EP 88: No Insurance? No Problem.

Ever feel like dropping all insurance? For some doctors, it can be the right thing to do. But for others, it’s not (especially if you drop a carrier based on emotional decisions instead of hard data). So, how can you make the right choices about insurance without risking a loss of patient flow, production, and profitability? That’s the subject of today’s episode of the Double Your Production Podcast. 

Listen now to discover:

  • How to avoid costly “knee jerk” decisions about insurance  
  • The only way to tell patients you’re dropping a provider
  • How to remain profitable after a 20% cut in reimbursements  
  • When insurance is helpful to your practice, when it’s not, and how to make changes

Welcome to the Double Your Production podcast with the Team Training Institute, the one place designed for dentists and their staff who want to grow their practices by following in the footsteps of those that have done it, who are in the trenches, who know exactly what you're going through. And now your leaders, the stars of the podcast, Dr. John Meis and Wendy Briggs.

Dr. John Meis: All right. Hey, everybody. Welcome to this episode of the Double Your Production podcast. I'm Dr. John Meis here with Wendy Briggs. How are you doing, Wendy?

Wendy Briggs: I'm great, Dr. John. Love starting the day off with a Facebook live, right? We're kind of at a habit of this. During COVID, we did this three or four times a week, and now we'll do it occasionally. We've recorded some podcasts lately, but we haven't done very many on Facebook Live. And so today we wanted to hop on and do a quick video to our group.

Dr. John Meis: It's going to be awesome. There's always a little technology glitch with this here and there, so glad to be with you, Wendy. We just had our Blue Diamond Retreat in Salt Lake City last weekend, and there was a lot of buzz about insurance. A lot of buzz about one particular company sending out a letter to their providers saying they were dropping reimbursement by 20%, or some percent anyway. So a lot of tension around that, wasn't there?

Wendy Briggs: Absolutely. And it's all over Facebook as well, and Twitter, and the social media groups, because dentists are rightfully outraged that yet another insurance company has decided to really minimize and trivialize patient care and pay dentists less while their CEO's are raking in millions and millions of dollars in bonuses. Right? So the injustice of it all, it gets people talking.

Dr. John Meis: Yep. And this isn't anything new, there's just some milestones that we hit and we've just hit another one. There was a big public kind of in-your-face letter sent out to dentists. So that gets everybody riled up, and well, it should. But we saw that there was some knee jerk reaction, "I'm dropping all insurances. I'm going to send out a letter to all my patients and dropping." We heard thought processes like that. So I thought it would make sense to really talk through the strategy of when insurance is helpful, when it's not helpful, and if you want to go from one to the other, what does it look like. Does that sound good?

Wendy Briggs: I think that sounds amazing. I think there's a lot of people out there that, like you said, have those knee jerk reactions, and then they are asking advice or opinions on a social media forum, or a group of some kind, where people may not really be making data-driven decisions. Maybe they're making emotional decisions and that might not always be the best strategy. So we do see some long-term damage from these knee-jerk reactions.

Dr. John Meis: What we feel like doing sometimes interferes what we want to accomplish, right? So we have to be careful about that.

Dr. John Meis: So I thought we could start out by talking about, first of all, from a patient perspective. Patients want us to be providers for their insurance company. It's very important to them, and we know that that draws in patients. And when you're not a provider, when you switch from being a provider to not a provider, it also drives patients out. And I think there's this dream that we're going to not become providers, and it's going to increase the cost to the patient. We have this dream that our patients, because we're so wonderful, they're going to continue to love us, continue to see us. And certainly some will, but there also will be some drop-off. There'll be patients who aren't going to pay the extra freight and they're going to move somewhere where their insurance is more accepted. Does that make sense?

Wendy Briggs: Yeah, absolutely. We often survey our rooms, a room full of doctors who say, "How many of you see a physician that's not on your insurance?" and very few hands go up. So consumerism matters, giving patients what they want really matter. In fact, you mentioned our retreat just ended. That was our topic of the entire retreat, was how to give patients more of what they want. Certainly, not being a provider on their insurance is not giving patients what they want, but that doesn't mean it's not appropriate to do it occasionally. Here and there, it does make sense.

Dr. John Meis: So the question that I have for people who want to drop insurance is, do you have enough patient demand to keep your chairs full when you're not a provider for any PPOs? That's kind of the question that I have. And a lot of people don't think of that. They don't think that insurance attracts people, which it does, and they don't think dropping it is going to repel, which it will. So where are you? Are you so over demanded, meaning you're so booked out, you're so busy, you can't possibly keep up with everything? Well, that's a time where you may want to consider making some changes with the insurance, right? So this is a capacity demand issue. If you don't have enough capacity and you want to tamp down demand, one of the ways to do that is to pick an insurance company and let them go.

