Episode 116: Step #2 to Successfully Resign from PPO Plans

Naren: This is the less insurance dependence podcast show with my good friend Gary Takacs and myself Naren Arulrajah. We appreciate your listenership, your time, and most of all we appreciate your intention to reduce insurance dependence in your practice. Our goal is to provide information that will help you successfully reduce insurance dependence and convert your practice into a thriving and profitable dental practice that provides you with personal, professional, and financial satisfaction.

Naren: Hello everyone, welcome to another episode of the less insurance dependence podcast show. This is Naren your co-host. Today is a special day when you listen to this it’s the 31st of December. New year’s eve and Gary and I of course celebrate the new year like all of you do. So, Gary, how are you doing?

Gary: Hey Naren I’m doing great, New Year’s Eve, imagine that and I imagine that not only for you Naren, and myself but probably all of our listeners are going to be very happy putting the year 2020 behind us. It’s been a challenging year in many ways and I think this particular year is going to be fun to kind of close the book on 2020. How do you feel about that Naren?

Naren: I have to agree with you Gary it’s one of those years at least in my entire lifetime that I feel like, this was a roller coaster. 

Gary: It was a roller coaster and I can certainly look at some data points 

Naren: Yeah 

Gary: and say in many ways it was very good but if we also look at the emotional side of it the emotional side of 2020 has taken its toll on everybody and I’ve always enjoyed figuratively turning the page to a new year. It represents a clean slate it represents opportunity and but I’m feeling especially encouraged by flipping the calendar this year.

Naren: Yeah, on a personal note I agree with you, uh but sometimes some of us enjoy roller coasters so I guess there are some silver linings that came out of its new ideas new ways of doing things. So that’s kind of 

Gary: Yeah there are definitely some points to celebrate from 2020 some pivot points uh whether it be at the practice level or business level there been some pivot points that have been uh just very very good but also just the entire impact of the virus and how it’s impacted people as has left a shadow and emotional challenges for many. So, I’m excited about 2021 and one of the things that we’re working on is how to make it our best year yet and I think we’ve got an awesome topic 

Naren: Yeah 

Gary: That will sort of lead our listeners into 2021 in a very positive way and as you saw in the title, step number two to successfully resign from PPO plans. So if you’re a listener and you’re newer to less insurance dependence podcast, go back three or four weeks and you’ll discover step number one and we talked about step number one to successfully resign and now we’re going to go to step number two. So very excited to share this information with our listeners and maybe use it as a launch, a way to launch into the new year and hit the beach running so to speak.

Naren: Absolutely this is the topic I’m very excited and I love your six steps Gary and I really appreciate you sharing this with our audience of people who are interested in reducing insurance dependence. Not too long ago I saw a survey in one of the groups and more than half of the people have said they have dropped one or more PPO plans. That’s amazing, so the good news is only 10 of the practices are totally free for service or less than 10 maybe even five. So seeing half of them now saying you know what enough is enough. Let’s start reducing insurance dependence, I think this is a great thing for 2021.

Gary: For many Naren, I think that’s one of the silver linings

Naren: Right 

Gary: In 2020 is that my interpretation of it is that the disruption caused by the shutdowns caused many dentists to really look closely at their practice and sometimes we’re so busy working in our practice that you never have time to work on it.

