Lie #5 To be Successful you Have to be In-Network

This is our fifth post in the Biggest Lies in Dentistry series. Things the dental industry repeats to itself until they sound true. See the full series here.

Suggest to a room full of dentists that a practice can thrive without being in-network. Now watch half of them react as though you had proposed replacing their dental chairs with beanbags.

The other half will admit they've wanted to drop PPOs for years, but are convinced that the minute they do, every patient will leave and the building will somehow catch fire.

That fear didn't appear by accident. Insurance companies have done an extraordinary job of convincing dentists that participation is responsible for their patient flow. And to be fair, it's excellent marketing. Join our network, accept the fees we determine, follow our rules, and in exchange we'll place your name beside several hundred other dentists in an online directory. Apparently this is now considered a marketing plan.

Being in-network can certainly introduce patients to your practice. I'm not arguing that it never does. What I'm challenging is the belief that you must remain in-network forever to keep those patients or continue attracting new ones. Those are two entirely different ideas.

What the contract actually does

The insurance company has some influence over which dentists are presented to its members, and it absolutely controls the negotiated fees you're allowed to collect from those patients. If someone other than you determines what your dentistry is worth, that alone should give every practice owner pause.

Dentists often say, "The insurance company sends me patients." Fine. How many? Which company? What are those patients producing? What are you writing off to receive them? How many stayed because of the insurance plan, and how many stayed because they liked the doctor, trusted the staff, and had a genuinely good experience?

Most practices have no idea. They see insurance patients on the schedule and assume the insurance company created the relationship. That's a generous amount of credit to give a company whose principal contribution may have been listing your name in a directory.

A patient may, at first, find you because you are in-network. That doesn't mean the network is why they stay. Patients stay because you're prompt, gentle, and helpful. They stay because you do good dentistry, your staff is friendly, and somebody explains their treatment without making them feel as though they'd failed a dental vocabulary test. They stay because they trust you. If the only reason a patient remains in your practice is the logo on their insurance card, the problem isn't your participation status. The problem is that the practice never gave them another reason to stay.

None of this means you should get emotional, call every insurance company tomorrow morning, and announce your independence. There's a right way and a wrong way to leave PPO participation. The point of this article isn't to teach you that process. It's to convince you the process is worth learning.

And look, you might be wondering why a company that handles your billing is telling you to get out of network. Seems counterintuitive, right? Not really. In network or out, you can still file a patient's insurance and accept assignment, if the plan allows it for out-of-network providers. You should still verify benefits either way. The issue isn't whether you deal with insurance. It's what you're charging and what you're getting paid.

So yes, you can still play the insurance game. I'm just lobbying for you to get paid what you're worth while you do.

What happens when practices leave

In all my years working with dental practices, I have never seen a practice fail because it went out of network.

Never.

Have I seen practices struggle?

Occasionally.

But always for the same reason. They skipped the planning. They failed to prepare the team. They didn't communicate properly with patients. Even then, those practices recovered. The truth is that this is much harder to screw up than most dentists believe.

If your practice fails because you left one or two insurance plans, your biggest problem probably isn't insurance participation. Your biggest problem is that the business itself isn't healthy. Giving away even more of your profit won't fix that. It postpones the day you have to address the real issues.

Healthy practices usually get healthier when they transition away from poorly reimbursing PPOs, because they stop giving away the very profit they need to build a better practice. They can hire people with more expertise, pay their existing team more, invest in better equipment, improve the patient experience, market properly, and keep growing. Those are the things that attract and retain patients far more effectively than an insurance directory ever will.

The belief holding you there

As long as you believe being in-network is the reason your practice survives, you'll keep accepting whatever the next contract amendment brings. You'll keep calling reduced reimbursements the cost of doing business, even as the business gets harder to operate. You'll keep giving away the profit that could have improved your practice, because you've mistaken dependence for security.

The moment that belief changes, you start asking different questions. You get curious. You start reading. You start investigating. You start looking for people who have already done it successfully. You become willing to learn, because you finally believe there's another way.

There's more than one correct way to leave PPO participation, but there are people who have done it successfully and can help you avoid years of trial and error. Find someone whose philosophy makes sense to you. Someone with a track record. Learn the process. Then have the courage to follow it.

You don't have to leave every PPO. You don't have to do it tomorrow. But you should stop believing you have no choice. That's the myth. Everything else is just learning how to make a good business decision.

Part of The Biggest Lies in Dentistry. Read the full series here.

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