#263 The 12-Step Drop Insurance Playbook (No More Theory)

 🚀Check out our new Dental AI Receptionist! It schedules better than humans: https://bit.ly/4tmFXwQ
🚀Grow Your Practice with Cherry Payment Plans: https://bit.ly/4tjNlsC
➖➖➖➖
Most dentists don’t realize insurance write-offs are quietly killing their profitability and growth.

In this episode, Gary Bird breaks down a proven 12-step system to drop PPO plans the right way, without losing patients or slowing new patient growth. You’ll learn how to increase case acceptance by 30%, restructure your practice management, and use financing, phone conversion, and patient communication to transition to fee-for-service successfully.

This is the exact framework SMC uses across hundreds of practices to replace insurance-driven revenue with profitable dental marketing systems.

Subscribe for more real-world strategies that help dentists grow faster.

Connect with our Host, Gary Bird, Here ⤵️
SMC: https://bit.ly/4tkHRxV
Personal: https://bit.ly/4cjS1sY

Want the strategies we talk about delivered to your inbox? Subscribe to Dental Marketing Digest: https://bit.ly/4s6Lzdm

➖➖➖➖
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.

🚀 Want to see how SMC can help you grow?
📱 Book a call here:➡️ https://bit.ly/4tkHRxV

🎙️ Check out our 3 Dental Podcasts ➡️ https://smcnational.com/podcasts/
📅 Upcoming Events ➡️https://smcnational.com/events 

