#254 Decision Making Framework When Dropping Dental Insurance

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In this episode, Gary Bird and Dr. Jancy Parkerson discuss dental practice growth strategy, dropping dental insurance plans, how insurance changes impact dental practice revenue, and how to adjust marketing, KPIs, and production goals after losing patients due to insurance network changes. They cover dental practice management, increasing new patients, improving case acceptance, tracking dental practice KPIs, internal marketing strategies, and leadership strategies for setting realistic goals and maintaining team morale. This episode is essential for dentists, practice owners, and dental practice managers looking to grow a dental practice, drop PPO insurance, increase production, and build a fee-for-service dental practice.

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Website: https://chattanoogadentalarts.com/

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Dental Marketing Goat, the go-to podcast for dentists who want to grow faster, market smarter and build practices that thrive in today’s competitive landscape.
Hosted by Gary Bird, the Dental Marketing Goat himself and founder of SMC National - recently named Best Dental Marketing Agency by over 60,000 dental professionals. Each episode unpacks the real strategies, marketing frameworks and operational shifts that high-performing practices use to attract more patients and increase production. Whether you're a solo practitioner or scaling a DSO, you’ll learn how to align your marketing, team and systems to drive predictable growth.

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Transcript

SPEAKER_00 0:00

Some things changed with that. And as that changed, it impacted your practice a lot more than you thought it was going to.

SPEAKER_01 0:05

That was about 210 patients in our practice, or about 10 to 12 percent of our patient, but it was also, you know, that much of our revenue. So it's about$250,000 worth of revenue out of 2.1. We completely had zero control over this 210 patient. One of two things happened. I'm gonna take a hit to my revenue and my goals.

SPEAKER_00 0:27

How do you deal when you just lost a quarter, basically? You haven't hit your goals, you have all these bonuses, you have all these team incentives, you have all these financial goals that you're investing, you have a building, you have all these things, right? How do you, as a business owner, deal with that? Like, what do you do now? Welcome back to another episode of Dental Marketing Go. I'm your host, Gary Bird. I'm the owner of SMC National, where we help offices just like yours level the playing field against the big guys out there so you can grow the way that you want. And today we have our client, Dr. Jancy, who's joining us again, and she's sharing her journey as she goes to$3 million as a practice. Today, she's gonna be super vulnerable with you and tell you how she's dealing with dropping insurances and when that doesn't work out. She's gonna give you the whole playbook on what happened to her and what she's doing as far as pivoting with her team and resetting goals. This is super informative. And at the end of the show, she's gonna tell you exactly what numbers she looks at to make sure that she's gonna get to her goals and that she's not getting anything wrong. This is so valuable. I don't think there's any really anything else on the internet like this. So stay tuned for this one. This is super valuable. It'll definitely impact you, especially if you're thinking about dropping insurances. Stay tuned. All right, we are live for another episode and just got done talking with Dr. Jancy. And this is gonna be a good one. And to be honest with you, most people, this would have to be multiple episodes, but Dr. Jancy is a beast and she can absolutely tackle all this at once. And because it's a lot of moving parts, but as I presented it to her, I gave her a couple of ideas and she was like, no, this is all impacting all the things together. So I'll try to frame it the best that I can for the audience, real quick. So you have been growing year over year, and you got a new building. And if you guys haven't watched her past episodes, go watch those because she laid all that out really well. And this year you wanted to keep growing, and we didn't get the growth that we wanted in Q1. And the reason why was something that you didn't foresee. So one of the insurance plans, and we'll dive deep into that, that you happen to be in network with, which you're out of network, but you had one plan that you kept because for particular reasons, some things changed with that. And as that changed, it impacted your practice a lot more than you thought it was going to. And so you missed some of your targets. So now your first quarter's off a little bit. So now we're trying to figure out okay, are we gonna keep the same goals, change our goals? How are we gonna manage that? How are we gonna manage expectations for the business, for the team, and how is that going to impact our future growth and all those kind of things? So let's peel this back one by one. Tell us a little bit about the situation that happened and start with some of the good stuff first, and then we'll get into the some of the negative things, and then we'll make it positive at the end.

