The Big Thread. The Fate of Insurance Is In Your Hands The Townies help a fellow-dentist decide to keep or drop insurance

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1 The Fate of Insurance Is In Your Hands The Townies help a fellow-dentist decide to keep or drop insurance timmy Timothy Test, DMD Total Posts: 879 Member Since: 3/11/2004 Location: Bethlehem, PA Posted: 3/8/ :15:04 AM Post 1 of 127 Hello to all, please take a moment if you can to help me out. I have been considering ending my participation with ALL insurance plans for some time now, and with the patient urging of some Townies, I think that it has now reached critical mass. This is what I would like to do: A simple poll of as many of you [as] I can reach keep it or drop it. If I can get a result favoring either decision, I will move in that direction, and if the decision is to drop, I will keep everyone posted on this same thread about how well it works out. I thank you all in advance for your time and effort. Chip Payet Total Posts: 8,752 Member Since: 10/30/2001 Location: Charlotte, NC Posted: 3/8/ :50:20 AM Post 2 of 127 If you have your staff well-trained in verbal skills to handle the situations [with] upset patients and can afford a potential drop in business (maybe, maybe not if they re really that good), then I say go for it. I tried to scratch start not accepting insurance, changed after 1 year. Still accept assignment, but at some point in the 1-2 year time-frame I may go insurance free. Basically, make sure you have all your ducks in a row BEFORE you do it. And then go for it!!! bridges Scott Bridges, DMD Total Posts: 2,870 Member Since: 2/2/2002 Location: Kentucky Posted: 3/8/ :01:30 PM Post 3 of 127 If you really want out, then you should do it. Here is my advice, for what it s worth: 1. Plan to file for patients existing policies, even though you are not a provider this can be done electronically with most if not all [insurance]. 2. Ramp up your marketing first with a reputable firm e.g. NPI, Chrisad, etc. Get some in-office training on becoming insurance free. 3. Drop each company in succession, with time intervals between to absorb some new patients. 4. Instruct your front desk on how to handle phone calls, We will work to maximize your insurance benefit, NOT, We no longer accept insurance. 5. Sign up with CareCredit (this is very important). 6. Plan on becoming less stressed and more wealthy! jguros Total Posts: 108 Member Since: 10/26/2002 Location: Fort Atkinson, WI Posted: 3/8/ :15:05 PM Post 4 of 127 We ve never signed on with any insurance as a contract provider and my staff loves it compared to what they hear taking place in offices that are on contract. My vote, for what it s worth, is to drop the plans but still file for your patients; do not simply say you no longer accept insurance I think that might hurt your practice good luck with any decision you make. madmike Total Posts: 1,097 Member Since: 1/7/2004 Posted: 3/8/ :39:00 PM Post 7 of 127 Go slow. I have seen some severe damage by dropping too much too soon. Make sure you have a plan to keep the new patient flow. We are VERY dependant on the plan, and have slowly over the past 2 years been working our way out. Dropped all HMOs first. Now have been dropping a plan every three months or so. We were on over 20, now [we are] at around 15. So I guess my opinion is do a good analysis and make sure you are dropping the right ones first, just because the fee schedule is lower does not really mean that is the one to go first. continued on page 16 14

2 continued from page 14 drtique Tom Schoen, DDS Total Posts: 2,535 Member Since: 5/15/2001 Location: Wabasha, MN Posted: 3/8/2005 4:35:04 PM Post 12 of 127 Shad, there is usually no gain the first year you drop PPOs as you have to spend $ to attract replacements. The profits begin once you have new patients in the door who are there for YOU, not their insurance contract. If you treat them right, they will send you far more quality profitable business than the PPO was sending you, so after they are replaced, the new patients still come without extensive marketing. It may take a year or two to replace the PPOs, and your profits may stay the same or even dip a bit, but by the third year you will see significant increases in profit. I was dropped by DD and it was tough at first, but it has paid off by increasing profits 40% the last few years. jerryrose Dr. Jerry Rosenberg, DMD Total Posts: 224 Member Since: 10/14/2001 Location: Jamesburg, NJ Posted: 3/8/2005 5:46:51 PM Post 15 of 127 Are you dropping being a preferred provider, or are you dropping accepting insurance assignment for any insurance? I agree with minimizing being a preferred