Lie #11: It’s too hard to get out of network

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

One of the biggest reasons dentists stay in PPOs isn’t because they believe it’s the best decision for their practice. It’s because they’ve convinced themselves that getting out is simply too hard. Sometimes they call it risky.

Either way, they’re usually talking about the same thing.

Hard depends on who you’re asking

I’m not a dentist. Preparing a crown would be hard for me. As a matter of fact, if it were legal for me to try, I’m pretty sure the patient would be in serious trouble. And so would I. For you, it’s just another Tuesday morning.

Getting out of network is no different. It feels difficult because you’ve never done it before. You simply haven’t learned how yet. But that can be fixed.

I’ve done this so many times that, for me, getting a practice out of network is just another Tuesday morning. That wasn’t always true. It became true because I learned the subject.

And if you need some reassurance, I’ve never seen a practice fail because it went out of network.

When it goes wrong, this is usually why

I have seen practices struggle after going out of network, for a completely different reason. Going out of network wasn’t the problem. A weak business foundation was.

It’s like putting a beautiful crown on a tooth that’s about to fall out because of advanced periodontal disease. When the tooth fails, nobody blames the crown. The crown didn’t create the problem. It simply couldn’t fix everything that was already wrong.

Business works the same way.

If your marketing is weak, your case acceptance is poor, your scheduling is inconsistent, your patient communication is weak and your team isn’t trained, don’t expect dropping a PPO to solve those problems. They existed while you were still in network. Insurance simply helped hide them.

Going out of network didn’t create the weakness. It exposed it.

What successful transitions have in common

That’s why practices that are successful at getting out of network don’t start by dropping insurance plans. They start by strengthening and preparing the practice and the staff.

Every successful transition I’ve ever been involved with follows the same broad pattern.

First, the business foundation gets stronger. Marketing becomes effective. Lead conversion improves. Case acceptance is handled. Reactivation is working and active patients are being seen in hygiene. The team is trained. The stronger the business becomes before the first PPO is dropped, the smoother the transition.

Then the homework begins. Every insurance plan is analyzed. Contracts are reviewed. Fees are evaluated. You determine exactly how many patients are covered under each plan, what those plans actually contribute and what your options really are. Most dentists are surprised by what they discover, because they’ve never looked at their PPO participation from a business perspective.

Once you understand the numbers, you develop a strategy. Then you decide the order the plans will come off and the timeline that makes sense for your practice. You can do this on any gradient.

Then you prepare your team. They understand why you’re making the change. They know what patients are likely to ask and how to answer those questions confidently, because they’ve been trained before the first patient ever asks them. They also know how to handle questions from new patients and how to schedule them effectively.

Only then do you begin implementing the plan. Not all at once. You move through it deliberately. You monitor results. You make adjustments. You continue strengthening the practice as you move forward.

There isn’t only one way to get out of network. There are probably dozens. But every successful approach I’ve seen contains the same basic ingredients. A stronger business foundation. A plan. A trained team. Good communication. Careful implementation.

The details vary. The principles rarely do.

Learn it, or find someone who has

If you don’t know whether your practice is ready, find out. Learn enough business to answer that question yourself. I recommend that anyway.

The day you bought your practice, you made your financial future dependent on your business decisions, not just your clinical skill. If you’re going to trust your family’s future to your business ability, spend a little time learning business.

If you don’t want to learn it all yourself, then work with someone who has successfully guided practices through the process many times before. Learn it yourself. Find a mentor. Hire an advisor. Take a course.

I don’t care which path you choose. All of them will work, as long as you actually do it.

Move at a speed you’re comfortable with

If it takes a year to prepare your practice before dropping the first plan, then take a year. Nobody wins because you rushed the process and gave yourself a bleeding ulcer.

On the other hand, if staying in network is already giving you a bleeding ulcer, it’s time to start moving on this.

One more thing

Going out of network does not mean you’re done with insurance.

Your patients still have benefits and they still expect you to file. The claims are just bigger now, because you’re submitting your actual fee instead of a discounted one. Bigger claims get looked at harder. And depending on the plan, the check may go to the patient instead of to you, which means somebody in your office is now following up with the patient rather than the carrier.

None of that is a reason to stay in network. It’s a reason to have the billing handled properly before you make the change, instead of discovering it three months in.

You’re at the helm

Getting out of network is never hard, the same way doing a crown is never hard if you know what you’re doing. That knowledge can be learned.

If you really want to get out, start with the first step. You’ll probably discover that the anticipation was far worse than the process itself.

This is Lie #11 in The Biggest Lies in Dentistry. Read the full series here.

Smile Care Claims handles billing, insurance verification, and A/R management so your team doesn’t have to. If you’d like to find out whether we can help, book a consult with one of our billing specialists.