written by Jill Shue
You heard in on a podcast, you’ve read articles, and you’ve decided you’re going to do it! You’re going to drop all those insurance contracts and go fee for service — but what’s the best way and is it the right decision for your practice?
It’s important we first say, going fee for service may not be right for every practice. It’s okay to want to stay in-network, it’s okay to want to go fee for service. This is merely a reminder to slow down and evaluate your decisions. Changing your insurance contracts drastically changes the financial relationship your patients have with your practice and this may negatively affect your practice if not managed appropriately.
Know Your Numbers. Talk to your consultant, talk to your accountant, run your reports, and know your numbers. What percentage of your patient base is affected by insurance? If you’re in-network with several plans, how will this change affect the patient’s processing and reimbursement?
A common overlooked topic is your referrals. How are patients hearing about your practice? What is bringing patients in? If the majority are hearing about your practice from their insurance list, this is a good indicator that those patients may choose to leave your practice should you leave their network. If you have a large amount of patients who are referred via word of mouth, you are more likely to retain those patients.
In addition to your patient demographic stats, look at your scheduled. Ideally your doctor schedule should not be booked out more than one month and your hygiene should be scheduled for around 6 months with the exception of scheduling holds for new patients and scheduling needs like scaling and root planing. If you’re schedule is booked to the brim and you are not looking to add additional providers, it may be time to evaluate your insurance contracts.
Evaluate Your Philosophy and Portrayal of Your Philosophy. Many providers do not realize that by being overly conscientious and aware of insurance benefits especially when presenting treatment to a patient, this is hurting the relationship you may have with the patient. We often unknowingly change treatment needs based on if it’s covered by insurance — think fluoride age restrictions, frequencies on x-rays. By making these adjustments in your recommendations, we are indicating a patient’s insurance benefits affect the care they receive.
Another common behavior that suggests an insurance carrier’s “opinion” matters in a patient’s care is our overuse of preauthorizations. Often we recommend a preauth to obtain an accurate estimate; however, this is also giving your patient the idea that we are seeking “permission”. If a patient requests a preauthorization, of course, send the preauth. If the patient does not ask, do your due diligence to be as accurate as possible in your estimate while ultimately having the patient approve the balance of the treatment vs getting caught on the estimate.
Invest in Your Team. Before adjusting your insurance contracts, invest in training for your team. Ensure your team knows how to walk the walk and talk the talk. The ROI on training speaks volumes when it comes to your customer service as well as ensures your team is all sharing the philosophy and terminology.
Prepare a Timeline. Before pulling the trigger, evaluate the timeline in which you wish to make any change to your contracts. You and your team need time to educate your patients as well as inform the patients of the upcoming change. If at all possible, you want your patient to learn about your intent from you. If they hear about it from their insurance carrier, they will unfortunately see the change from the carrier’s perspective, which will not necessarily reflect well on you.
Educate and Prepare Your Patients – Change the Mindset. On a recent shopping trip, I overheard a conversation of two customers. One was saying that she needed to find a new dentist because her current dentist stopped taking her insurance. The other in response exclaimed that she also had this happened and just switched to a new dentist to only find out he stopped taking her plan also a few months later.
This overheard conversation indicates a common misunderstanding and prompts a much needed conversation especially in a time when dental practices are making these difficult decisions. Educate your patients about the insurance’s relationship in their care. Be open that the insurance carriers are placing restrictions on their care. Your patients need to be informed that this change does not mean they are no longer a patient at your practice, in most cases they can continue to come to you and utilize their benefits, that you will still submit claims on their behalf, and work with them to maximize their benefits.
Notify Your Patients and Continued Communication. Put thought and consideration into your verbiage and the reasoning behind your decision. Your patients should never feel as though you are terminating the relationship with their carrier because they do not pay you enough – financials should never be a reason you portray to your patients in the notification process.
Your patients should begin receiving verbal communications, while in person at their visits with your office, as soon as you’ve decided to make a change. Once you have a termination date confirmed with the carrier, your patients should receive written notice 30 days prior to the effective date. Continue to communicate with your patients while monitoring what is too much and what is too little communication.
We know this decision is a scary one — there are so many unknowns. While you can’t prevent the loss of patients while implementing this change, you can reduce the impact by fully evaluating your practice needs, preparing a proper timeline, and continued communication with your team and patients.