SPEAKER_01 3:14

Absolutely. So, to give you guys some background, we are a Morphe for service office. We are only in network with Blue Cross, Blue Shield, and Delta Dental. And our practice over the last July will be seven years. We, when we purchased the practice, we were in network with 10 or 12 plans, and we've strategically dropped those over the last six years. We had planned at the beginning of 2025 to drop MetLife. We had very few patients on it. It was only about$51,000 worth of revenue. We did$2.1 million in collections last year. So that was a negligible amount. So we had taken, even though it was negligible, we took the whole year last year to have conversations with patients at every appointment that they came in for, whether that was hygiene, whether that was restorative. Hey, this is what's going to change next year. This is what this means for you. You know, we can still use your out-of-network benefits. This is how that will change. So we took a year to prep just like we did with bigger plans that were more impactful for the practice, even for the small guys. And that's how we've been really strategic and been able to grow even while we're dropping plans. So we knew that we were going out of network with NetLife. The problem was, and if any of you are a Tennessee dentist, you might this might resonate with you. So Blue Cross Blue Shield had bundled together the whole time that I've been practicing in Tennessee, which is since 2019, was Blue Cross PPO and Blue Cross of Tennessee Medicare was kind of under the same umbrella. It was the same fees fee schedule, same fees, et cetera. The only difference was your Medicare patients, most of them had a$3,000 yearly maximum and they had no co-pays, zero for any preventative, any work, any restorative that was done up until their$3,000 max. Well, of course, after that, there would be some cost, et cetera. But basically, these elderly patients were coming in, they're on fixed incomes, and they have$3,000 to spend each year. So the Medicare, we actually had more Medicare patients than we had PPO patients, just because of the way our population and our demographic is in our area. So that was about 210 patients in our practice, or about 10, 10 to 12% of our patients. But it was also, you know, that much of our revenue. So it's about$250,000 worth of revenue out of 2.1. So again, 10, 11, 12%. And Blue Cross made an executive decision that they did not communicate well with members, with the doctor's offices or with insurance brokers. Mid-December, we got a letter stating that Blue Cross Medicare would all of a sudden be processed and managed by Optum, which is United Healthcare. And we would be under supposedly the same fee schedule. A lot of a lot of promises were made. January rolls around, a lot of the promises were not upheld. We don't participate with United Healthcare. So we basically were no longer to see these patients unless we were willing to go back in with United Healthcare, Medicare at a much, much lower fee schedule, which we were not willing to do. So we found this out the first or second week in January. So needless to say, all of all of that big backstory to tell you that we thought we had prepared all of 2025 to drop this one strategic small plan.

unknown 6:58

Yeah.

SPEAKER_00 6:59

We've got to do that. And you've done this over and over and over again.

SPEAKER_01 7:02

Zero control over this 210 patients that now one of two things happened. I'm going to take a hit to my revenue and my goals either way. I either just drop this, I don't, I don't play by United Healthcare's rules and I don't go and network with them. And these patients aren't used to paying a copay. This year, in network or out, they were going to have to pay some copay some things. But as an out-of-network, it was going to be substantially more. So fixed income, they're used to not paying out of pocket. So of course they're going to try to stay in network and pay as little as they can out of pocket, most of them, which is understandable. But the decision making and the autonomy was taken away from the practice. And the decision was ultimately made for us. And we didn't want to compromise our level of care and what we can provide to those patients. And we didn't want our staff to have to go back through all the red tape that we had experienced with United Healthcare in the past and take a loss anyway. So we decided that we were going to pivot. And that's what Gary and I are going to talk about a little bit more. But that's the that's the backstory of a decision that was out of our control. We were blindsided and we had already set goals before we knew this for 2026. So that's what Gary alluded to.

SPEAKER_00 8:24

Well, and also you've it's not like this is your first time, your first rodeo of dropping insurances. Like you've done this before. This was like, this is like the craziest curveball because it's in the middle of you making a change, they also change the rules of the game on you, basically.

SPEAKER_01 8:41

Extremely. I mean, and I'm giving you like the tip of the iceberg of a lot of other convoluted layers that lie beneath. But yes, it's I've been practicing for 13 years. I've owned a practice for almost seven. We've all had experiences with dental insurance. I've never experienced anything like this transaction was. So this was a complete blindfight.

SPEAKER_00 9:05

Dental insurances never disappoint. They never disappoint.

SPEAKER_01 9:07

This this is a new record. So if you're in Tennessee and you've lived through this, my heart goes out to you. So you're not alone.

SPEAKER_00 9:16

Yeah. And I can only imagine, too, the patients have to be I, right?

SPEAKER_01 9:20

They were very blindsided and very frustrated that it was after open enrollment. So they were they were burned and stuck as well.

SPEAKER_00 9:29

They were trapped.

SPEAKER_01 9:30

It was a lose lose for everyone but the insurance company, as usual.

SPEAKER_00 9:34

Yes, as usual. Okay, so so now you're in this, you're in this position because you have all these goals and you you now the good news is the silver lining before we jump into that, you actually, even with that loss, you still did the same as you did last year. You didn't grow the way that you wanted, but you also didn't shrink. Yeah. Okay, so that's the positive. So now, and my question to you was off air was okay, so how do you deal with this? How do you deal when you just lost a quarter, basically? You haven't hit your goals, you have all these bonuses, you have all these team incentives, you have all these financial goals that you're investing, you have a building, you have all these things, right? So, how do you as a business owner deal with that? Like, what do we, what do you do now?