provider, as you would have to decrease your fees, but going totally insurance free is a major move [and] YOU NEED TO BE CAREFUL. I find that accepting assignment, but not being in the plan is the best of all worlds, the insurance company helps your patient afford tx, you get paid 98% of the time, but you don t have to reduce your fees. DJStokes Derek Stokes, DDS Total Posts: 231 Member Since: 9/21/2001 Location: Idaho Posted: 3/8/2005 6:04:31 PM Post 17 of 127 FWIW, in my neck of the woods, if it were not for insurance, VERY FEW would come in for checkups, etc.; let alone getting a crown for dollars! Absolutely no way! So very few of the patients I see come in except that they DO have some sort of dental plan or welfare (it is considered insurance by many)! Dropping insurance here would put you in the street fast. Nancy Hammel Office Manager Total Posts: 1,572 Member Since: 4/20/2002 Location: Clay Center, KS Posted: 3/8/2005 6:42:10 PM Post 18 of 128 There ARE patients who are not insurance dependent and who WILL pay out of their pocket BEFORE their appointments IN FULL BUT you have to provide services they are willing to pay for AND your office has to provide outstanding service. Shad, you said you didn t get it. We spend about $2k/month on advertising. I am much happier paying that money to radio stations vs. having to write it off because I have signed a contract with the inscos to accept their fees. IMHO, it is unfair to make patients without insurance benefits pay MORE. In our office, we treat everyone the same regardless of insurance benefits, i.e., everyone pays in full [on the] day of service. Going insurance free does mean that you will lose patients BUT there are many, many more who will walk in your door who will be worth more and who will not always be saying, I will only do what my insurance will pay for. extractor Tim Adams Total Posts: 5,134 Member Since: 10/29/2002 Posted: 3/8/2005 6:47:18 PM Post 19 of 127 Tim don t do it. Keep busy, fix lots of teeth on lots of different patients. Take the best insurance plans around and shun the worst plans. Few can pull off the insurance free office. It s the path that takes many dentists off a cliff. Be the Wal-Mart, and not the Nordstrom. Wal-Mart could buy Nordstrom with its spare change. DJR Total Posts: 2,933 Member Since: 6/9/2001 Posted: 3/8/2005 7:04:49 PM Post 21 of 127 Tim (TT), whatever you decide to do, please do it gradually and over time. Making a drastic and impulsive move on this project is not a good idea as I m sure you ve seen on a number of threads here from those who have tried it. Know the numbers of each of the plans you accept, how many patients are on each of them, [and] what the write off is on each. Be sure to find out what the coverage on these plans is for out-ofnetwork providers. Drop one at a time, slowly, and then measure the effect it has. I take a number of PPOs there are days I would like to call up all of em and tell them off, but I know that it would be economic suicide to do it. continued on page 18 16

3 continued from page 16 Howard M. Goldstein, DMD Total Posts: 2,743 Member Since: 9/16/2003 Location: Bethlehem, PA Posted: 3/8/2005 7:20:20 PM Post 23 of 127 Tim, if you are wondering if you can survive without participating [with insurance] in the town you practice in, ask a non-participating dentist in your town. Wait that would be me! I dropped all plans in I m doing fine. Do what Bridges says. In addition, get a good script and letter written up for what to say when patients ask why you don t accept their plan. If you need one, ask me. You will lose some patients, but you will be surprised by how many come back after they realize that they liked the individual service received at your office and the careful time spent compared to the PPO practices. Bill the Dentist Total Posts: 36 Member Since: 4/30/2002 Location: Florida Posted: 3/8/2005 7:45:14 PM Post 24 of 127 Tim, if you drop your plans you will need to offer that service that Howard talks about the service they [patients] miss when they leave your office to try one of the insurance offices. I think that another key to limiting or eliminating insurance has to do with education, Howard Farran says that if you can get your FAGD you have a tendency to take less insurance, and if you go on to get your MAGD, that group takes even less. In my rural area where we have a lot of penny pinching retirees, for me things started to happen financially in a positive way when I signed up for Delta Premier and a couple of other PPOs that weren t too bad in the numbers department. pulaskitoothdoc Matthew McMasters, DDS Total Posts: 1,169 Member Since: 9/22/2003 Location: Pulaski, TN Posted: 3/8/2005 8:28:17 