Dentaltown November 2022 - 8

howard speaks
column
Is It Time To Reconsider
Going Out of Network?
For decades, we experienced little to no infl ation, so
when you got out of dental school, it was normal to sign
up to be an in-network provider with several insurance
companies. Sure, their reimbursements stayed pretty
much the same year over year, but so did your costs,
which meant you could grow your practice by adding
new patients. And being listed as an in-network provider
with PPOs and insurance companies meant more
exposure-and potential patients-for your practice.
But when labor and supply costs begin rising-
especially as dramatically as they are nowadays-those
set fee schedules become a burden, not a blessing. You
could actually be losing money when you treat patients
as an in-network provider on certain plans. (Yet another
reason that I'm constantly telling my dentist readers
that they need to know their practice numbers. After
that exam and cleaning, did you make $5 or lose $9?)
Opting out of one plan at a time
I recently visited a practice in Glendale, Arizona,
whose dentist did a deep dive on what each PPO and
insurance company paid for the most commonly performed
dental procedures. (That included regional
variations within those companies-determining how
much Delta Dental of California paid, for example,
versus Delta Dental of Washington.) Armed with that
data, at the beginning of 2022, they decided to go outof-network
with Delta Dental.
During the early months of the trial run, there
was a tremendous burden on the treatment coordinator
when it came to explaining the changes to patients:
As a courtesy, the practice would
still send a claim to the patient's
insurance company, but the reimbursement
would likely be mailed
to the patient, who would then
need to sign it over to the practice.
And the reimbursement likely
wouldn't cover 100% of the cost of
treatment, so the patient would be
responsible for any balance.
by Howard Farran, DDS, MBA, founder and CEO
8 NOVEMBER 2022 // dentaltown.com
" The biggest thing to focus on is patient education
and participation, " the treatment coordinator told me.
" We had to tell them things like, 'Your reimbursement
is probably going to be a paper check, which will come
in an old-school envelope, so be on the lookout for it.' "
Losses and gains
Now that it's in the second half of the year, most
of the practice's patients are coming back for their
second round of biannual cleanings. They've had the
better part of a year to decide whether they wanted to
stay at the practice even if they had to pay more out
of pocket, which means the practice now has numbers
that track whether its decision led to a loss of patients.
Before 2022, about 30% of its patients were using
Delta Dental plans; during the year, the practice lost
an estimated 10% of those patients-which means
97% of its patients are still with the practice. And the
gaps have largely already been fi lled with new patients
who either use higher-reimbursing PPOs or make use
of the in-offi ce dental plan, which brings more money
to the practice than it was earning before.
Going out of network does mean more follow-up
work for your fi nance team-calling and texting payment
reminders and checkups with patients, going
over lists of various claims still due from the PPOs and
insurers. " You need a good support system, " the treatment
coordinator says. But that's well worth the effort
when it comes to maximizing your practice profi ts!
Should 2023 be the year in which you drop your
least rewarding PPO relationship and see what happens?
If you don't already have the numbers to help
drive those decisions,
start now, during the fi nal
months of 2022, and get ready to make changes in
the new year.
Dentaltown founder Dr. Howard Farran would love
to hear your thoughts about the ideas and suggestions he
mentions in this column! Post your questions and comments
under the online version of this column, which is at
dentaltown.com/magazine. ■
http://www.dentaltown.com/magazine http://www.dentaltown.com
Dentaltown November 2022

Table of Contents for the Digital Edition of Dentaltown November 2022