SPEAKER_01 10:22

Initially, and Gary can attest to this. I called Gary, called Kristen, who's kind of our point of contact over our account, and was like, hey, this is what's going on. This is completely, you know, out of our control. In January, we didn't really have enough information to know how it was going to shake out. We anticipated that most patients would leave because, again, fixed income population, they're used to having full coverage. They're now going to have to pay something out of pocket regardless, but it's going to be vastly different in network out of network. So it's not like a PPO plan where it's somewhat apples to apples. It would, we just pretty much we figured we were going to lose a lot of these patients, but we didn't really know what that was going to look like and how that was going to translate into actual KPIs and numbers in the practice. So it was hard for us to know, okay, we're going to have to increase marketing at some point, but how by how much? What kind of budget do we need to put towards that? How many patients are we really going to need to grow on top of what our original growth goal was? We didn't know that. Lots of lots of variables that we weren't sure of, that Gary and Kristen, we were all, you know, we were kind of shooting in the dark and anticipating things that we didn't have enough real data to go off of. So we actually made the decision that we would not change our marketing budget in January and February. We would get some time under our belt, figure out how this was actually going to shake out, play out. And we did a few things internally. We started really focusing on our referrals again. We're doing some internal, like referral contests and some things like that. So some internal marketing. We are in a very busy high traffic area. So we started doing some promo banners and some things like that, very tastefully out by the road, just trying to kind of drive literal traffic from drive-by, things like that, really making sure that we're giving a lot of time and attention to our social media, trying to, we even restructured our intake forms to be a little bit more streamlined for new patients and existing patients to help drive elective type procedures. So like implants, clear aligners, smile makeovers, veneers, whitening, cosmetic type things. So instead of at that point guessing as to what our marketing budget should be, we pivoted and tried to go internally and figure out what we could make up with our existing patient population or the new patients that were be driven being driven to us. And then as we gained that information and really knew what we needed to be replaced, then go back to Gary and the team and say, okay, this is what we have. We're tracking the same way we did last year. We're not going in in the hole. But if we wanted to not, if we wanted to still hit our goal for this year, this is where we where we need to be. So that's when last week we actually sat down and we were like, okay, I think we need to ramp up new patients. We're doing the things with existing patients. We have to bring those two avenues together to help us still reach that initial goal that we set before, you know, X, Y, and Z happened unexpectedly.

SPEAKER_00 13:41

So good. And yeah, you're already off to a good start with that. Now, how do you deal with how are you gonna tackle like the goals? So, are you gonna take your goals and like stretch them out and make you know make all your goals bigger now? Which there's a downside to that. There's a risk to that, and right, you might reach make a goal that you can't reach or your team gets defeated by. Or are you gonna let it play out and keep your goals? Or how how are you gonna tackle Q2 and the rest of the year?

SPEAKER_01 14:10

I'm going to keep the goal for now. Again, we just implemented implemented this second layer of increasing our digital marketing. We already had implemented some things internally that are working. So the internal component is already rolling. We went back to the drawing board this week with really fine-tuning verbiage on the phone with the staff, trying to make sure that we're converting as many calls as we can and using those marketing dollars wisely because you don't want to increase your marketing budget and not be converting the calls when they come in. So we, you know, we were like, okay, let's go with our front desk team. Let's really fine-tune the verbiage. Let's take a deep dive on the phone calls. Okay, that's going well. Let's look at internally is there anything that we can do better with our treatment planning conversions and conversations? Is there, you know, why are people saying no? And when they are saying no, how can we track that? Gary and I talked about this last week. So we're going to start using that as an additional data point. So, you know, a month from now, if we can figure out 50% of the patients are saying this is their roadblock, okay, how do we now tackle that? How do we tweak that, lower that barrier so that our conversion towards treatment is better? So it's not just increasing my marketing spin. It's not I'm just increasing my internal, my internal existing patient population to drive referrals and what have you. It's making sure every step along the path is optimized as much as we can to try to continue to reach that goal. With that being said, I need a little bit more data, kind of like we did at the beginning of the year, to know what that goal modification needs to look like. I don't want to do it too soon and not hit the target and the sweet spot of where it should be. I don't want to leave it too high, but I also don't want to set it too low. And but I'm very open to moving the needle to compensate for leadership decisions in Q1.

SPEAKER_00 16:16

That's what I was gonna ask you. That's what I was gonna ask you next is how are you gonna frame that? And and yeah, dive into that. That's so good.

