How to handle when a large employer changes dental plans (and you’re not a member)

Do you have a large employer in your town? Have you seen what happens when this employer changes dental insurance plans – especially if the company switches to a plan that you have not joined? People believe that they can only go to the dentist when they have dental insurance – and even if you have taken care of a patient for 10 years, if their dental insurance changes, most will switch to another dentist. This is maddening for dentists who work hard to provide high quality care and develop a nice relationship – only to feel cut off at the knees by the insurance plan. So, what can you do?

One of the most important steps is to use your dental practice management software to determine how significant an impact this has on your practice. As a Dentrix user, you’ll want to go to office manager, letters and then select last visit dates for the year, select the employer in question and then take a look to find out how many of your patients will be affected. In the data tab, you may also want to select balance, billing type and email address. Then you can see if these patients are paying their bills on time or if you’ve moved them into a billing type that reflects being written off or sent to a collection agency. Finally, if most have an email address – you may be able to save yourself some money by contacting these folks through email instead of US mail. Once you have this report, I recommend running it as a data file only, then you paste it into excel so you can see the total number – and sort to get rid of the collections problems to find how many ‘real’ patients you are at risk of losing.

Of course, you always have the option to join the plan. However, there may be a reason you are not already a member of this plan. Perhaps you’ve checked out their fee schedule and it’s just too low to accept? Perhaps they don’t have enough subscribers in your town to make it worth your while. Let’s assume that you do not want to join this plan, but you want to keep your patients – what steps can you take?

First, find out the whole story. Find out the date that the switch is taking place. Find out if the new plan accepts out of network dentists. Will the new plan send the insurance checks to an out of network dentist – or will it send them to the patient? Try to find out the fee schedule – have your secretary contact the insurance plan, tell them you’re considering joining and request a fee schedule. Using this fee schedule, you can determine exactly how much a patient would pay out of pocket if they came to you as out of network. Do the math on a cleaning and exam. For example, if your fee for a cleaning and exam is $125 and the fee schedule will cover $85, then you know the patient’s out of pocket will be $40.

Next, it’s time for some dental practice marketing communication. Write up a letter to patients that work for this employer. The letter should be direct and to-the-point stating that you understand that the employer is changing their dental insurance and that you will be considered out of network and that you would like them to remain your patient.  Show them the math so they can see they will still be able to use their dental benefits – and then highlight the value your practice brings to the table to show why you believe you are worth the extra money. Explain who will receive the insurance reimbursement check – if it’s the patient, then explain how your office will handle collections. Tell them if you expect them to pay you in full since they will be receiving the check directly. If you can, you may want to allow them to spread out payments so they can use their reimbursement check once it arrives.

Next, make sure everyone on staff knows about this situation. In your next staff meeting, let all the hygienists, assistants and secretaries know that this employer has switched to the new plan. Show them your letter and help them to understand why a patient would want to stay with your practice instead of switching due to insurance. Tell them what to say when someone asks about this situation. Coach them to look at the employer for their patients and bring it up when the patient is in the chair.

Finally, send out your letter: email, US mail, whichever method seems to work best. If you have a Facebook page you can post a comment about this situation. You could save this letter as a pdf file and add it as a link on your website. Anything you can do to get your story out. If you find patients that are loyal to you and plan to stay – ask them to share their opinion with other employees.

To see how this turns out for you, you can again, turn to your dental practice management software. In Dentrix, I would run the same report –  6 months later and then again 12 months later – to compare the lists. How many patients did you keep? How many did you lose? What are the percentages? This is excellent feedback for you if this happens with another employer – perhaps one with which you have even more patients?  Then you’ll know if you need to join that plan or be prepared to lose some patients.

By using Dentrix, you are managing what can be an emotional situation using actual data:

  • You identify the exact number of patients involved
  • You eliminate the collections problems patients
  • You consider this volume of patients compared to your total patient number to see if you feel that this is a large number or small
  • You look at the finances – comparing your standard fees vs. the new plan’s fee schedule you determine the loss you would take from the insurance adjustment alone
  • Finally, you see how many patients left vs. remained

I hope this scenario never occurs in your town, but if it does, you have a protocol to help manage the situation. Follow this link to learn more about how to Manage Dental Insurance. Here’s to you keeping your patients!

For more ideas to improve the business-side of your dental practice:

AUTHOR: Jill Nesbitt
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