Dr. John Meis: So, I have not seen people have anything other than a disaster if they drop them all at the same time. So our approach for doing this is you have to be over demanded first. So if you're over demanded, pick an insurance company that is a particular pain in the butt and you don't have a lot of patients with, and just drop that. Maybe you have two or three of those that you're going to drop. And then give it some time. Are we still over demanded? Well, great. If we are, we can drop another one, and we can drop another one. The ones that have the most patients are the ones that I would save till last, and you'll get a sense of how retentive you are once you drop a few. You'll get a sense of how many patients stay and how many patients go, and that's helpful in making future decisions.

Wendy Briggs: All right, Doctor. So what about the doctors who say, "It doesn't matter because the patients that you do see will be paying more, so you can drop those insurance companies and still make the same, if not more, money." What would you say in that scenario? Because I know sometimes we assume that that's how it's going to go and that's not how it goes at all.

Dr. John Meis: Yeah. So, dentistry is a business of flow. The more flow you have coming through, the better off you're going to be. Yes, patients paying your usual customary fees, that is significantly more money and therefore they're significantly more profitable, and if you have enough of them, great. But don't go too quickly down the path of dropping insurances, unless you know you've got enough to replace them. And how we become over demanded, meaning more patients that we can care for than we have time or room for, first of all, the great patient experience, the topic of our retreat... Other things is what are we doing for patient attraction. What kind of marketing are we doing? All that kind of stuff. So you could gear up that and drop insurance, but don't plan on it being smooth. We're going to have significant disruptions in patient flow, we're going to have significant disruptions in revenue, and we're going to have significant disruptions in profitability if we don't take it deliberately, slowly, thoughtfully.

Wendy Briggs: Right. And what would you say about how you alert patients? I see a lot of people asking, "We're going to drop this insurance company. Can I get a sample letter? What letter do you send out to patients?" And for me, that sets off the alarm bells, because I'm like, "Ooh, danger, danger. I have not seen a letter work well at all for the dentist." It might work well for the patient because they have plenty of advance notice to find a new dentist, but that's not necessarily what we want to have happen.

Dr. John Meis: Yep. No, I totally agree. I think this is news that is better given face-to-face at the office. And the challenge is, of course, that the insurance company is going to be writing a letter saying, "Your provider is now no longer a preferred provider, therefore you're going to be paying a lot more. And here's a list of five other dentists in your area that are providers that will save you out of pocket expense." So that's the balance, and I'm with you Wendy. I really haven't seen the letter, the persuasive, for patients to stay. I think a face-to-face conversation is better.

Wendy Briggs: Absolutely. Patients need to know, obviously, the reason to the change. We got to sell it to the patient. They need to have clarity on the why, and the why can't be, "We're making less money." The why needs to be, "We're committed to providing a high standard of quality of care and this company is interfering in our ability to do that." So therefore we're going to continue to provide the highest quality of care. But they also need to know that there's some good news and the good is, from their perspective, almost nothing has to change. "We're still going to take great care of you. You may have a higher out of pocket for some of the procedures, but we're still going to do everything we can to make it affordable for you. We're still going to submit your insurance. We're going to file your insurance. We're going to take care of as many of those details as possible."

Wendy Briggs: So the messaging to the patient should be, "You may have a little bit higher out-of-pocket, but nothing else will change. You'll still be able to receive the best quality of care possible at our practice." So I think sometimes patients misunderstand. They think if we're not a provider, that means they can no longer be a patient. They need to understand that that is not true. Even though they may have gotten a letter from their insurance company that says that's not true, it's really not true.

Dr. John Meis: Yep. So the letter is really sticky. If you're going to do one, I think the messaging that you just said, Wendy, is really ideal. But it is hard to get your heart, your emotion, your connection on paper. The written word is very, very tough. Spoken word is much easier. So be cautious about the letter. You don't want it to come across as you being greedy, you want it to come across about quality of care, quality of caring, and that you're going to continue to take care of the patient in the same way or even better than they did before.

Wendy Briggs: Right. So, Dr. John, when we have practices that are out of capacity and they have high levels of demand, the strategy you just mentioned about dropping some of the lowest insurance plans is just one strategy. We often see practices, depending on their long-term vision, that go another path, and they choose to continue adding additional capacity so they can continue growing the practice. And there are some myths out there, I think some false, false messages, that are sent to dentists in that the only way to really be profitable is to drop insurance. So could you talk to that for a minute and talk about how there are other paths that you can choose? And even those Cigna dropped 20% of their reimbursement, and it's really frustrating and it's unfair, there's still a way to accept Cigna and be profitable.

Dr. John Meis: Yeah. So I remember I met with the CEO of a large dental group. We were speaking at a technology conference, and we were in the little green room, the prep room, ahead of his talk. The technology was all on analytics, so I asked him, "What measures correlate with profitability well? And he said, "Well, I can't tell you that, but I am going to give you one." It was proprietary information so he didn't want to share it with me, but he did give me one. He said, "The number of insurance plans an office accepts, that's directly correlated to profitability." It stunned me and I didn't believe it for a long time, and then over time I could see how practices that accept plans, their chairs are full. When their chairs are full, they cover their fixed overhead more quickly and there's more profitability at the end of the month. Even though their payment per procedure is less, they still end up being more profitable.