SPEAKER_01 16:24

So two things with that. One I feel like my team should never be punished for not hitting a goal that I set if I set it incorrectly. That's that's a leadership situation. And as a leader, I believe in full transparency with my team. And I know not everybody likes to share things with their team, and sometimes they hold numbers close to their chest. That's not my philosophy. I've worked with a team before where a goal has been set and it was too high, and they realized by April that there was no way they were gonna hit it, and everybody just gave up. So the goal needs to be attainable. It doesn't need to be so low that no one has to work for it. It's not a real reward. But it also doesn't need to be so high that everyone, you know, they get in their head and they're like, we're never gonna do this, and then they start giving up. So you have to find the sweet spot. And personally, I need more data to know what the sweet spot is. I don't want it to be a moving target all year. I want to make one modification and make it strategically and stick with it. But at the same time, I, how am I gonna frame it? I'm very much gonna go to the team and I'm gonna say, Gary, you know, we knew that going into this year, this was our goal. However, as all of us know, we've lived through X, Y, and Z with Blue Cross Medicare. And none of us knew what that was going to do to our numbers, what it was gonna do to our schedule. We needed some time to figure out what kind of impact that was gonna have on us. Now we have three months, four months, six months, whatever that time frame is. And now that we know, we've been able to offset things by increasing our marketing. We've been able to offset it by doing more lecture procedures, da-da-da-da-da. But we also lost time that we can't make up for during Q1. And as that was a leadership decision, that wasn't you guys not doing a good job. I didn't put enough patience in front of you. So if I don't put enough patience in front of you, I can't hold you accountable for people that were never there. So, with that being said, now that I can make an educated goal that's attainable for all of us based on all of this information that I finally do have, this is our new goal. And y'all have already been taking measures to get there, and that's how we're gonna hit it as a team.

SPEAKER_00 18:50

That's great. And I I know you're super data driven. So I feel like most doctors are probably not as data-driven as you just because you you've said it before, your dad was an accountant, and so you just have like you look at numbers in a totally different way when we talk about marketing budgets, all that you think about it in a totally different way than most doctors. Could you, and I'm sure you're doing the same thing with the insurances and all those kind of things as well. Could you just walk me through the data points you're gonna be watching this quarter to make sure that you make a good decision at the end of the quarter to adjust the targets?

SPEAKER_01 19:27

For sure. So at the end of the quarter, and I'll try to just hone in on a few that I look at kind of weekly, because at the end of each quarter, I sit down and I do an extremely deep dive of a lot of KPIs, of what was our production per provider, what was our adjusted production, what was our collections, you know, what was our hourly, how many open hours did we have in the chair? And what was our conversion rate? I mean, there's a I look at a lot of KPIs, and then we pivot based on what we're doing well, and then if there's some issues, how do we fix those? So quarterly, I do a deep dive. I don't know that that some people might say, I want to do that monthly. For me, I feel like that's a lot, and I feel like you need a little bit bigger data pool for it to be meaningful. So quarterly tends to work for me. But when I'm making this these decisions with Gary in between January 1 and the end of March, when we have three months of data to look at Q1, I'm looking at my production reconciliation report. I'm looking at my collection reconciliation report, I'm comparing that to what that looked like this time last year. I'm mid-March saying, okay, in 10 weeks, I've collected this. Let me extrapolate that out into whatever that average is and say, if that's what Q1 is, then if I extrapolate that to the rest of the year, okay, I'm gonna do what I did last year, what do I need to do to take it and get to that original goal that I had? And that's when we start deep diving into what is our phone conversion rate, what is our treatment plan acceptance rate internally? If we're focusing on clear aligners, let's track our clear aligners. So we have kind of a small subset of data points that we like to look at internally to help us keep a pulse on kind of the 30,000 foot view, and then we hone in at the end of Q1 and get into the nitty-gritty details so we can actually see how it played out and make any pivots that we need to for the next quarter.

SPEAKER_00 21:41

This has been so good. And the reason it's so good is I I feel like a lot of people go through this, but nobody talks about it. Like, good luck going online and finding what we just talked about. And uh it's basically what you've done is like you're you've helped people mentally, you've helped people like almost from a consultant level. And I am so thankful that you're just letting us document your journey. I'm some people are further ahead, some are way behind you, but you're just like, hey, this is where I'm at, this is what I'm going through, here's what I've learned. And this is like, this is a goal. So, Dr. Jancy, I just really appreciate you because you're just like matter of fact. And hey, this is just the way it is, and here's what we're doing. And you always do it with such an abundant mindset. So I really value you. I know our audience does as well. So thank you so much for coming on and sharing on. This is like absolutely like this is great content.

SPEAKER_01 22:31

Well, I appreciate you guys for having me, and I appreciate all of our listeners for taking a listen. Let us know what you think and whatever experiences you've had, we're always willing to learn from each other.

SPEAKER_00 22:42

That's awesome. Thanks, Dr. Jancy. Have a great day.

SPEAKER_01 22:44

Thanks.