Dental insurance helps patients afford the dental care they need. This can help patients and dental offices perform needed services such as dental checkups, cleanings, fillings, root canals, extractions, crowns etc.
When a dental office becomes a participating provider in a dental insurance network, they often agree to accept reimbursement rates below their usual fees. This can save the patients some treatment fees, but also reduces the amounts the insurer pays out. As long as the reimbursement rates are manageable- the system is sustainable.
What happens when expenses go up year after year but the reimbursement levels stay the same or decrease? This can begin draining the practices’ resources when staff need a cost of living raise after several years. Many dental practices face the challenge of unsustainable reimbursement rates that ultimately impact the quality of care they can provide. However, there’s good news: Being an out of network provider for these low-paying insurance plans could be the game-changer your practice needs.
Initially, you may hesitate to switch to out of network. Still, by making this strategic shift, you can not only improve your financial stability but also provide a higher level of care and a more personalized experience for your patients. And the copays for patients can still be affordable if special attention is placed on the fees charged. In this blog, we’ll walk through the key steps to successfully navigate the transition away from low-paying networks, ensuring your practice thrives both financially and in terms of patient satisfaction.
Step 1: Evaluate Your Current Insurance Participation
Before making any decisions, it’s important to understand your current situation fully. The first step is to evaluate the existing insurance networks you participate in and identify which ones are not providing adequate reimbursement. If needed, make a list of pros and cons to make an informed decision.
Analyze Reimbursement Rates
Start by reviewing your reimbursement rates. How much are you being paid for various procedures under each insurance plan? Compare these figures to the actual costs of providing care. Many dental insurance plans pay below the cost of treatment, especially for more complex procedures. If the reimbursement rates are unsustainable, it’s time to consider alternatives.
Assess Patient Volume & Financial Impact
Next, analyze the patient volume tied to the low-paying insurance plans. How many of your patients are covered under these plans? While it may seem like dropping these plans could result in a loss of patients, it’s important to assess the overall impact. Estimate potential revenue loss and explore strategies, such as lower patient fees, to keep out of network care affordable for patients but at sustainable levels that better cover costs than the in network rates.
Step 2: Set Competitive Out-of-Network Fees
One of the key challenges of dropping low-paying networks is making sure your fees remain competitive while still being profitable. This involves setting your fees carefully to align with local and national standards, as well as the quality of care you provide.
Benchmark Against Local and National Fee Schedules
To ensure your fees are competitive, benchmark your rates against the Usual, Customary, and Reasonable (UCR) fees in your area. Research what other practices charge for similar procedures to ensure you’re in line with industry standards while still maintaining profitability.
Implement Transparent and Value-Based Pricing
Transparency is key when adjusting your fees. Your patients should understand the value they’re receiving for the prices they pay. Emphasize your practice’s strengths, such as advanced technology, personalized care, and better treatment options. Offering value-based pricing can help patients feel more comfortable with out-of-network costs, especially when they know they are receiving top-tier care. Explaining how the out of network copay can still be affordable will help patients understand how seeing an out of network provider can work for them too.
Step 3: Communicate Effectively with Patients
Clear and proactive communication is one of the most critical components of successfully transitioning away from low-paying insurance networks. Patients will have questions and concerns, so it’s vital to address them before they become roadblocks.
Proactive and Clear Messaging
Send letters, emails, or text messages to your affected patients explaining the changes and why you’re making them. Highlight how dropping low-paying insurance networks will allow you to maintain the high standard of care they have come to expect. Be transparent about how the change will affect them, and assure them that you’re still committed to providing the best dental care possible.
Train Staff on Patient Conversations
Equip your staff with clear messaging and scripts for handling patient inquiries. Ensure your front desk team and treatment coordinators are prepared to discuss the reasons for dropping certain plans and explain how patients can continue receiving care at your practice. This can include out-of-network options, payment plans, or membership plans. Preparing your team to handle these conversations smoothly will ensure a positive patient experience during the transition.
Leverage Patient Loyalty and Value-Based Messaging
Emphasize the unique aspects of your practice that differentiate it from volume-driven practices tied to insurance companies. Highlight your focus on quality care, personalized treatment, and advanced technology. Reinforce to your patients that you’re not motivated by insurance-driven numbers but by a commitment to their health and well-being.
Step 4: Offer Flexible Payment Options
One of the main concerns patients may have about leaving their insurance networks is the out-of-pocket cost. To help ease this transition, offer flexible payment options that allow patients to continue receiving care without financial strain.
Membership Plans for Uninsured and Out-of-Network Patients
Develop in-house membership plans that offer discounts on preventive care and other services. These plans can provide an affordable alternative to insurance, making your practice more accessible to patients who don’t want to rely on insurance or who are out-of-network.
Once patients know your out of network treatment fee and what their copays after insurance- they may realize that out of network care is indeed affordable with their plan. Especially if your out of network fee is only slightly more than the reimbursement rate from the dental insurer.
Financing and Payment Plans
Partner with third-party financing companies, such as CareCredit, to provide payment options for more expensive treatments. Offering flexible payment terms can make it easier for patients to commit to necessary care without financial stress.
Help Patients Maximize Out-of-Network Benefits
Patients often don’t realize that many insurance plans still offer reimbursement for out-of-network care, though it may not be at the same rate as in-network coverage. Educate your patients on how they can still receive a portion of their treatment costs reimbursed. Continue to assist with the claim submission process to ensure they get the most out of their benefits in a seamless manner.
Step 5: Transition Gradually and Monitor Results
Making a sudden change can be jarring for both patients and your practice’s bottom line. Instead, consider a gradual transition to ease the process for everyone involved.
Drop Plans in Phases (If Possible)
If you’re planning to drop multiple low-paying insurance networks, consider staggering the process. Start with one or two plans and monitor the response from patients. This gradual approach will allow you to address any issues as they arise and minimize disruption to your practice’s operations.
Monitor Patient Response and Financial Impact
It’s essential to closely track how patients are responding to the change. Are they remaining with the practice, or are you seeing a decline in patient retention? Measure revenue per patient, case acceptance rates, and retention of out-of-network patients to assess how well your transition is going. Adjust your marketing strategies and communication tactics as needed based on these metrics.
Continue Delivering an Exceptional Patient Experience
Throughout the transition, continue providing an exceptional patient experience. Excellent care and strong relationships will help retain patients, even if they have to adjust to out-of-network care. Follow-up with patients regularly to ensure they are satisfied with their treatment and remind them of the value they are receiving.
Conclusion
Dropping low-paying dental insurance networks may feel like a bold move, but it’s often the smartest decision for your practice’s future of reimbursement levels are not sustainable. When executed thoughtfully, it can lead to a more profitable, efficient practice that focuses on providing exceptional care rather than chasing after insurance-driven numbers. By evaluating your current participation, setting competitive fees, and communicating effectively with your patients, you can ensure that this transition is smooth and beneficial for everyone involved. It’s important not to allow a low paying plan to force providers to prioritize quantity over quality—take control of your practice’s financial health and invest in the long-term success of your business and patient relationships.