Transcript

SPEAKER_00 0:00

Today I'm going to give you the 12-step process that you need to go through if you want to drop your insurance plans. Now, this is not for the faint of heart. These are not for scared people, and this is not for people who don't want to grow. You will grow numerically. It'll also stretch you and your team, both clinically and operationally. And I'll explain why that is as we work through this. But this is not something that you do just to make your life easier, even though your well life will become easier as a owner. It is something that you do because the current model of having insurances just isn't working out for most dentists. Now, if you figured out how to make it work, great, good for you. But I don't know if you've noticed insurance companies have figured out that their margins go up when they cut your fees. And so they're just going to keep doing that. So today I'm just going to walk through, I'm going to give you 12 steps and what you need to do. These are going to be in order. And this is almost all of this is what you do before you drop the insurance. So most of this is things that you get prepared before you drop your insurance. Now, if this is helpful, just drop a comment down below for me. It really helps me out. And make sure you subscribe wherever you're watching this. So let's jump into this. Number one, step number one is to know your numbers before you touch anything. Know your numbers before you touch anything. You are going to want to run a full report on all your PPO plans. You want to know the number of active patients, gross production, total write-offs, net collections, and write-off percentages per carrier. So you need to spreadsheet this, okay? Then from there, you're going to rank them by write-off percentage, not patient count. Your worst contract isn't your smallest, it's the one writing off 40 to 50% per patient. Those are going to be the ones that are the low-hanging fruit, so to speak. Okay, because they're the easiest to replace. If they're writing off 50% and you can get, and let's say you have 20 patients coming in every month on that, then it's only going to take 10 patients to replace them paying full fee. So make sure that you pay attention to that. Anything above 40% write-off is a drop candidate. Anything below 30% is something that you're acknowledging, but we're putting that at the bottom of the pile. The other thing that you want to know and you want to look at really, really carefully is you want to know your active patient base. So how many patients do you have in your active patient base? If you're under 800 to 1,000 active patients working four uh days a week, build up first. Don't drop yet. Okay. So make sure that you have an active patient base that you can pull from. So this isn't, again, for like brand new practices, things like that. All right, number next, check each contract's termination clause. Some require a 60-day notice, some require six months. You you need to actually plan this out based on the rules, and you want to make sure to check in with that. And then next, and I I think you can figure most of that out with AI now, and you can in getting your hands on your contract loaded up in the AI, have it work through that for you. All right, number next, find out which plans pay out of network benefits, same pay nearly as well as out of network. So some of the plans you're gonna notice going out of network doesn't really change things, especially for specific kinds of treatment that you may be already doing a lot of. So pay attention to that. So this that is step number one. If you're watching this on YouTube, there's AI right down below. You can literally just say, give me step number one outlined, and it'll give it all outlined for you. Okay. Works really, really well. All right, ready. Here's step number two. Step number two is try to renegotiate before you drop. Always renegotiate first. It's faster, less disruptive, and you can actually save a boatload of money pretty quickly with that. And there's also companies out there that can do that on your behalf as well. So that's gonna be step number two. So once you know all your numbers, now we're gonna go in, we're gonna potentially renegotiate with some of these insurances. Even if we renegotiate and we drop them a year later, you're still making more money while you're waiting. Okay. So that's step number two. If they say there's no offers, uh something like that, then you're um, you just you know you try, right? So you're gonna move on from that. All right. Step number three, drop your worst plans first, not your biggest. Start with a plan that has the fewest patients and the highest write-off. This is your lowest risk. Do not, and I've seen people do this, where they drop their biggest insurance, it's like half their patient base, and they just start freaking out. So don't do that. Start little, work your way up. Don't drop everything at once, phase it. Worst plan, one to three months, next plan, four to six months, ex, et cetera, et cetera. And you kind of gotta watch it. This is a long-term thing that you're gonna be doing and working through. It's gonna take time, it's not gonna happen overnight. Send your uh termination letter via certified mail, get in written confirmation that you are out of network with them now. Okay, and again, gotta do this all before you go out of network. Before you start doing anything, you need to do all of these steps, okay? Get get everything in order. All right, number next, step number four, get your team's buy-in before telling the patients this is huge. This is another huge mistake that offices make. Hey, we're dropping insurances. Well, you just made everybody's job way harder because if you've been training your team just to sell the insurance, meaning patient comes in, we see this work, the insurance is going to cover it. It's an easy yes. That's so easy. Same with the phones. Patient calls, you ask them what insurance do you have? Okay, yeah, we're in network with that insurance. So easy. Everything's so easy and smooth. The problem is that you can't sell a lot of treatment. You're not doing what's best for the patient, you're not giving them what they need, and you're taking a huge discount on it. So you gotta get your team on board first before you tell the patient. So important. So you got to tell your team why you're doing it too. This is a financial decision that we have to do because it's best for the business, and guess what? It's best for the patient. Patients aren't getting what they need because they think insurance is covering them like health insurance, but it's not. So this is a patient care issue, and it's best for the business. It's gonna be best for you guys, it's gonna help all of us. We can't provide the level of care on these current rates. We just can't. We can't do what's best for the patient. Ask your team, what would it take for you to go out of network as an office? They're their answer is gonna tell you, okay? If they go, oh, I would never go to an office that's out of network. You have a problem. You have a problem, and so you're gonna have to solve that one by one. So you're gonna have to talk with the team, work through it with them. Super important. The biggest barrier on the phone is that the person answering doesn't believe that it's worth it themselves. Same with selling treatment. Oh, they're not gonna want this because it's not covered by insurance. Then you're never gonna sell treatment. Ever. Um, you're gonna need scripting, role-playing, QA sessions, et cetera, et cetera, around this, okay? All right, number next, step number five, control the narrative with the patients. 