Episode 158: Can I STOP seeing New PPO Patients if I am still in Network?

Hello everyone, welcome to the 158th episode of the less insurance dependence podcast. The official podcast of the reducing insurance dependence academy. www.rida.academy this I Naren your cohost today’s topic is Can I STOP seeing New PPO Patients if I am still in Network? Can I STOP seeing New PPO Patients if I am still in Network? Before we get into the topic, I have a quick announcement. We have the thriving dentist MBA coming up on the 16th, 17th, and 18th of November. 7 to 10 pm eastern time. 16 17 and 18th of November. 7 to 10 pm eastern time. We limit the attendance, so if you are interested, I would recommend going to www.thrivingdentist.com/mba. One of the reasons people attend is that they learn the ten elements, and then they learn how to apply them. Garry goes through 10 workshops 9 hours of CE, and one of those elements is using insurance dependence. The entire three of our podcast. So you are going to get amazing nuggets and amazing information in all ten elements but denial in the steps you have to follow if you want to be successful in reducing insurance dependence, so check it out, go to the urn thriving dentist.com/mba and sign up. Now, Gary, this is a question Can I STOP seeing New PPO Patients if I am still in Network? This is a question that came up in one of our webinars recently, and I thought that was a good question; even though you and I have down a few webinars over the years, I think that was the first time someone literally asked that question. That was kind of interesting. 

G: Yes, it is a great question. We got that LIVE, you know, because sometimes our webinar attendees will resubmit questions – 

N: Yes to us.

G: They are thinking about the topic, and they- we encourage anyone who is attending to pre-submit questions, but that one actually came up live in one of our webinars. So it is a great question, and I suspect it is also motivated by very timely developers. Let me take a minute to explain that. Many practices today are experiencing an increased demand for their dental services. Not only from their existing patients but from potential new patients as well, and we certainly expense that in our practice and throughout our client base; we hear that all the time and one of the struggles that doctors have today is being able to fit in new patients relatively soon. You know how I feel about that, Naren, correct? 

N: Yes, I know you do this with Life Smiles. You ask every client to do it; you want to see patients ideally – new patients ideally within three business days. 

G: Yeah, we want to see new patients within three business days in times of increased demand. I will flex that a little bit and will say we will extend that to a week but let me also emphasize we are not talking about an emergency patient today. We are talking about a patient like this – maybe they call and say, hey, I just moved to the area, I went on Google, and I found your office, and it looks great; I spent a lifetime on your website it looks great, nothing is going on, but I just want to get established with the dentist in the area. I want to roll the red carpet out to that patient, and I want to get them in within a week. We know that the shorter the amount of time between their call to your office and that first appointment, will result in a higher conversion rate – the conversion rate is what percentage of the calls from potential new patients are converted to a kept new patient appointment. The keyword is kept. It is one thing for them to make it, but they have to actually show up. And so many of our clients that we experience at life smiles is – we see a wonderful surge of demand. For services, and it is becoming harder and harder to meet that you know to me that criteria of seeing it within a week, which is a good news-bad news story. The good news is that we have got increased demand. That is great we love that – I am dancing in the isles, that is great. The bad news is that if you can see new patients relatively soon, then that new patient, especially if they come via a digital referral, you know if they come from digital marketing, people are impatient today. If they are being scheduled out 6 7 weeks, which we see routinely now, for offices that are not paying attention to this, then what do you think that potential new paint is going to do next after they – they will probably make the announcement just as a place over right – a 100 percent. 

N: Worse case, nobody else is willing to seem, then I have this as a backup. 

G: Where do you think they are going next? 

N: They are call-in the next person on their Google search!

G: They are pressing the back arrow on their browser, and they are going to the next dental office to see if they can get in sooner. 

N: I think you are bringing up an excellent point. I think I find this the world continues to change around us. I remember the days when I would go to the blockbuster and rent a tape and then the dad and all that hustle, and today you press a button, and I have unlimited content for ten bucks a month. Thanks to Netflix and thanks to Disney. 

G: I mean, can you even imagine? I mean, you are right, Naren. Just culturally, can you imagine getting in to watch a movie? Getting in the car driving to the local blockbuster perusing the titles, standing in line, and renting it – that sounds like horse and buggy.

N: I know! And then I come home, and the VCR player doesn’t work because the VCR is messed up! Now I have to go back and complain and get a new tape! 

