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Episode : Magic Out-of-Network Verbiage

Podcast Description

Spiffy Tiffy is giving fantastic verbiage that your practice needs to start using when retaining current patients and enticing new patients when you’ve dropped insurance.

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0:00:05.9 Kiera Dent: Hey everyone, welcome to the Dental A Team podcast. I’m your host Kiera Dent. And I had this crazy idea that maybe I could combine a doctor and a team member’s perspective because let’s face it, dentistry can be a challenging profession with those two perspectives. I’ve been a dental assistant, treatment coordinator, scheduler, biller, office manager, regional manager, practice owner, and I have a team of traveling consultants where we have traveled to over 165 different offices, coaching teams. Yep, we don’t just understand you, we are you. Our mission is to positively impact the world of dental and I believe that this podcast is the greatest way I can help elevate teams, grow VIP experiences, reduce stress, and create A Teams. Welcome to the Dental A Team podcast.


0:00:48.2 KD: Hey, Dental A Team listeners, this is Kiera and you guys, I am beyond giddy about the fact that we are having a way for you guys to kick off your 2023 in the most epic way. That’s right, I want you guys to go into 2023 with direction, with a plan, and to actually get something done, done, and done. If you’ve been looking at that operations manual, it is time guys. For 3 months, every single week, I’m going to be doing a workshop with you and your team in January, to get that operations manual done in 3 months. Guys, this is a value of over $10,000 that I know you’re gonna freaking love because you’re actually going to get it done. So if you wanna get your ops manual done in 3 months and kick off your January ultra strong, head on over to the thedentalateam.com/opsmanual, and I will see you January 5th, for our kickoff.

0:01:47.1 KD: Hello Dental A Team listeners, this is Kiera and guess who I’ve got today. I feel giggly about it [chuckle].. ’cause her nickname came from this podcast. Guys, Spiffy Tiffy, the one and only, my right hand, the one who has been with me since practically day one, who I paid via Venmo and didn’t pay her all the time and she still works here. Tiff, welcome back to the show today. How are you?

0:02:08.3 Tiffanie Trader: I’m good. I just keep coming back. I stay here because I like being on the podcast [chuckle], so it’s working.

0:02:13.0 KD: Oh, I’m glad to know. Or was it the fact… Guys, Tiff’s 5 year anniversary was this year, and I think maybe that’s what keeps you coming back ’cause you never know what kind of gifts I’m gonna send you. But I do think you should share what your 5 year anniversary gift was. This is like clout status. Guys, if you wanna work for Dental A Team, this is what your 5 year future could be.

0:02:34.4 TT: Well number one, I got a really cool award looking thing from… I think Shelby did awesome on that… From you guys. And then I got… Well I really use and and enjoy my scrunchie that has my face all over it, my caricature scrunchie. And then my coat, I haven’t gotten to use yet, it’s coming up on winter months, with my caricature and my nickname, Spiffy Tiffy, across the back of it. So that I can’t wait ’cause it makes me feel like… You remember like the T-Birds in Grease? That’s exactly what that jacket feels like.

0:03:09.1 KD: That was exactly what we were going for because guys, Tiff is one of my favorite humans in the entire world. Tiff’s cartoon character, which go check it out on the website guys, we are all… All the cartoon characters are there. And Tiff and her cartoon character have been like since day one, buds. And it’s funny because we had masks, and Tiff’s little face was on her mask and people would ask her all the time, like, “Is that you?” I think Tiff’s character… Tiff and Dana, I think have some of the best cartoon characters. Mine? Mmm… Debatable. But Tiff and Dana totally knock it out of the park. So, we surely made her like Letterman jacket style. So guys, that is Dental A Team’s 5 year. But Spiffy Tiffy back on the pod and today she’s bringing you all the goodness with the favorite. And I think this is so paramount right now, because offices are sick and tired of insurances.

0:03:56.7 KD: They’re playing nasty games after Covid. They’ve always played nasty games, but they just feel worse now. Inflation’s on the rise, so therefore, what they’re paying from the 1900s… Like, let’s be real, I feel like dental offices have not… Or insurances have not increased their reimbursement amounts. So you guys are being paid such low reimbursement rates that we are now dropping and trying to go out of network. And so what’s some out of network verbiage? So Tiff, let’s kind of dive into this. That’s why I think it’s super important because I know you guys are trying to go fee-for-service, but what really can help you guys with it.