Naren: Right 

Gary: That’s a Stephen Covey concept, you can be so busy working in it that you don’t work and if all you’re doing is working in it, sometimes we don’t have a chance to step back and look at things objectively. Well like it or not, dentists had extensive time to reflect on their practice based on the shutdowns, and for many dentists, they actually looked at it and said I really don’t want to go back and continue to practice the way I practiced before and for many, the big decision that they wanted to change was their relationship with insurance companies because first of all, they realized they’re spending an obscene amount of money to the insurance company to provide them patients, and they realize there’s a better way and then they also realize that the number one reason why overhead is too high, is from third party intrusion, PPO fee schedules, and they just want to do more meaningful dentistry with people that actually appreciate them. So you put all that together and many, there’s a groundswell of dentists that are taking action and moving towards reducing their insurance dependence and I’m excited to be part of that and uh excited to see dentists taking action. There’s a bigger group of people that are just still sitting on the bleachers thinking about it and uh if that’s where you are perhaps our content will move you from spectator to action and you’ll get the benefits of it through taking some action but very excited to share this topic step number two, which if I can just cut to the chase step number two is mastering digital marketing. That’s step number two, and the timing on it is very important. We’re going to go through six steps with you over various episodes of the less insurance dependence podcast, but notice this is step number two because we want to have your practice proactively replace any patients you might lose when you go out of network. You’re going to lose some, proactively replace them through successful digital marketing because now you’ll deal from a position of strength because you will have replaced any you might lose. Remember our goal is to keep as many as possible, and what we’re seeing in our client base is we’re seeing across the board in practices all over the country, they are keeping or they’re losing 10 to 15 percent of their in-network patients. Meaning they’re keeping 85 to 90 percent of them. Remember when we go out of network it’s not just a matter of being arrogant and saying we don’t take your insurance anymore it’s a matter of remaining patient-friendly remaining insurance friendly, continue to file their claims for them continue to submit all the documentation continue to follow up and help your patients get every benefit they have and the fact is they can use those benefits in your practice and if we do it that way you end up keeping 85 to 90 percent of your patients but the second step is to master digital marketing. I want to go through some bullet points for our listeners.

Naren: yes Gary.

Gary: One if you’re going to begin to master digital marketing, the first thing you need to do is have a mindset shift and the mindset shift I want you to make is, from this moment forward I want you to think of your insurance adjustments and your insurance write-offs as a marketing expense because you are literally paying the insurance company to provide your patients. I want you to begin there, I want you to really feel that in every ounce of your DNA, and once you look at it that way depending on the size of your practice, you might be spending thirty thousand forty thousand fifty thousand dollars a month on marketing, not in the sense of writing a marketing company a cheque, but it’s the same concept because you’re paying delta and the other PPOs’ in the form of your insurance adjustments and again the adjustment is the difference between your usual fee and your contracted fee. You’re paying them to provide you, patients. So you need to look at that as a marketing expense and if you feel like I do about that, it’ll probably make your blood boil to realize you’re spending 30, 40, 50 000 dollars a month but the reason why I want you to really get your arms around this because once you realize that the only possible answer is I need to change that because that doesn’t make sense right would you agree, Naren?

Naren: Absolutely and Gary I remember you had an example with one of your clients who you are going through this exercise with, a million-dollar practice meaning the doctor collects a million, eighty percent PPO driven meaning they are giving away approximately forty-two percent to get those eight hundred thousand dollars into their bank account and when you did the math, they are giving up five hundred and thirty-seven thousand dollars a year this office had to Purdue this was hard data from an actual you know a practice where 

Gary: This practice had to produce One million five hundred and thirty-seven thousand dollars’ worth of dentistry in order to collect a million dollars and it was not a collections problem, I want to be really clear about that this office collects over 99 of their adjusted production, so it’s not a collections problem, it’s an adjustment problem and when we shared with that what is 537 annually divided by 12 what is that a month, Naren?

Naren: I think it’s around forty-four thousand dollars just approximately 

Gary: here I’ll do I’ll get you the actual I thought you had to calculate I’m going to do it actual numbers it is 44 750. So I told that doctor you’re very close on that Naren, I told that doctor do you realize you’re spending forty-four thousand seven hundred fifty dollars every month on marketing and his first reaction was oh no, no, Gary I think you’re looking at the wrong place on my profit law statement. I’m not I’m spending money on marketing but I don’t spend that much and I said "think of your adjustments as a marketing expense because that’s what they are… you’re paying the insurance company to provide your patients, you’re spending 44 750." He said, "oh my gosh I am, aren’t I?" I said "you could spend a fraction like for example the in my own practice I’m going to spend 1.6 percent of our revenue this year. The average adjustment in PPO plans today is 44 percent." So doctors which would you rather spend on? 1.6 or 44 percent on marketing take as long as you like. That’s the second big breakthrough 

Naren: Right, right. 

Gary: It’s like the timing on the timing on this is very important this is why it’s step number two you want to increase your new patient flow before you drop any plans. Keep in mind you know most practices that are PPO practices, Naren, over the years what has been their number one form of marketing? What’s been the number one form?