PM Post 26 of 127 Again, that is great for you, but I just can t see that being the case for most offices. While I take a few PPOs, I absolutely refuse to take MANY others. My reasoning is that I will treat all of my pts the same FFS or INS. Same materials, same lab, etc. but it just isn t fair for me to accept ridiculously low fees...as a matter of fact, it is an insult. SOOOO, what have I received in return for taking that stand? I am still practicing just over 2 days/week in my main practice, and have the luxury of driving 1.5 hrs the other 2 days to my satellite office, which I am thankful for, mind you, but it s not easy. I have had well over a hundred people (pure guess!) here tell me that they would rather come to me...but I don t take their insurance, and, You know that you would be able to work here everyday if you just took our insurance...everyone would come to you. Yet, they go down the street to another dr, and then complain to me about his work...but hey, it costs them less...and in reality, that is the bottom line. The other dr I work with has had [a] loyal pt for over 30 yrs recently walk b/c he refuses to take their crappy insurance as well (the two largest factories here just changed ins). My point is that our office provides (in my opinion) outstanding service to our pts and while many appreciate it...others take it for granted that all offices are like this. They don t see the value until they go somewhere else, and even though they may like our office better, it is better for them financially to go elsewhere. To sum it up, when you have a family of 4 to feed, and have a 35K/yr job, money is definitely the top priority (for most). What you describe may be the case in your area, but I don t think that it is indicative of rural US...at least not in middle TN. theonceandfuturegumslinger Total Posts: 3,145 Member Since: 10/21/2002 Location: California Posted: 3/8/2005 9:01:28 PM Post 28 of 127 No surprise there there is no such thing as loyalty where money is concerned. Tim, I would think in terms of transitioning out of insurance, not getting up one morning and canceling the contracts. You will see attrition, and while you may not miss the loss-leader insurance patients, you still have to find other patients to put in your chairs. Everyone will tell you about all those patients who are willing to pay for a higher level of service...however, they are also a highly sought-after and competed-for group and aren t going to flock to you just because you re not taking insurance. flailing Total Posts: 47 Member Since: 10/12/2004 Posted: 3/8/2005 9:35:35 PM Post 29 of 127 I agree with Tim in regards to going to Wal-Mart type places than the Nordstrom atmosphere. But I m a guy. The majority of appointments are made by women, so maybe Nancy has the insight to the touchy, feel-good-type atmosphere. I m in So. Cal and depend on the PPOs for patients. No cozy, spa atmosphere in my office. continued on page 20 18

4 continued from page 18 Imattdds Matt Total Posts: 377 Member Since: 10/29/2004 Location: Los Angeles, CA Posted: 3/8/ :54:39 PM Post 30 of 127 In my area, where it is very competitive, it would be unwise to drop insurance. For this reason I have an associate, competent staff and a different philosophy about insurance. For me it is a necessary evil and part of doing business. If I dropped insurance today I would probably lose about 30% of my income. It won t break me, but that means both my wife and my daughter will have to start shopping at Wal-Mart and give up Nordstrom, a risk that won t be so prudent to take. klmdds Kevin Total Posts: 465 Member Since: 1/18/2002 Location: Wisconsin Posted: 3/9/2005 6:30:30 AM Post 35 of 127 Been ins. free (no plan participation, don t accept assignment, but do file claim for the patient) from scratch 6 years. I love it. (My old practice I did it the other way.) I do notice I have far fewer young families and children as patients. (Have less money to pay up front, thus a bigger problem with our policy.) [I] do have a larger balance of older retiree types (with money) [and] I m busy. My reputation in the area either draws or repels patients (due to their priorities): He s an excellent dentist. His shots don t hurt. He doesn t take insurance. Tim-may Tim Goodheart Total Posts: 2,135 Member Since: 4/14/2002 Location: Kansas City, MO Posted: 3/9/2005 7:05:45 AM Post 36 of 127 This question always, always, always comes down to the same issues: 1) Demographics and location, 2) Temperament and skills of the doc, 3) Skills of the office staff. It s that simple and that hard. Each individual office, in order to be really successful regardless of format or practice style or type has to be