0:04:29.3 TT: Yeah, I think you’re totally right. I think a lot of practices have been dropping, PPO status in a lot of the insurance companies and even the bigger ones, which is dramatically different than previous years, where everyone was trying to drop the smaller, lower paying ones, always, and the ones that are the most difficult to work with. But now it’s like these major companies are becoming such a pain to work with that a lot of practices are seeing that the out of network benefits drastically outweigh the work that’s put in to get paid. And honestly and truly, I think a lot of times, they’re getting paid faster because there’s not as many hoops for the insurance company to jump through as well, to make the payments. So 100% agree. I think the biggest thing that I get from… Excuse me… From clients and from practices, the fear of drafting the insurance companies, are not getting in network as a new provider, is the patient base.

0:05:25.0 TT: Like, how are we gonna get new patients? And how are we gonna retain the patients that we have? And all of it just comes down to verbiage, how we’re talking about benefits, how we’re talking to our patients, what we can do differently or better in the midst of all of that. And number one thing, Kiera and I preach this all the time, word ninjas… Being a word ninja, being a word master. Like, really just getting a hold of what it is. I want to preface this with, we are honest, we are full of integrity, we love our patients, and our patients are the most important piece of everything that you guys do. So nothing that we’re gonna say, nothing that we’re gonna do here, is meant to be manipulative or meant to come across as something different than exactly what it is. It’s just using the right words to get your point across in a way that patients can still be excited about coming to your practice.

0:06:20.1 TT: So level up with that and be… Be full-facing and be fully transparent with your team in that in itself. Because that’s the number one thing… Number one pushback that I get from practice team members is, “Well, we don’t wanna lie to our patients,” or “We don’t wanna mislead our patients.” I just wanna tell them that, sure, 100% agree. I want to as well. But I don’t wanna take away the excitement of them coming to a really great practice at the same time. So being able to say something in that manner would be like, “Yeah, absolutely. We accept all insurances, as long as it’s a PPO insurance that says, “You can go anywhere”, we accept it 100%. And while we may be out of… Not be considered out of network with your insurance company, we work really, really hard to exhaust and use as many of your benefits, if not all of them, every year, just the same. I know you’re gonna love it here at this practice so we can’t wait to welcome you as a new patient.”

0:07:14.3 KD: I love that. Keep going.

0:07:15.1 TT: Thank you. I was gonna say, so I told them, “It’s in there, it’s totally in there, but I’m excited. And I am truly excited because I want to welcome you as a new patient.” And to be truthful and honest, if I’m the billing representative, I’m even more excited because there’s less work welcoming you as a new patient compared to if I were in contract or in network with that insurance company, welcoming you as a new patient. So, “Heck yeah, I’m excited. I know you’re gonna love my practice because I wouldn’t be here if I didn’t love it, therefore you’re gonna love it. And I’m gonna be truthful and honest, we absolutely accept your insurance, we bill on your behalf, we do all the work to make sure that we get payment received, and we exhaust as many, if not all, of your benefits as possible, even though we’re considered what they call out-of-network.”

0:07:58.6 TT: And then the patient or the soon-to-be patient may say, “Well, what does that mean, out of network?” Well, it just means that we actually don’t hold a contract with them, but the great news is that insurance companies typically don’t require that, as long as it’s that PPO status, which we can find out for you and we would do before your appointment regardless. You can go anywhere you want to, that contract’s not really necessary.

0:08:22.0 KD: Absolutely, and I think that that’s something where it helps because you’ve gone through and you really took control of the conversation. You also made it very positive, and I also feel like people should rewind what Tiff just said, listen to it, and roleplay in the practice. Because people get really uncomfortable. And we’ve gone to a default mode… Like I think back to elementary school, you guys all remember on your desks where there are those pencil grooves on your top of your desk. And I would take my pencil and I would just keep being in the groove.

