. It’s a pretty unique position and have yet to meet another consultant who has clinically lived in both worlds and thus understand the ins and outs of how to make both work.

Being 100% fee-for-service is an aspiration that many claim to want but few consider what’s truly involved to make it a reality for the long term. In a minute a doc who’s been affiliated with us for some time will share his “chair-side story” on what has allowed him to remain fee-for-service in one of the toughest markets in the U.S.

From a business stability perspective, “blended” practices are almost always the best option where there are some niche cases (if that’s something you like doing), some dental insurance based cash flow, and some fee for service cash flow. Why blended? Because it is the scenario that most dentists are capable of achieving and managing effectively for decades. It’s no surprise that most of our members have blended practices.

Why not a universal rallying cry of “fee for service” for everyone? Well, because the reality is few dentists are equipped to be completely fee for service from a clinical and an administrative/customer service perspective. They aren’t going above and beyond the norm for what patient’s expect from a professional service experience nor are they equipped with the right clinical background nor do they have the administrative mindset or have hired the right administrative help. The 100% fee for service model requires bigger “set-up” required for patients to see the difference between one that is discounted under contracts versus one that is not and then be willing to pay for the one that isn’t discounted.

What follows is a story from a doctor’s practice in Southern California that has navigated the waters of being fee-for service in 2015.

“We have been out of network for about 10 years – when we dropped our last couple PPO plans including Delta “premier”. So since then we have had one fee schedule. We collect what we produce. No write offs other than pre-pay discounts or bank financing fees.

Southern Cal is managed care mecca. The race to the bottom is in full swing and the cost of living is high enough that many people are struggling financially – so they go to XXX Dental until they have a bad experience, then they look for something else. So far, we don’t have any reputable corporate clinics – such as Heartland (James’ comment…take a look at their reviews!). I’m sure they will come, but for now all the corporate offices are mills that abuse both the patient and the dentist employee. We hear about it first hand from all of my son’s classmates that are working in that environment.

Some thoughts:

It is a constant effort that requires the right team and continual reinforcement with that team – led by me and the office manager/treatment coordinator who is on the front lines dealing with it every day to create the value in coming to us “out of network”.

We “lose” about 1/3 of the new patients that call, so we need numbers high enough to allow for that shrinkage. We are transparent about being out of network, however we let them know that we have lots of patients with their dental insurance who choose to come to us anyway. The reason we are so open is because, as you teach, we don’t want to waste everyone’s time with an insurance dependent patient that will only do what their dental insurance will pay. It sucks the wind out of you to spend an hour with a patient who is never going to move forward because they don’t see the value of our care. We bill the insurance for them and we do accept assignment – in a way – but we estimate super conservatively – for example if the insurance says it pays 80% of their fee schedule we are not getting just 20% – we ask the patient to pay 50% or more depending on the plan and we will reimburse them if the insurance pays better than expected.”