Do you sometimes feel as though you are being controlled by the insurance contracts you’ve signed? The PPO nightmare plagues many dental practices nationwide. We recently interviewed an ACT Dental client who has been through the process of dropping PPOs on multiple occasions. Dr. Richard Morales shares his thoughts on the subject with ACT coach Heather Crockett.
Heather Crockett: Tell me about where you were in the past with PPO participation.
Dr. Richard Morales : Mine is a two-fold story. When I first opened my own office back in 1997, I opened up from scratch. I didn’t buy into a practice I just found a little space for my chair and started giving my card out. I started by signing a dozen or so PPO contracts.
Dental school prepares you nothing for the business world and you don’t realize how much influence and power the insurance companies have.
Heather Crockett: Tell me about the decision to drop your PPO contracts.
Dr. Richard Morales : Within about two years of that experience I realized that the insurance companies were keeping people from doing what I recommended we do. Everybody was more concerned with what the insurance company paid, as opposed to what was going on in their mouths. In one fell swoop, I decided to sign eight or nine letters and send them off to the insurance companies to say, “I don’t want any more”, I dropped them off at the mailbox all together and I let them all go. My revenue increased right away!
After a while when my lease was up in this particular spot, I decided to accelerate things and buy another insurance-free practice. It was very smooth because I actually got paid for what I was doing!
Then we had the crash of 2008. I had this big mortgage to pay and the panic began to set in. We saw the schedule reduce to nearly empty and signed up with a handful of insurances to fill the chairs. People were afraid to come in because they were afraid to spend money.
I also brought in an associate, however, she was signed on for all the same plans that I was! I decided to go through the same exercise I had gone through years ago of sending letters to the insurance to drop PPOs. Little by little, we dropped one by one. We have contracts with only two right now, and we are drafting a letter to drop one of those by October 1 this year!
My associate wanted to stay on some of these plans and I quickly learned to realize that I was competing against her! In the same office with the same staff and that didn’t make a whole lot of sense, so very carefully, we went ahead and got rid of one of hers.
Heather Crockett: Tell me why you were motivated to drop these PPOs.
Dr. Richard Morales : If we’re charging $125 for a hygiene visit and we’re getting only $60 from the insurance plan, we are working for free. We are essentially working for the insurance companies and no longer working for ourselves, it doesn’t make any sense. If you’re doing a crown for $800, it’s taking three of those patients to make up for the one patient paying out of pocket. As dentists, I guess we don’t do very well with math, but we went ahead and did it (signed PPO contracts).
Heather Crockett: Tell me about the process you went through.
Dr. Richard Morales : Allow me to tell you about the most recent experience. We wrote a very nice letter to all of my associate’s patients, I think it was Metlife at the time and sure enough, 20% of the patients on that plan took off, and 80% of the patients’ stayed and her revenue went up by probably 50%.
We were very careful in our wording. We have a great front desk team member who answers all the questions people would ask. Now all of a sudden, they (the patient) were paying our fee.
Heather Crockett: Can you speak to the pros and cons of dropping PPOs?
Dr. Richard Morales : Every time you drop a plan a certain percentage of those patients leave. Patients that you probably don’t want in the office anyway. Again, revenue increases because you are now getting paid your fee rather than the insurance contracted fee, from the patients that choose to continue coming to you for dentistry. On the same note, where you were once only getting $60 some odd for a comprehensive exam, now you’re getting $150.
Heather Crockett: Can you speak to the verbiage your front office team member used when they had to take those questioning phone calls from patients?
Richard Morales: The verbiage is “Mrs. Smith, I will find out exactly what they’re going to do for you, don’t worry we’ll do it, we’ll make sure your benefits are maximized.” But almost without exception nowadays patients are paying us first, then they’re reimbursed by the insurance. They see that reimbursement in a very short period of time because the insurance company answers to them more than it answers to us.
Heather Crockett: Can you speak to anything that possibly went wrong in the process?
Dr. Richard Morales : You’re gonna get people that are upset.
And their initial reaction might be “Why? What did you not like about my insurance? Why is that an affront to you?” No, it’s not an affront, it’s a more intelligent way for us to do business, it keeps our ability to provide Ritz Carlton type service; which we couldn’t do otherwise. When you explain that to them, for some it goes over their head, but some people say “Okay, I’ve trusted you long enough and I believe you.” The services aren’t going to change, we’re still providing the best service that we can but we’re going to do so in a manner that we’re going to feel better about it. But, again, you will provide a service that they appreciate, that they value.
I can’t please everybody. We are trained, or we are put on that track to say we have to be able to please everybody and everything to be perfect. If you live like that you’re gonna kill yourself at some point because it’s impossible to live that standard.
Heather Crockett: Tell me what went right in the process.
Dr. Richard Morales : I think we purged out a few people that we probably didn’t need, our revenues are up, and everybody’s working a little happier!
Heather Crockett: I love that and when you get to that point and that realization, it speaks volumes of you.
Dr. Richard Morales : More often than not, those people come back. It’s true that they will go elsewhere, because of their insurance, and six months later they come back because they weren’t happy with the people that weren’t you.
Heather Crockett: Speak to where you are now and any other amazing things that have come from dropping so many PPOs.
Dr. Richard Morales : There’s not nearly as much stress.
Heather Crockett: What would you say to a practicing dentist that is participating in many PPOs?
Dr. Richard Morales : Everybody’s going to choose what they want to do, I preach nothing about this unless someone asks. I do have a close friend of mine, a colleague that’s probably about two miles away from my office and we had this conversation the other day.
He says to me “How did you do it?” I have the same conversation, the same thing that I’m telling you now. I told him, “Start with a plan, be ready to communicate, and repeat the same things a lot because people are going to wonder.”
I had somebody very early on tell me “you know you need to do things for yourself or you’re never going to be content and you’re going to butt heads with a lot of people.”
Now somebody that’s on the verge of burnout and spinning their wheels might work from 7-7, six days a week or something like that, just to make ends meet because insurance is leading them on a wild goose chase.
If you value your peace of mind, and you want to practice in the same manner, in a manner that you’re going to be happy that what you’re providing for your patients that you don’t look back and there are no skeletons in your closet, then learn to work for yourself, not for the insurance companies. It’s easy to say it’s not easy to do, a lot of it is fear.
Heather Crockett: Do you have any regrets about dropping any of the plans?
Dr. Richard Morales: Zero.
Heather Crockett: Would you say that it’s changed your life?
Dr. Richard Morales: I’m so looking forward to dropping the next one! You’re like “Okay, we can do this, we can make a living, we can enjoy life and work a little bit less.”
You get desperate and you worry about things, I still worry about things, all the time. Everything seems to work out as long as you’re doing the right things.
Ultimately, we have to be, I, I have to be satisfied that I’m doing what I’m doing and getting paid for it accordingly.
Many of you are not sure where to get started in the process of “working for yourself, not the insurance companies.” At ACT Dental we love helping practices get their start on that path and ultimately to a better practice, and a better life. Schedule a call and discover how you can also make the choice to change your life!
About the Author: Heather Crockett is a Lead Practice Coach at ACT Dental. She is also a dental hygienist, motivational speaker, and writer. With over twenty years of serving in different roles in dentistry, she combines her experience to provide our community with best practices for a better life.