0:08:50.0 KD: I feel like that’s the groove we’re in with practices, of being like, “Well, we don’t accept that insurance,” or “We’re not in network.” Why are we saying this? Because yes, you do bill their insurance, you just don’t hold the contract with them. So the answer is, yes, you accept those insurances, yes, you bill on it. And I love, Tiff, that you said, “We exhaust all possible resources and benefits for you and make sure we maximize and optimize that.” And I would also remind them why they should come to our practice over another one.

0:09:18.3 KD: You guys know, like, why should they come to you over somebody who’s in network with it? I think about this all the time like, “Why should a patient be coming to you? They’re only going to places with the insurance on there, not because of the service.” Guys, insurance is like 1,000, 2,000 max, it’s not that high. So we’re literally letting patients go to, not as great of dentists as you, because we don’t have this great verbiage at our front desk. That to me, I feel is something so simple, and I feel like Tiff, you do it so well.

0:09:47.3 KD: So what happens if… There’s some people don’t accept Medicaid, that’s okay, you can say that’s not one. But typically most insurance plans, you can bill out of network for them. I think offices get really scared though, Tiff, of what happens when they come in and they’ve been used to only having to pay nothing for a cleaning. How do we handle that, when they now have to pay in full for a cleaning?

0:10:10.4 TT: So I recommend to all of my practices that are going out of network to collect ahead of time, for them to collect the fees and then the patient gets reimbursed for that reason. Because tracking them down and asking them for the full fees or for the partial coverage later, and having to explain that on the back-end, is way more difficult than it is on the front-end. My suggestion there is to roleplay, roleplay, roleplay. Because all it is, is that you’re stuck in your comfort box of like, “This is the way that it’s been, and this is the way that it should be.” So you’re assuming that your patient base thinks the same way, and you’re assuming that this patient coming to you with insurance thinks, “My appointment should be covered 100%.”

0:10:56.9 TT: But let me just tell you, I went to the chiropractor just a couple of weeks ago, and they were like, “Do you have your dental insurance… ” “Do you have your medical insurance?” And I was like, “I don’t. I don’t even think I have coverage. I have no idea what this looks like.” And they’re like, “Oh, we’ll actually… ” they look into it, blah blah blah. I actually get coverage. But I went in like, “I don’t know what this means. I don’t know what this is gonna do here.” Most of us have no idea what our insurance coverage looks like. Have people been getting routine re-care, six-month cleanings for, “Free”?

0:11:31.8 TT: Probably. But guess what, they don’t know what the other option is. So if you give them another option, and you give them a better dental office to go to, they’re probably gonna be just fine paying for it. You’ve got to roleplay and get outside of that comfort zone and change your mindset on the way that you think about dental insurance and what you think should be, because you’re projecting it on to your patients.

0:11:54.4 TT: That conversation can be very simple of, “With the way that we work with your insurance company, our contractual obligation, we don’t have one, and so the way that that works is they actually are really smart on their end, and they reimburse you, the patient, after your appointment here. So we do the work, we do the billing, we put everything into that space for you. And then they actually will send you the check for that reimbursement. So what we do is we collect in advance so that we can show that you’ve paid for that cleaning, so that they can reimburse you. So we’ll collect those fees up front, we’ll submit everything, the insurance, and do the work on our end there to ensure that you get reimbursed. Typically, the insurance company reimburses up to the amount that you’re gonna pay today. Sometimes it’s a little bit less, we’ll find out when they make that payment, but that’s the way that it works here in our practice.”


0:12:44.0 KD: Are you guys sick of trying to figure it out on your own? I know I am. When I’m trying to run a business, sometimes I just think like, “There’s got to be a better way to do this.” And so for me, my answer has been to find someone who’s done it and does it really, really, really well. I’m talking the best of the best of the best. I want someone who’s been in my shoes, somebody who understands what I’m going through. When I was looking for the consulting business, I found a coach who literally has run a consulting business. Well, that seems like the perfect fit. So you guys, right now, we have a few spaces open in our Platinum Consulting. That is in the consulting where we actually come to your practice, we help you get systems implemented. We don’t just tell you what systems to implement, we actually implement them with you and for you.

