These TIPisodes keep getting better and better! Teresa gives us another round of great advice and in this tip, she is talking PPOs
Teresa Duncan, MS is such a wealth of knowledge. Please visit her website and enjoy her awesome resources! For more info from Teresa, see below!
Teresa Duncan: Speaker on insurance and management, Podcaster, Author of a book and contributes to several magazines and the ADA’s publications!
use code TALE for $3 courtesy (offsets shipping)
For your viewing pleasure this TIPisode has been transcribed:
Michelle Strange: A Tale of Two Hygienists presents this week’s TIPisode: Quick and easy tips to keep you up to date, and presented by the experts in the profession. Now, get ready for your unofficial TIPisode.
Teresa Duncan: Hi. This it Teresa Duncan with Odyssey Management and a co-host of the Nobody Told Me That! podcast. I’m here to talk to you today about what is going on when your office decides to leave a PPO network. Well, your dentist and your admin or the business owner is making this decision hopefully based on facts and not just emotion. I know a lot of doctors want to get off of plans, and they’ll just kind of throw a fit, and next thing you know you’re off a plan, and it just didn’t go the way it was supposed to. Hopefully, they ran the numbers and were able to see that it was not very profitable for the office. In fact, you probably have even lost money participating with certain plans. As with offices, some plans are better than others.
Well, what is your role in all of this when your office decides to go out of network? Well, two things I want to tell you about that are the problems that your dentist and front office are going to be looking for, particularly your insurance coordinator. The biggest issue that they’re going to run into is that, often, the checks are sent to the patient. Now, it depends on the carrier, and they’ll probably have to double-check it, but what that means is we then have to ask the patient for the full payment up front. And, as you know being a consumer yourself, a partial payment is better than full payment. And, truthfully, some of your patients may not be able to afford that. So that’s one of the reasons a lot of offices decide not to go out of network so that they don’t have to deal with that.
The second reason is that it actually does cost the patient a little bit more money. I know a lot of — there’s a lot of talk out there that there’s really not much of a difference. I can’t make that general statement. In some plans, it will be not much of a difference; in other plans, it’s a very big difference. So lean on your insurance coordinator and your manager to tell you what’s up with that. But those are really the two big concerns that we face when we’re deciding whether or not to get off a plan.
Now, what do you have to do with this, clinical team, specifically the hygienist? Well, the goal overall, of course, is to retain patients. So I’m going to give you this analogy, and just bear with me for a second while I explain it out. You’ve heard the saying “If you love someone, let them go.” Well, this is where it applies. If you love your patients, let them go. What will happen is the patients who love you back and truly appreciate the extra service that you bring will come back.
In my years of consulting — not doing it anymore, but in my years of consulting, we always noticed that it was about one-and-a-half hygiene cycles in which we would see the patient come back. If the patient is faced with having a lower out-of-pocket, many of them jump on that, so they’ll go to another office that is on the list. Typically, they may not like the office very much. They’re not used to it. Yours is the one that they prefer. They love you. But when they go to this other office, it’s not that great, but they’re willing to deal with it because it’s not that big of a deal — well — in their minds. Well, then the second time they go, they’ll notice there is a difference. It wasn’t just a one-time thing that they weren’t the best office, the friendliest office, the cleanest office, and so they will probably come back.
Now, they’re not going to think to come back unless you ask them to come back. So what I’d love for you to do is circle back with them in about 12 to 15 months after you go out of network. Suggest to your admin team to send an email to these patients saying, “Just checking in. Would love to see how you’re doing. You’re always welcome to come back. Call us if you have any questions about your benefits,” because we’re going to be welcoming. We’re sympathetic that they may have gone to another office, but we definitely want them back.
Now, what happens if you get questions from the patients on why are you deciding to go out of network? So what will happen is your admin team will either send a letter — which I don’t quite recommend — they’ll either send a letter or they’ll get in touch with patients ahead of time. Well, we all know you get the questions in the back. So what is your answer when someone says to you, “Well, I don’t understand why you’re going out of network. Why are you doing this?” Well, again, I want you to be sympathetic but resolute in your decision. It is a better business decision.
