Episode 113: Three Reasons Why Going Out of Network with PPO Plans is a Wise Move in the Post-COVID-19 World

Naren: This is the less insurance dependence podcast show with my good friend Gary takas and myself, Naren Arulrajah.

Gary: 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 the less insurance dependence podcast show. This is Naren your co-host. Both Gary and I are super happy about what we have accomplished with the show and of course we couldn’t have done this without your help. We have finished more than a hundred episodes of bite size practical information from Gary on how to become less insurance dependent. Every month almost it seems like is the best month ever we continue to grow, thank you for that. We of course love the reviews. Gary, how are you doing this morning and what do you think about what you and I started more than two years ago?

Gary: Naren, I’m doing fantastic here in Scottsdale today and I am beyond thrilled, we started this a little bit over two years ago. We’re over 110 episodes of less insurance dependence, bite-sized pieces that doctors and team members can use to successfully reduce their insurance dependence and like you mentioned, I want to take a minute and thank all of our listeners for their listenership but also thank those that have gone on iTunes or written us a review. We’ve gotten wonderful new reviews lately. If you haven’t done it yet guys I’d encourage you to jump on iTunes and write a review that helps more dentists find us and one of the things that I’m experiencing Naren is there is a bit of a ground swell of dentists that’s happening right now we’re in the middle of it of dentists that are deciding to take back control of their practices from the insurance companies have complete control of their destiny and those numbers are growing and it’s kind of a grassroots groundswell effort and I know that all of our listeners are part of that effort and so doctors I’m sure you know colleagues that would benefit by reducing their insurance dependence. Maybe they were classmates at dental school, maybe they’re your CE companion, the docs that you love to go out and take CE courses with because they’re like-minded. Well, I would love you to have people like that in your circle. Naren I know when I started running again, I hadn’t, I ran in college recreationally and then I stopped running after college and I spent 35 years in the gym and I started running about five years ago. One of the things I wanted to do was surround myself with other runners in my world because I wanted to know about gear, I wanted to know about a running watch I wanted to know about the best shoes and i surrounded myself with a group of people that I consider mentors and guides for me in the world of running. Well, our listeners can do the same thing and they can surround themselves with people that are supportive in this process and sometimes it’s great to have someone you can talk to so you’re not just this lone voice in the wilderness, kind of wondering, am I on the right path? Hey so they share the less insurance dependence with you, with your friends with your colleagues and get a little support network going so that as you go out of network, you can have support with people that you like and trust and that’ll help you in that journey.

Naren: And if you want something even extra sign up for the thriving dentist Facebook group. It’s a group curated by Gary where he shares tons of tips tons of tools on a weekly basis. So that’s like just one extra thing you can get, so i will put a link and log into the Facebook group and see if you can meet other like-minded people and continue to grow your network.

Gary: This this topic we have today is an important one and you’ve probably noticed the title. We’ve titled it three reasons why going out of network with PPO plans is a wise move in the post COVID-19 world and the reason we chose to do this episode is that that’s the number one question that I’m getting these days and those come in in email messages, they come in messages private messages and Facebook in our different groups, they come at all of our webinars. We do a number of webinars and that’s, is now the right time Gary is now the right time to go out of network? That’s the number one question and so I did some research and I’ve got some what I think is compelling research to share with our listeners about three reasons, why now is the right time and why it matches up with our future in the post COVID-19 world.

Naren: Yeah, I think you are absolutely right Gary, like I would say at least a hundred times maybe hundreds of times we have heard this question and I think I know you’re jumping into this but at a high level I think there are other people who get stronger in times of crisis and then there are the people who really, really, struggle and the ones who get stronger typically have high margins anyways

Gary: Well, I think one of the reasons why that question is so pertinent today and so relevant is that COVID-19 has sort of been a pause button in the merry-go-round of life.

Naren: Yes, yes.

Gary: Think about all we have to do is go back about seven months pre-COVID-19, and this merry-go-round of life was spinning so fast for all of us

Naren: Yeah!

Gary: Right and I think over 19 has been a pause button and it’s allowed many people to reflect and to think about and actually and what a great moral, not that we wanted it in COVID-19 of course but what every once in a while, it’s a good idea to hit pause and actually think is what I’m doing leading me to the result that I want?