G: Yeah! I mean, true confession here for just a minute, we are talking about inpatients, we believe the human race is increasingly impatient, and I have been guilty of that. I am sure you have too, Naren ad I am sure all of our listeners have. I was reminded right before Covid started. I had a chance to lecture at ASDA, the American student dentist association, and Dr. Wartekris and I were co-keynoting that conference, and it was in Las Vegas. It was a quick trip for me because it was kind of sandwiched in between some other events that I was doing, and I remember when I checked out of the hotel, and I went outside and I – in Las Vegas, I never rent cars I always take Uber and so I hit Uber to get my ride to the airport, and it said 11 minutes and my reaction was I am not waiting 11mintues that is ridiculous! I went to Lyft – I am embarked by this. In hindsight, I am a little embarrassed about this, but I went to Lyft, and Lyft was 5 minutes – ok, I am doing Lyft. But imagine like before the era of Uber and imagine someone going – Naren listen to this it is a new thing coming on your phone wherever you are you can hit a button, and you can call up a driver that has been screened and secure and nice and clean and safe, and they will come to pick you up, right where you are – and then they will take you wherever you want to go 

– and by the way, you might have to wait 11 minutes for that. What would you say? Fine, that sounds great!

N: I mean, it is like I was happy I used to look forward to blockbuster nights 20 years ago. Now you give me a blockbuster night, and I am like, what? Are you crazy! 

G: I mean, when you describe that, it sounds like the horse and buggy days. T is like going back to a horse buggy for transportation. So let’s tie this back in. I imagine this question came in the webinar from a doctor who is experiencing increased demand like so many are right now and saying, wait a minute, and can I just stop seeing new PPOs?

N: And I understand where that is coming from right because he knows he has to take a 45% or 42% pay cut every time

G: Also, a lot recently remember the record that we have seen so far in insurance markups? 58%

N: 58% yeah

G: In Pennsylvania, 58%

N: And he is thinking, why do I need to spend all this time building this awesome relationship just to get 50 to 40% on the dollar?

G: When by the way, the next call might be a fee for service patient. 

N: Right 

G: Where I get a 100% but let me answer the question – let me rephrase it. Can I STOP seeing New PPO Patients if I am still in Network? The answer is no – you cannot. Because think about it; when you are in-network, that means the insurance company is going to send you new patients

N: Right

G: That is what it is all about. They are the marketing; this is the big breakthrough that I want all our listeners to get; I want you to think about those adjustments as a marketing expense because you are paying the PPO plan to send outpatients. That is the deal they will list; they will put you on their network dentist they list it in their print media, they will sit it in their digital material and print material, and that is the deal. They will send you new patients, and then you are obligated to take a big haircut on those fees because of your contracted status with them, so the answer is no, you cannot! Because I know what this doctor w thinking. You know what if I just stopped seeing new patients – I will continue to see my existing network patients and will live with that. But I don’t want to see any new ones because it is just going to add, you know, pain and suffering to my practice. But you can’t do that. If you read the fine print of your PPO contract, you cannot refuse to see new patients. But let me tell you what you can do. That is completely legitimate. You can push that potential new patient that is contacting you out in your schedule you can push them out. Depending on how you are booked, you decide how far to push them back. 

N: Yeah, you know-

G: Say block for the fee for service new patients that you are going to see sooner. By the way, if you are pushing a patient out as we are recording this, we are in late September, as we are recording hits episode if you push a PPO patient out into January or February, what is that PPO patient going to do?

N: He is going to find someone else.

G: He will find another PPO doc because you know 97% of the doctors and the dentist as PPO in the state no trouble finding one, and then you have affectedly stopped seeing new PPO patients without being in violation of your contract. 

N: Right

G: So you have effectively done that, and you know I want to emphasize something, Naren. You know when we were in-network when Paul and I started when we bought Life Smile, and we were contracted with 34 plans, one of the philosophical decisions that we made was that we would not have two standards of care or multiple standards of care. We were going to have one standard of care that meant that we would use the materials we are going to use the lab, we are going to use quality team members are going to use technology, whether the patient was a fee for service paints or a PPO patient, because that would allow Paul to sleep at night, me to sleep at night and not have integrity issues around that.

N: Right

G: So I know there are dentists who have one lab for their fee for sieve patients and another lab for their –

N: Some even have associate does the fee for service- I mean the PPO, and the owner doctor does the 

G: Right, I get that

N: Yeah 

G: But I feel like what I am suggesting is pushing those potential new PPO patients out in the schedule is not about changing the quality care is simply putting some herbals for that patient to kind of encourage them to go somewhere else. 

N: Yeah, it is being done in other types of medicine like dermatology. Like medical dermatology, I won’t get an appointment for 6months. If I want to get Botox, I can see the doc in 2 days. 