So what I’m going to give to you is a couple reasons that a patient can understand, not necessary anybody in dentistry. So let’s look at it from a convenience and business standpoint. It’s a better business decision because there’s so much that they require you to write off. Now, that is going to resonate because there’s no American with health care insurance right now that isn’t aware of how big the difference is for being in network or out of network or uninsured versus insured.
You could also say that being in network with so many plans make you feel like you’re on a hamster wheel, and I don’t think that many of you are going to be lying when you say that. Does it make your office busier? Sure. Does it make your office better? I don’t know. If you’re constantly hopping, maybe not. So you could let them know, “You know, it is very stressful on the office, and we know it’s going to be less stressful when we get out of a network because of all the difficulties that we may have.” Depending on how your office decides to say this — and what that means is if this office isn’t as stressed, you’ll be able to provide more patient care. And, actually, I would use the term “focused.” You’d have a better focus. We’re not worried about the paperwork.
These are all things that your patient will totally understand because they’ve heard about it. This is in the news. This is in conversations with neighbors and office workers. They know the squeezes on — in health care offices. What we’re going to do, though, is make sure that they know that they’re always welcome. We want them to come. I would even use phrases like “I know it’s going to be a change, and Lisa up front can help you figure out what it means financially, but I really would love for you to keep coming to see us. I really enjoy our appointments. I really want to keep an eye on whatever it is that you’re treating.”
So that heartfelt conversation is what the patient’s going to remember when they’re sitting in another chair that — with another hygienist who is not aware of them, doesn’t know their family, maybe isn’t even as friendly because she or he is on that hamster wheel. So your conversation with them needs to resonate.
What do you do when that patient comes back in? They will come back in. I’m telling you. I’ve worked with a ton of offices to transition them in and out of PPOs, and the fear that they don’t come back, yes it’s real, but a lot — maybe even a majority of your patients are going to come back. And the ones that don’t come back, you’re not going to miss them. You won’t. You will have new patients that you bring in from better marketing and even more referrals because you’ve stepped up your customer service game.
What happens when this patient comes back into your office? Well, again, that friendliness, that endearment, that relationship is going to come through because you’re going to make statements such as “We were really worried and hoping that a lot of our patients stay. I’m so glad you cam back. It’s so good to see you again. I understand Lisa worked with you about your insurance. I’m really excited that you came back. I really want to focus on doing — taking care of your upper right or whatever it is.” Basically, make a big deal about the patient coming back, and then most importantly, thank them. A lot of times we don’t thank them. “Thank you for making the decision to stay with us. We so appreciate it.”
That’s how I want you to handle going out of network from the beginning to the end. Beginning is we want to know why we’re going out of network, so hopefully your team expresses that to you. Then we talk to the patient about preparing them and hoping that they stay and sympathizing with them, but giving them really good relatable reasons. And then, when they do come back in, we’re going to make a big deal about it because our patients are awesome. And we did let them go. We let them go — we love them — we let them go, and the ones that love us back are going to return, and that is really — that’s what we’re here for.
I hope this has been helpful. If you’re not a subscriber to my personal newsletter, Odyssey Management, check me out. Check my website out. I give management and insurance tips. Maybe you’ll like it. Maybe your admin team will like it. And, also, check out my podcast Nobody Told Me That!, which is always good for management, team, and insurance information.
Thank you to A Tale of Two Hygienists for hosting this TIPisode.
Michelle Strange: We hope you enjoyed this week’s TIPisode. Be sure to reach out to our guest experts and let them know how helpful their tips were. Follow A Tale of Two Hygienists on Facebook, Instagram, and head over to ataleoftwohygienists.com and subscribe to our newsletter. You can also email us at firstname.lastname@example.org, and keep listening for more awesome content from your unofficial dental hygiene podcast.