0:13:31.8 KD: You guys, it is one of the best investments I have ever made, is to hire a coach who understands the business I’m in, who’s lived it, who’s done it. And that’s what we and the Dental A Team do. We literally, physically, fly to you. So if you’re sick of trying to figure it out on your own, if you just want somebody who understands you, join our Platinum. I’d love to have you. I’d love to have our consulting team come out and see you, be in your office, be with your team, and truly help you get onto the easy path of dentistry. It doesn’t have to be hard. So join us in the Platinum. We’d love to have you.


0:14:03.9 KD: I love it. And I love that you said, “We’re going to do this so we can show the insurance company what we’ve billed for you.” I also love that you say, “We’re gonna do all the work on behalf for you. We’ll take care of it all for you. They’re going to reimburse you.” And what I found is some offices are finding that the insurance companies are not paying as much out of network as they thought they were. If you come up to that guys, you can, honest to goodness, make a decision in your practice, that maybe to retain these patients as you’re going out of network, maybe you honor those Delta fees on those cleanings so that way there’s nothing out of pocket. But you can then charge more for all of your restorative procedures.

0:14:41.3 KD: So there’s a thousand different scenarios. I feel like we just have to remember these are gonna be opportunities for us to really win our patients over. But I think the biggest piece, Tiff, is you’ve gotta have that mindset because your patients will pick up on it a 100%. Like if you’re like, “Oh gosh, this is so hard, and you’re gonna hate this, and I have to present… ” They will hate it, and they will be mad at you, and they will feel like you’re a scum, and they’ll be ticked off when Delta calls and says, “Did you know you’re out of network? Because that is happening.” But if they had an awesome experience with you, if they love your practice, if you make it really easy for them, if you take care of them and you have a solid mindset on it, they’re gonna keep coming back for your confidence all day long. I feel like front office, don’t lose these patients because you’re not comfortable with these conversations. Roleplay them, because the patients love the doctor, we need to make sure the front office is equally as amazing. And we do it by making it really simple with these out of network experiences.

0:15:39.3 TT: Absolutely. You reminded me of a conversation I just had with one of my practices and they’ve dropped a ton of insurances this year, like all of the major ones, and they just cold turkey-ed, said, “We’re doing this.” So we’ve been working really, really hard, and really diligently in tracking things really closely to see what’s working and what’s not working. I chatted with them last week and one thing that she said to me that she has loved and her patients have loved, is that they’re doing, what they’re calling, ‘good faith refunds’ or ‘write-offs’, for the patients. So what they’ve done is they’ve said, “Okay, we’re willing to accept X amount of money for our recare patients or our new patients.” So if I’m good with $150 for my recare appointment, anything that the insurance company or the patient paid above and beyond that, they’re sending a check to the patients that they’re calling a good faith refund for their recare appointments.

0:16:34.2 TT: Because what she said to me was exactly what you just said. She said, “We’re seeing such an increase in the treatment cost, that patients don’t know what the treatment cost was or is. They know what we’re telling them now. They’re willing to pay that. That they’re gaining the respect and the control over the initial appointment with these good faith refunds, and getting higher case acceptance, and retaining more patients for the actual treatment.” And they’ve actually had patients call and say like, “What is this? What is this check for? This good faith? What does this mean?” It’s like $20 or $60 or whatever. She said she had a few patients call and say, “Oh my gosh, thank you so much for doing this, but I’m not cashing this check. Apply it towards my account because you guys deserve… You guys deserve the money, you did the work and this is what you should be making.”

0:17:23.1 TT: And I was just floored by that because it made me think of how many times we just devalue what we’re doing because we’re so used to working with insurance companies. And it’s all of those pieces. It’s exactly what you said, getting those patients that good faith with the patients, and getting them to stick around because you’re showing them from the get go that they are the important part, and then they’re paying the insurance company themselves, and the patients are paying the higher fees that you’re actually owed for the treatment that you’re doing in order to get it all done and keep the patients.