90 to 120 days out now. So notify the patients 90 to 120 days before the effective date. You want them to hear it from you, not from the letter from the insurance company, because they're gonna get the letter from the insurance company, right? One practice um will uh be able to send thousands of letters, and you want to get those into their hand before the insurance company does, and you want to control the narrative. So ideally, if you can send letters, that's great. But ideally, you want to be dealing with this with the patient in office, and you're gonna want to uh educate them about what's going on. And some people are just gonna be problem patients, and you're gonna have to let them go, and that's fine. About from what I've seen, about 10% of patients are gonna be like, no, you know, this is silly, ridiculous. And you gotta you gotta prepare yourself and your team for that. You have to let them know, okay, this is something that's going to happen. We're going to lose 10% of patients. Some are going to get really mad. But again, we're explaining this through the lens of, hey, we can't treat you well as a patient. We can't do the things that we need to do to keep you healthy as a patient and accept this plan. And we can't survive as a business doing it either. This is gonna help them understand that their insurance is the problem. All right, time it before open enrollment for most. That's late fall. So patients can adjust their plan selection if they want. It's a big one, especially if you're doing big amounts of treatment. The clinical team starts the conversation in person during the hygiene visit, not a cold letter in the mail. Again, letters are great, um, but that is not enough. Okay, so if you can do it in person, you're just gonna be way better. Number next, step number six, nail down the phone scripting for the new and existing patients. Nail down the phone scripting for the new and existing patients. The phrase to never use, we no longer accept your insurance. So we don't, we're not gonna say that. Okay. The phrase that works is we have several patients in our practice with the same insurance as you. I can share with you how it works. We're non parti we're a non-participating provider, but the good news is that we have a great system that makes it easy as possible. We process the cames for you, and we can do a benefits check for you. Let's figure that out. And then you work through that. Uh, for callers who push back, I know being an insurance network is important to you, but what else is important to you to you when it comes to your dental care? What else is important? Well, I want to get like good care. Great. Well, the reason that we actually had to go out and network with them was because why we couldn't treat you properly. So you need to get that all nailed down. You really want to make sure that you're making insurance. The bad guy, we wish plans were different. Unfortunately, we can't deliver that level of care uh because the contractor rates just weren't paying us enough to be able to do that. Like we couldn't stay in business again. Make it make it very obvious why you're making these decisions. Always collect up front, don't chase reimbursement checks. That's really important. All right, number next, launch a membership plan as a safety net. So this is really important. You have a large number of patients that are uninsured, anyways, and some that are like grossly underinsured. If you just had like a plan, you could push them towards that. So get that set up. We have a whole um podcast and a whole training on that, how to do that. Step number eight, have patient financing ready day one. You gotta get really good at patient financing if you're gonna go out of network. This is uber important. You do not use patient financing to save the treatment, you do it to set the treatment. What does that mean? We should be leading every conversation with monthly payments. This actually eliminates a lot of the insurance conversations in the T with the TC. Just they completely disappear because you're all of a sudden you're talking about$80 to$150 a month, not thousands of dollars, and how much is insurance covering? So the insurance, you just work it into the plan and into your estimate. And if anything, you do it in such a way, I actually learned this from Dr. Blake, it's really good. You do it in such a way that you're getting an insurance uh reimbursement check for them that they overpaid. So if anything, you're delighting them because it's like, hey, here's a couple hundred dollar check, you overpaid. That's great. But never, never, never uh with patient financing should they be having to pay more money back to the insurance. So you always want to overestimate, not underestimate. Really important. So have that in place. Now, if you don't know Cherry is a sponsor, we have a link down below. We have a training on how to use Cherry properly, which will increase your case acceptance by 30%. And you will absolutely win if you are able to use that and um get a discount with it. It's huge, okay? So check that out. It's down below. Number next, increase your marketing budget. This is not a new cost, okay? So now you're gonna be spending more marketing dollars than you've ever spent before. You're gonna spend more than you've ever spent before. And what's really important is that you understand that insurance is marketing, but you're paying on the back by discounting and writing down your treatment. Now, what you're gonna be doing is you're gonna be paying up front. So before you're maybe spending two, three thousand bucks. Now you're gonna like 5x that. You're gonna be paying six, seven to ten, twelve thousand dollars depending on your practice size. However, you're making more wet money on every single patient because you're not dealing with insurances. So that is what I wanted to share with you guys today. Let me know down in the comments if this was helpful and uh let me know if you want any of that scripting. We have it all for you. I hope you have a wonderful day.