Naren: Yeah PPO plans exactly because you send me patience and every time I do anything with those patients, I give you 44 cents on every dollar 

Gary: yeah but that’s been the number one way of getting clients getting patients and if it starts out to be a smaller percentage it quickly grows and what we typically hear today is Gary I don’t know if I can do this because 80 to 90 percent of my patients are PPO patients and that’s what we hear but when you change and you start getting patients another way, you want to replace any you might lose ahead of time with successful marketing. That way you’re dealing with the position of strength and it’s so important that it’s important to have, be patient as you do this and it’s important to get all the marketing steps in place. So let’s just talk about digital marketing 101, Naren, and I’ve got, you know what does it mean to master digital marketing and I’m going to start with your definition I want to give you credit for this because you put an amazing spotlight on this for me, what is successful dental marketing it’s only two things. It’s helping your ideal patients find you and then secondly once they’ve found you giving them a reason to choose you. That’s it, that’s it. They got to find you and by the way, if either one of those is missing, you’re not going to succeed. So if they can’t find you then they can’t choose you so number one but if they found us but we haven’t given them a reason to choose us then we’re also going to stop short of the finish line. So it’s got to be both, help them find us but then give them a reason to choose us and you put both of those in place and you’ve got a winning formula for mastering digital marketing, that’s what we do in my own practice. So to help them find us it’s all about Google, today, it’s all about you know what’s the number one search engine in the world, google. What’s number two?

Naren: Who cares

Gary: I mean literally it’s down who cares because they’re so dominant by the way number two search engine is Youtube which is owned by Google. So we’re right back to google. So it’s all about mastering google and so there are some things you can do we’ll kind of rattle through those really quickly. Google review I’m going to rattle through these in there and I’m going to ask you to amplify some of these. So number one you want to master google reviews. Over time, you want to be the dental office with the highest number of google reviews in your community. Google won’t share with us what their ranking algorithm is. That’s their secret sauce. They will not share it but we do know that certain elements of reviews are a very important part of their ranking algorithm. In other words when someone types in phoenix dentist, how do you get on page one of a google search or plug in your community. If you’re in Seattle dentist Chicago 

Naren: Only thing I would add is there are two ways google helps us one is google maps. Some people call it three pack because usually there are three listings below the maps. The other way is through what’s traditionally referred to as organic search, which is what google literally will give you as answers to a question. So for maps it’s around 10 percent they’re looking at a frequency they’re looking at uh how many reviews you have and they’re looking at how in-depth the reviews are, so just some tips I know we have a lot to cover but let’s go to the next one Gary

Gary: Yeah, so in terms of helping people find you. Want to master google reviews, next on my list is that you must have unique website content. It must be unique, because Google will penalize you if there’s duplicate content on your site and, Naren, I don’t have hard data on this but I bet the number one reason why practices are not showing up on page one of a google search is they’ve got massive duplicate content on their website. So you might think, oh yeah I hired a company to help me with my website and the truth is I know they have my same websites all over the internet but I’m in Phoenix and I don’t care if a dentist in Chicago has a similar site. Well, you may not care about it but google does and they will penalize you and it’s you will not get on page one of a google search if you have duplicate content. So one of the first things you can do is make sure that your website has unique content that is customized and unique to your practice very, very, very important. Next is SEO, search engine optimization, and search engine optimization is many factors but you want to make sure you’re found for the services that you’d like to be found for and whatever those are those might be your high-value services, it might be adult ortho, it might be dental implants, it might be cosmetic dentistry and you want to make sure you’re found for those. So we want to make sure we have content on your website encoding on your website that makes you an obvious choice to google when someone’s looking for a dentist that provides certain services.

Naren: Just a couple of quick points on that Gary search engine optimization is a huge bucket right so everything we do around google is such an optimization, so Gary talked about content is one part of it, really important original content and again you have to follow the rules and I know Gary is going to talk about some of these other parts but lighthouse score, nap, external backlinks there are many, many, many, many, pieces to the puzzle and there are around 200 pieces last year alone google made 3 000 changes to its algorithm. So all these pieces again google is evolving how it thinks about it, how it deals with it so you need to not only get a high score but you need to keep your score high along with Google’s changing algorithms.

Gary: I just want to amplify one point that you said you used an acronym nap. Some of our listeners may not be familiar with it that’s an acronym that stands for name address phone and it has to do with the way your practice is represented across internet directories. There are hundreds of internet directories hundreds, that publish information about businesses in the community and it’s important that your practice be listed consistently through all of those internet directories that your name address and phone is consistent, is represented exactly meaning that if there are abbreviations in your address such as boulevard, that it’s rep you either spell it out or abbreviate it but just be consistent across every directory and you want name and address phone consistency.