0:17:56.3 KD: Exactly. And I think like… I feel one of the things as you were saying that is, before you’ve decide to go out of network, I’m gonna beg you, and ask you, and plead with you, to make sure that your practice is fee-for-service worthy, that your experience is topnotch. Because I have a lot of offices and all they’re thinking about is, “Screw Delta. They don’t hardly pay me anything. So we’re gonna drop them and go out of network.” But in doing so, I feel like they forget that those patients are coming because they do get… I know they’re not “Free”, but it feels like to the patient, “a free cleaning.” And now if they have to pay for you, and you are crazy, and your front office is not nice, and we can’t get in for appointments, they’re going to go somewhere else that does accept their insurance.

0:18:42.1 KD: And I feel so many offices are so gung-ho to drop insurance, they’re so excited about the verbiage. They’re like, “Yeah, we’re gonna do this, we’re gonna drop it.” But they forget that you have to deliver a much higher level of customer service, higher level of patient care, love those patients more so, because now they’re coming to us because they love us and not because they’re tethered by an insurance company. And I feel like if you forget that, you’re going to see a huge patient turnover and spend a lot of money trying to market and bring in new patients that are fee-for-service, rather than retaining the great patients who already know you, love you, like you, want to do business with you, have paid you to do business, that you could just make their experience better and ensure that it’s really topnotch before you go out of network.

0:19:25.0 TT: I totally agree. The same practice I was just speaking on, they spent months prior to dropping any insurance company, imploring to their team what their patient experience needed to look like in order to be that practice to retain those patients, so that they didn’t drop insurance and then drop a ton of patients. They spent a ton of time… We spent a ton of time on calls with the team, with just the doctor and his wife. So much energy and effort was put into making sure that they were prepped and ready to retain patients before dropping the insurances.

0:19:57.7 KD: Which I think is not a 1 month process, guys. This is like a 2, 3, 4 month process because I’ve seen some other practices who have just dropped. We’ve gone through them like, “I can be out of network in like a month.” And they had no systems in play. They didn’t roleplay what they were gonna say on the phone. And then it becomes pure mayhem when all those letters go out to the patients. All these patients are finding out they’re dropping. You have to then handle all these patients calling into you. I feel a little bit of forethought on this, a little bit of roleplaying on this, really preparing your practice for it, is going to save you thousands of dollars long term.

0:20:35.7 TT: Yep. I totally agree. Totally agree. My most successful practices that have dropped insurances, have done the prep work. We’ve been on calls at the front office, training and roleplaying. I’ve been in person roleplaying. All of those pieces have happened way prior to dropping any insurance company. I totally agree.

0:20:53.6 KD: Yeah. So guys, I feel like Tiff gave you some really, really fantastic verbiage. Tiff, you always are really impressive with your verbiage and I love that you just have… Like you said, “The number one intent is that we love our patients first and foremost and we’re gonna make their life really freaking easy.” So I love that you come from that mindset and I think it helps your words just flow easier. So guys, go back, listen to it, roleplay this. Action times would be one, if you wanna become an out of network provider, let’s make sure you prep, roleplay, figure out what kind of patient experience we need to be having for these patients, and then really, really dive into it.

0:21:27.7 KD: Practice, practice, practice, practice, practice, practice. Have them call in, have them get upset for a payment that wasn’t covered and handle it, and practice on that and try it, because at the end of the day, we do accept all insurances. If you want to, you can bill on all of their behalf and it’s not a lot of extra work for you and you can make that patient experience amazing. I just think it does take some foresight and practice to really make it amazing. So Tiff, thanks for all the the gems today. I super appreciate it.

0:21:53.6 TT: Of course. Thanks for having me as always. I love being here and you fill my soul bucket with all of your appreciation, so thank you.

0:22:01.0 KD: Of course. All right guys, if you want help with this, if this is something where you’re like, “Wow, out of network and systems.” And you guys do the whole shebang, give us a call, email us [email protected]. We’d love to come to your practice, coach your team virtually or in person, and help you guys really have that topnotch, amazing patient experience. So as always guys, thanks for listening. I’ll catch you next time on the Dental A Team podcast.

0:22:24.5 KD: And that wraps it up for another episode of the Dental A Team podcast. Thank you so much for listening and we’ll talk to you next time.


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