Naren: Right

Gary: Is what I’m doing, I mean its kind of a simple question but as a merry-go-round spins and spins and spins and spins, we don’t ask that question we just keep spinning

Naren: Yeah, it’s get up in the morning, do whatever you’re doing yesterday, take a quick break on the weekend and then do it again

Gary: and do it again

Naren: Run for a vacation and then run back and then do it again and again

Gary: But ask yourself that that that question

Naren: Yeah

Gary: Is what I’m doing leading me to the end result that I want and I would politely suggest that that what most dentists want, is a practice that provides personal professional and financial satisfaction. I want, most dentists want to do rewarding work, that’s the personal side. Professional, they want to help more patients enjoy great oral health and then the third element financial satisfaction, is they’d like an income from their practice that allows them to achieve their financial goals and really in all three ways participating with PPO plans doesn’t necessarily lead down a path to achieve those three results

Naren: Yeah, because you’re giving away like 44 percent,

Gary: Certainly, it doesn’t lead financial due to financial satisfaction

Naren: Exactly

Gary: I would argue it also doesn’t lead to professional satisfaction because you’re constantly banging your head up against the wall with patients that only want to have things done if it’s covered by insurance and it doesn’t lead to personal satisfaction because you and your heart know you can help these people but there’s a  saying that that I teach our coaching clients and it’s  a blunt reality and that is, the dentist can’t care more about their patients mouth than the patient cares about their mouth. Would you agree with that Naren?

Naren: 100 percent, 100 percent

Gary; Now you can but it results in a whole lot of frustration, in other words if you care more about their health than the patient cares about their own health, then you are just banging your head up against a brick wall. So, it’s a sad reality sometimes that the dentist actually cares more about their patients’ health than the patient cares about their own health and participating with PPO plans leads to severe compromises on all three of those fronts, to achieve personal professional and financial satisfaction. So I’ve got three reasons let me let me let me list those and then I’ll amplify each one and these are not in order, I think all three are equally important but I’ll number them, so I make sure I cover them, okay, number one as a result of COVID-19, many companies are dropping dental insurance coverage for their employees. Reason number one, we’ll go back and amplify these. Reason number two if companies are not dropping dental insurance coverage for the employees, they are asking the dental insurance companies to reduce their premiums and as a result of the reduced premiums the they are lowering reimbursement fees to dentists. So the short version of that is doctors, if you think your adjustments the difference between your contracted fee and your usual fee is high now, they’re only going to get greater, it’s going to get worse in the future if the insurance company drops their premiums, who’s going to bear the brunt of that, the dentist

Naren: and I also heard corrected fees Gary like around 10 million jobs are not coming back. So it’s so I mean these people probably may have had insurance many of them

Gary: Yeah

Naren: That’s gone

Gary: Another reason, let me go to reason number three and maybe this is the most compelling. I said they were equally weighted but perhaps I’m making a nod to reason number three. Reason number three, many people as a result of COVID-19 are becoming even more selective about who they choose as their health care providers. It’s a by-product of the incessant focus on the virus.

Naren: Almost like a silver lining

Gary: Yeah, and this is a silver lining and many people, more than now will want to go to a dental office where they’re taken care of by a dentist and team who they know like and trust. I believe that number is going up geometrically, they don’t want to just pick a doc in the box, they don’t want to just pick oh I drove by and I saw their big sign. They really want to know wait a minute is this someone is this an office that I can truly place my trust and confidence in and I think it gives us all an opportunity to demonstrate that we are an office where they are our patients can know like and trust us. So, let’s go back and talk

Naren: Gary, just one quick thing. I know you listen to calls and we at EKWA, record calls for mutual clients and one of the calls that you and I listened to literally yesterday was, there’s this patient who calls his office and she wants to leave her current dentist and the reason she gave is she didn’t feel like they really care about her, they really appreciate. You remember that call Gary?

Gary: Yes, and I had two emotions

Naren: Yeah

Gary: As I was hearing that of course the call was coming into a client office, so my emotion there was awesome, because we I believe in this office. I would sit in this dentist chair in a heartbeat and let her provide care to me because I absolutely know she’s amazing and so on one emotion I was happy but there was another emotion I had at the same time there are competing emotions

Naren: Right

Gary: The other motion was one of sadness

Naren: Sadness that this patient didn’t feel that she was going to an office where she could truly place her trust, I was so glad that she made a decision to switch and absolutely made the right decision but yeah, you’re right. Let me come back to that first reason, many companies are dropping dental insurance coverage for their employees, that’s just a reality of the economics of COVID-19. There is a massive rise, it’s happening right now, and it’s continuing to happen and it’s going to be amplified of people who don’t have insurance well you know Naren, and by the way you’re a massive partner with my life smiles practice in bringing in people to my practice who don’t have insurance. When we love patients that don’t have insurance because when they don’t have insurance, they don’t ask you two questions. They don’t ask are you in my network that would be just an irrational question, right, you don’t have a network if you don’t have insurance and then secondly when you present any dentistry to them, they don’t ask doc is this covered by my insurance because again that will be an irrelevant question. So that universe is going up radically and I believe doctors you need to be on the wave of attracting those patients to your practice because that universe of patience is growing. So, one compelling reason right there. Let’s go to the second reason. Hey if we think our contracted fees are low now, they’re going lower. So now your expenses are going up just one expense PPE costs

Naren: Right

Gary: PPE costs are going through the roof, absolutely through the roof

Naren: And in many states it’s illegal to charge the patients or pass it on to the patients, so you are you are stuck

Gary: You’re stuck. You those trend lines are going in reverse direction and they’re squeezing you doctor. They’re squeezing you your profitability is going down literally by the minute as long as you’re in PPO plans