Naren: this is big like 30 of organic versus around 25 of maps plus the direct traffic you will get from every one of these sites. So this is huge carry this can make a huge difference.

Gary: it’s a huge weighting yeah when it comes to google. Naren, also mentioned lighthouse score that’s that has to do with how your pages are ranked within a certain criteria within google also being compliant with the google eat update eat stands for expertise authority and trust, how your content demonstrates to google that you have expertise authority and trust that fits in within the your money, YMYL your money your life update with with google all these factors come into play but let’s recap a little bit we’re covering a lot of things very quickly but step number two is to master digital marketing and that really means what that means in a in a nutshell is mastering google which means helping people find you on google and then giving them a reason to choose once they do find you and if and if you’ll do that and you’ll be proactive about it meaning that you ramp up your marketing before you resign, let’s just use an example there let’s say you have a plan a PPO plan that has a hundred patients. I’m just making a number a round number and if our goal is to keep 85 percent of those, we’re going to lose 15 of those. So fifteen percent of one hundred is fifteen. So I want to have a marketing plan in place that replaces those fifteen that we’re going to lose before we go out of network because then we are not going backwards.

Naren: Right 

Gary: We’re going forward and we do that with every single plan that’s why this is step two let me recap real quickly digital marketing 101 in in in kind of in order here number one just understand that it’s all about helping people find you and then give them a reason to choose you. Number two, master google reviews become the office that has the highest number of google reviews within your community. Next make sure that your website is unique if you don’t know ask your website provider whether yours is duplicate or whether it’s unique. If it’s if it’s duplicate you need to start developing your own content. Next work on your SEO your search engine optimization which has many factors in it including, nap name address phone lighthouse score google eat update google maps is part of all of that. Now  if you would like to just sort of come in on our shoulders on  all of this. Do what I do what i’ve done in my practice I mean last year in my practice we saw an average of 80 new patients a month, 80 new patients a month. They provided all the growth that we needed. We grew despite the fact of being shut down for seven weeks, we grew in 2020 over 2019. Use the resource that I use which Naren is your firm we use EKWA and I’m a paying client and it is an Incredibles you do all those things that we mentioned. The truth is an inerrant you know total transparency any of our listeners can do this on their own yes they can do it. Some of it’s fairly sophisticated they’ll have to learn how to do it but any of our listeners can do this on their own however when you look at the time that it takes, it’s not a useful allocation of your time to do it you’re going to spend hundreds of hours and you simply don’t have the time to do it. Jump in on our shoulders and do what I do in enlist EKWA you have a all-inclusive flat monthly fee to do all these things. It’s twelve hundred dollars a month. There’s a there’s an annual contract that’s fourteen four uh if you do the math 1200 times four is fourteen 4. I’m going to suggest that if you’re spending 30 40 or 50 000 a month, on your insurance adjustments, wouldn’t it be great to cut that down to 14 4. For many of our clients that’s all they need to do with marketing to completely successfully resign from these PPO plans, fourteen four, and Naren, your kind enough to provide a marketing strategy meeting for any of our listeners. They will put a link in the show notes, it’s on lessinsurancedependence.com but simply click that marketing strategy meeting and you’ll schedule a meeting with EKWA where they’ll walk through and show you how you’re currently scoring when it comes to google, how you can improve, and you’ll walk away with information you don’t already know about your practice. You normally charge for that marketing strategy meeting but you’ve been kind enough to gift that to any of our listeners and I’d highly recommend that our listeners do that. Naren, as we come to the finish line here I just want to take a minute and wish you a very happy new year. I know that you’re going to make 2021 your best year, yet right?

Naren: absolutely Gary and thank you for those wishes it means a lot and I want to wish you a happy new year and I think together we want to wish every one of our listeners and it’s just a couple of years ago, a little more than a couple of years ago when you and I started this journey of reducing insurance dependence podcast or what we call insurancedependence.com, we have come so far and we have had so many best months yet in those last years 

Gary: Yeah, in terms of listenership our listenership goes up every month the number of reviews that we have on iTunes go up every month and I want to thank our community thank you all, and from Naren and I happy new year and we would love to help you make 2021 your best year yet. On that basis, thanks so much for joining us we look forward to bringing you future episodes of the less insurance dependence podcast.