really in tune to all three of these things and what format will work best when all three are considered. Without considering all three before going insurance free I think the chances of success are slim. drdave David Total Posts: 1,656 Member Since: 4/14/2000 Location: St. Lufkin, TX Posted: 3/9/2005 7:24:30 AM Post 37 of 128 Although we do not accept PPOs, HMOs or other type plans which dictate fees, we accept assignment for indemnity insurance in order to make it EASIER for our patients to do business with us. Going insurance free is dogma being taught in the lecture circuits, which has put many dentists on the verge of bankruptcy. Getting out of PPOs slowly may be a good idea if possible but not accepting assignment is shooting yourself in the foot, in my opinion. Demanding everything up front and having the patient wait for reimbursement has an air of arrogance to it. It s hard enough to get people to the dentist without putting up MORE barriers (financial) to treatment. FREE FACTS, circle 10 on card stevestamas Total Posts: 4 Member Since: 6/16/2004 Posted: 3/9/2005 8:27:20 AM Post 39 of 127 When we say insurance free are we talking no PPOs [or] HMOs, but filing claims for patients and collecting their portion at time of service, or all cash up front and we ll print up a claim for the patient to send in themselves. There s a big difference here that hasn t been clear in some posts. continued on page 92 20

5 continued from page 20 I m no expert, nor a seasoned veteran to private practice, but I don t mind waiting another 30 days for the rest of my fee as opposed to the patient seeking another dentist because they don t have the $800 up front for a crown. drdave David Total Posts: 1,656 Member Since: 4/14/2000 Location: Lufkin, TX Posted: 3/9/ :07:38 PM Post 76 of 127 Nancy, pretty good way to tell the patient they have to pay it all up front. However, it is not NEARLY as inviting and comforting to the patient as: Yes Mrs. Jones, we will be happy to help you with your insurance and we will make it as EASY as possible for you to pay the fee by accepting the assignment from the insurance company. That way you will only be obligated for a small portion of the fee. How would you like to pay for this treatment? Doing it your way, the patients hear and understand quickly, Dr. Smith wants ALL of his money up front. He is unwilling to work with me and help me with my insurance. If you cannot understand how someone needing a crown and BU would have an easier time coming up with about $400-$500 vs a GRAND out of pocket, I don t know what to say. BARRIERS TO TREAT- MENT HAVE A DETRIMENTAL EFFECT ON NEEDED TREATMENT. How about you? All things being equal, wouldn t YOU rather have the dentist or medical doctor help YOU out by accepting assignment? You fracture a tooth and don t have $1,000 on hand (like many in the same boat), which office would you be headed for? It s the Golden Rule ya know. timmy Timothy Test, DMD Total Posts: 879 Member Since: 3/11/2004 Location: Bethlehem, PA Posted: 3/10/2005 9:02:25 AM Post 80 of 127 In case anyone is nervous, I was kinda joking about completely relying on an absolute thumbs-up, thumbs-down vote. Sorry if I misled anyone. What I was hoping for was what I got, only fifty times better! When I logged on this AM and saw that there was already a second page, I was floored. You all are really great folks, sincerely. Lots of time and thought obviously went into each and every post, and I truly cannot express my warmth and gratitude to you all. As I explained to a few folks in private messages, this was sparked when I got a check back from BCBS for an endo that was absurdly low, and it had already been a tough day. Usually I m a pretty even-keeled kind of guy, but it kinda set me off. After reading everyone s comments, and taking a close look at the variables which so many different folks listed, I think it certainly would be foolish to do anything too hastily. But we have already done the following: Instituted a no-balance policy. We got hooked up with CareCredit, and have begun using it. FREE FACTS, circle 3 on card Contacted Trojan, so we can be much more efficient at collecting at time of service. If we decide to drop anything, it would not be the customer service aspect of ins, simply becoming non-par. We would still do the grunt work, etc. Gotta run, an impatient looking hygienist has just darkened my door. Everyone give him/herself a little pat on the back, you have all done your good deed for the day, and then some! Many, many thanks. FIND IT ONLINE This is just a portion of the discussion taking place on Dentaltown.com. To read this message board thread in its entirety, log on to Dentaltown.com today