Naren: this just reminds me of some of the things you were telling me like several of your clients are getting approached by smaller practices that are not able to survive especially the insurance dependent practices and you I think are doing an episode on this for thriving dentist

Gary: Yeah, we in multiple so let me amplify that for just a minute. In multiple situations around the country clients of mine have been approached by typically a senior dentist who has decided that they’re just washing their hands of their practice, they’re done, they’re done, and either they haven’t opened or aren’t reopening after COVID 19 and they’re looking for a practice existing practice to merge theirs into. These are typically small practices but that could be a very useful strategy, so stay tuned if you’re a less insurance dependent podcast listener, we’ve got that one coming up on the thriving dentist show. You may want to listen to that that can be a in the right circumstances it can be a good way to grow your practice but that’s part of this by-product of the changing world that we’re in. So doctors if you’re already had it up to your neck and you’re fed up with the low fees low contracted fees, I’ve got bad news for you. It’s about to get worse because when a dental insurance company cuts their premiums, when they lower their premium and so the company’s paying less, do you think the CEO of the insurance company is going to say, oh if our premiums are lower, I’m going to cut my salary and I’m going to cut the board of directors salary and I’m going to cut my expenses in the in the dental insurance company. Are they saying that Naren?

Naren: No

Gary: No

Naren: They’re not

Gary: No, they’re not

Naren: Actually, one of the biggest beneficiaries of COVID was insurance because they don’t have to save claims

Gary: Seven weeks nine weeks 10 weeks 12 weeks without ever paying claims

Naren: Yeah

Gary: So where else can they make up for the lower premiums, they can cut your fees, they can cut your fees and that’s what they’re going to be doing. So and number three, and I think maybe this one on a personal level is most important many people are going to be more selective because of the spotlight that that COVID-19 has shined on our health care system and many more people are going to want to go to a dental office and be taken care of by a doctor and team members who they know like and trust and so I think the stars moon sun and tide are aligning here Naren, literally with a neon sign saying now is the time to go out of network and there’s never been a better time giving the trends that are happening and I really want you to look through that lens doctors, now is the time and I know we’re  seeing some great results with our clients that are on this path to reduce insurance to successfully reduce and remember when you reduce insurance dependence we remain patient friendly, we remain insurance friendly, we do it in a very friendly way we let the patient know they can use their benefits in our practice, we file their claims we submit all the documentation that’s required, we follow up on these claims and literally arm wrestle with the insurance company to help the patient get every dollar of benefit that they have and so this isn’t an arrogant approach where you just well we don’t take your insurance, that’s not it at all. We simply do so in a way that works for us and the patient and we cut out the 5 000-pound bully gorilla which is the PPO plan

Naren: Right so if you are if you are considering taking action like we said hundreds of people have written to us about going out of network and really having some help and guidance in doing so I would recommend one of two things. Go to thrivingdentist.com slash coaching and see if we have any seats available. We should have some available. We only allow a limited number of people Gary only allows a limited number of people to sign up for coaching. So, go and check that out thrivingdentist.com slash coaching or what you can do alternatively is book a coaching strategy meeting with Gary he does have a couple of splash spots, so click on the link see when he’s available and book a one-hour meeting to see if this is right for you. I really, really, think it’s time that a lot of these dentists who have been writing three hundred thousand four hundred thousand half a million dollar invisible checks in the form of write-offs, stop doing that because over a five-year period that could be millions over a 10-year period that could be tens of millions right so really, really, take advantage of this opportunity yes we don’t like COVID but unfortunately a lot of people are going to be better off because of the decisions they made during covet they are looking at how do I change my life, how do I change my practice and we would love for you to be one of them and we are extending the COVID pricing. Gary had asked the team to not increase the pricing because he feels that a lot of dentists were still struggling. So, Gary can you talk a little bit about that real quick

Gary: yeah, I when COVID-19 hit we want to design a virtual personalized coaching service and practice management support. I’m going to be very transparent share our fees there’s no onboarding fee there’s no upfront fee there’s no travel fees there’s no travel expenses. It’s an all-inclusive fee that’s 1500 a month and we are achieving amazing results. So as Naren mentioned if you have been listening to the podcast and you realize it’s now, now, is the time to take action I simply want to invite you to follow one of those steps, sign up for coaching, or schedule the virtual coaching strategy session meeting with me and that’s with me I actually do that call we’ll talk about your practice we’ll talk about your goals and I’ll be very candid and share with you and we can determine whether our coaching services is right for you or not it’s not right for all people it’s not right for all dentists but we’ll determine that. You’ll determine that based on the information that we discuss on that note I want to close by again reiterating as we’re recording this, we’re in the month of November. I think of November is the month of gratitude I just want to express my gratitude personally for each and every one of you we appreciate your listenership and as it says in our opening, we appreciate your commitment to successfully reduce insurance dependence. Thanks so much for joining us today.