G: Right, that is absolute- there are plenty of medical health care examples where this is absolutely the case, so if you are experiencing increased demand, this is an approach that you can follow. You can push it out of your schedule. Make sure you have got new paint blocks that are blocked and held in your schedule. For potential new patients who are fee for service patients and you are going to want to see them sooner because that is who you will build your practice on, and if you continue this, you are going to stop seeing new PPO patients, which is good because every time you do you make a big fat haircut on your fees and you are going to be making more room to see more fee for service patients. By the way, if you want more fee for service paints, just follow my lead! Use my marketing resource. You know we are an EKWA client – a digital marketing company with founder Naren who is the CEO – we have been working with you for the last five years, and you supply my practice with really quality new patients and any of our listeners I would encourage you to take a look at EKWA and follow our lead on that, the website is very easy – it is www.ekwa.com/msm that stands for a marketing strategy meeting. Put in the forward-slash MSM, and you will click that, and you will see Lila Stone’s calendar – Lila is your director of marketing where they could schedule a marketing strategy meeting where she could share with you how you are doing ho your website is ranking in Google all the different Google analytics things you can do to prove marketing and really have a blueprint to follow to attract quality new patients so that you can say goodbye to the PPO plans and goodbye to the 44 to 58% tax that you are paying the PPO plan so this is a very good thing to do. And remember, if things change, you are mobile – you are nimble. If all of a sudden now, let’s say the spike in demand starts to wane, then you are still in-network, and you still see those patients, but this is a really good way to take some baby steps towards successfully reducing insurance dependence so that is why o thought this would l be a really good episode.

N: Thank you so much, Garry, I think it is a wonderful point, and I am glad the person who asked it – I think it is a great question, and you provided an awesome answer, and It runs parallel as it happens in all different part of health care, so you are not doing anything new or unique. 

G: Now, and you know this kind of allows you to create space in your practice. I mean, for quality new – I mean, why in the world would you want a space being held with a potential new patient when we have a fee for service patients who wants to get in and see you? And now you get a 100% of your fee, and you are not subjected to that 44 to 58% discount and patient by the patient by patient, you will strengthen your practice. Every one of those you will strengthen your practice. So this is something you ought to sit down for, doctor. So let’s follow through on this – Dr., what I suggest you do is that you share this episode with your administrative team members. Any of your team members that answer the phone and you know it is easy enough to play it at a break-out team meeting. I am suggesting to the doctor that you and your admin team members – play this. And hit pause and talk about it – and then get everyone on the same page, and you could come up with a strategy, and I suspect your team members will be very supportive of this, because as we strengthen the economics of your practice, there is more opportunity for them, and remember you are not the only one doctor that feels like the proverbial hamster on the treadmill with the PPO plans. Your team members feel it as well. So this would be a really good way to take some baby steps that are completely reversible (laughs). Remember if all of a sudden today you are booked out with new patients till January, and by the time we come to January, that is not the case – b the way, I don’t think that is going to happen. I don’t see that happening – but if that would happen, you are very nimble, and you can adjust, and we can see PPO patients sooner, and you are not violating anything in your PPO contract. Well, hey, this has been a fun episode. I think there is a lot of always take here for our listeners, and as we wrap up today – I want to share a quick reminder Naren in the opening, you talked about Live stream MBA thriving dentist workshop coming up but also in November, November 12th we have our very first RIDA summit. RIDA is both a play on words – we want to help you get ‘Rida insurance, and I know for the grammar policy I am not saying that grammatically correct I know that, but I love the sound of it. We want to help you get ‘Rida insurance, but it is also an acronym. It stands for reducing insurance dependency academy. Anyway, we are doing our first summit, and it is coming up on November 12th from noon to 6 pm eastern we have an amazing panel of guest speakers, 6 hours of CE for attending that, and you will be armed with all kinds of practical information you can use to successfully resign from PPO plans., and if I had a drum roll this is where I would roll the drum roll out – so drum roll please, let me take a minute and tell you what the tuition is – free! We are gifting this to you! 

N: Yes

G: For free! So just go to www.Rida.academy/summit and you can register tell your finds about it, it is always better and useful to have friends if you are going through the same process, maybe you can do a study club meeting around it tell everyone you know, we as virtual – it is a virtual event so you can attend it in the continence of your home or office, you are going to be blown away when you see the guest contributors you have coming on that one. All – every bit of the content is geared towards helping you successfully drop PPO plans. Well, on that note, I simply want to say thanks to all of you – we appreciate each and every one of you, thanks to you – every single month, we are experiencing a new record in terms of downloads. 

N: Yes

G: For the less insurance – thanks to you! So thanks for telling your colleagues. If you have not done it already – jump on iTunes and write us a review that helps more dentists find us, the more dentists we have on this bandwagon are strength in numbers on this for sure. I think it is long past due that our profession stops being taken advantage of by the PPO plans. So can help you can join that campaign by telling others what we are doing in this podcast, what we are doing in this summit, and helping others follow this same journey. Thanks so much; we appreciate the privilege of your time and hope you enjoyed this episode.