Dr. John Meis: And now most people will argue that and say, "Well, I'm working harder to make the same thing." Well, maybe. Maybe that's true, but because once the fixed overhead is covered, there's so much profitability there. I want to get as many procedures after that big store ahead is done as I possibly can. I mean, that's just the way to profitability. And even with the 20% cut from Cigna, highly efficient offices can make up that difference using the three rules of hygiene that we teach, same day dentistry and the other strategies that we use, we can make that up. Now, you have to be providing value in order to get something back. So we got to be doing something for patients in order to get that. So some people look at that as working harder, some people look at it as serving patients better. It's all how you think about it.

Wendy Briggs: Yeah. I think this is so true, Dr. John. And again, some of the knee-jerk reactions that we see are often dentists making emotional decisions without keeping their eyes on the data. Interestingly enough, you know my family is a baseball family. And during spring training this year, baseball, I remember a story about a pitcher who decided that he was going to pitch this spring training game with one eye closed, just to see if he could do it, if he could still get batters out. I was fascinated by that. True champions and people who are fierce competitors are always looking for ways to challenge themselves. But I couldn't help but see the correlation with dentistry, and sometimes I think dentists are making these decisions on an unemotional basis with one eye closed.

Wendy Briggs: They don't really have a sense of their data, they don't know how many patients have this particular plan that they're thinking of dropping, they don't know what percentage of their existing, or active, patients have that plan. They really are going into this with one eye closed, making an emotional decision. And I think that's what we want to get across is that we have to have strategy rule the day and not emotion. We do see some practices that accept every single insurance plan, even some with Medicaid, that do very, very well. We also see some practices that are fee for service that do very, very well, or have a history of doing well, that are having more of a struggle today than they've ever had. Right?

Wendy Briggs: So we have to be mindful of the capacity and demand in our practice. And if we do decide to get rid of some of the crappiest plans, if they just don't fit your values and your strategy, we think that's wonderful. However, we've got to be very careful about how we go about that. Getting a letter from Cigna and immediately dropping them, which is very popular, it's trending on social media, it may not be the best strategy depending on where you are in your practice and what's happening in your practice. Don't go in with one eye closed and think you can win the day. That's a rarity that we see that happen.

Dr. John Meis: So before one would want to do that, one would want to understand their profit loss statement, they would want to run some projections, make some assumptions on what's going to happen to revenue, and then map out what that's going to look like for profitability. And I'd think very few people do take the time and do the work, and do the math, to figure out where they're going to be financially. To be making a big business decision without having some understanding of the basics in how the math is going to work, and how the math is going to affect the profitability, and how profitability affects everything. The value of your practice affects your loan covenants, all that kind of stuff. So one should really be thoughtful and careful about doing this. Not saying don't do it, I'm just saying, make sure that you're in a position that it's going to be positive for you to do it and not a negative.

Wendy Briggs: Right. I couldn't agree more. Dr. John, we have an event coming up. If there are our doctors listening today, if you're on our Facebook Live, what we will do is we'll post in the comments a link because we have a Double Your Production workshop coming up next month. It's September 17th, I believe, in Las Vegas, Nevada, and it's a workshop where Dr. John and myself get into the nitty gritty on how to successfully compete, how to do more same day, how to maximize the three rules of hygiene, the things that Dr. John just talked about. We're having a workshop for dentists who want to learn more about how we do that and how we help our clients really excel in spite of insurance participation, and some of the other challenges that we see in dentistry today.

Wendy Briggs: So if that sounds like something you'd like more information about, we'll definitely post the link in the comments here on our Facebook page. But if you're listening to the podcast after the fact, we'll also put a link on our podcast homepage so that you can get more information about that Double Your Production event. Every time we do that event, we have a few people show up and say, "Hey, we're listeners of the podcast, and we really love it." So we want to make sure that we give you that opportunity to join us live to go into some of the strategies on how you can compete in spite of these challenges that seem to be cropping up every day.

Dr. John Meis: Yep. They do, and they will continue to, unfortunately. It's the nature of business.

Wendy Briggs: Absolutely. And the good news is that there's good news in all of this. We just had our retreat this last weekend, and just about everybody there was record production months, record performance. Our team's really taking incredible care of our patients, which is what it's all about. So we know it can be done and we know many of you are doing it. It's just a delight to see some of those success stories. And certainly, our mission is to help as many practices and as many dentists as we can know how they can continue to be profitable, and effective, and successful without having to sacrifice the quality of care they're providing to patients, because we know how important that is to so many of you.

Dr. John Meis: Absolutely. All right. Thanks everybody for being with us on this episode of the Double Your Production podcast. We hope to see you at our Double Your Production event, and if not, we'll see on the next podcast. Thanks everybody.

Wendy Briggs: Thanks everybody.

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