Introduction:
If you’re a dental practice owner grappling with high overheads, low reimbursement rates, and increasing staffing issues, it might be time to consider exiting dental insurance networks. Though you may experience some attrition in your patient base, the increased reimbursement rates for out-of-network services can make up for the loss. In fact, the revenue generated by one out-of-network patient can equal that of two in-network patients, allowing you to work more efficiently and profitably.
If this logic resonates with you, here are 10 more reasons to consider leaving dental insurance networks in 2023:
- Slashed reimbursement rates – Dental insurance companies are more profitable than ever while patients are being convinced that their dental insurance plan will keep them healthy. Dental providers all over the country are suffering from decreased reimbursements that no longer cover the cost of doing business. This places providers in positions where they have to remove themselves from the dental insurance plan as a “preferred provider”. Patients have limited knowledge about their dental plans and even less knowledge about their rights to see a dentist outside of their list of plan providers.
- Increased payment delays – Dental insurance companies delay payments by claiming loss of claim forms, need for additional information, and continue to postpone payment to the provider, creating added business stress and hardships.
- Constantly changing reimbursement rules – Patients are often confused about their plans’ coverage, and the constant changing rules of their reimbursement continue to delay payments, frustrate policyholders, and ultimately reduce care quality for patients with lengthy waiting periods or no coverage clauses they were told they had.
- Staffing shortages – Covid left us with many gaps in the employment pool. Dentistry is a predominantly female field, with 99% of dental practices being female. This means when family crises occur, the dental office is left short-handed. Recruiting new people to the field will help in the long term; however, the shortages will be felt for years to come until more classes graduate and more people join the profession.
- Supply chain issues affecting dental supplies – Our supply chains have been backed up and will continue to be, with all the various sizes of equipment and supply needs. Many of our supplies come from overseas and experience constant holdups in customs.
- Rising inflation – The cost of doing business has increased 10-12%, while reimbursements have decreased and patients’ needs are higher than normal since the Covid shutdown in 2020.
- Growing patient frustration with insurance companies – Patients have grown accustomed to having their dental cleanings covered by insurance companies, and with the increased limitations to their policies, they have become more neglectful of their oral health. This increases risk factors and eliminates standard prevention. Patients become even more frustrated with the limitations to coverage for gingivitis and periodontal disease.
- Additional staffing needed to process insurance claims – The constant management of claims processing and data resubmission only causes increased wages for added staffing. This need, coupled with inflation, staffing issues, and short staffing, pushes more and more dentists to rethink their patient care model.
- Compromised standard of care due to insurance constraints – Dental practice owners tend to scramble when there are limitations to staffing and increased demand in their practice. Their first instinct is to shorten appointments, change suppliers, reduce overhead costs, and work with less. This causes even more stress on the company.
- Increased stress on dental providers – Dentistry is already the most stressful field according to national employment polls. The stress of performing procedures on awake patients, running a business, managing compliance, and managing employees can cause any dentist to break under these conditions.
Once you’ve decided to exit dental insurance networks, follow these steps to ensure a smooth transition:
- **Hold a team meeting**: Discuss your concerns with your staff and have them read this blog post. This will help them understand the rationale behind the decision and enable them to support and advocate for your practice. Together, review your patient list, contact the insurance company to learn about their termination process, and practice discussing the change with patients to ensure consistent messaging.
- **Customize the termination letter**: Download and edit the provided termination letter template to suit your practice’s needs. Send it to your patients before notifying the insurance company to give them an opportunity to ask questions and address any concerns.
- **Notify the insurance company**: Send a termination letter to the insurance company, including all relevant provider and business information. Double-check the dates and signatures, and keep a copy for your records.
- **Update your practice management software**: Record the termination date in your system and spend the next 30-90 days practicing how to discuss the change with patients during your office workdays.
By following these steps, you’ll create more balance in your practice schedule, address staffing challenges, and reduce the stress associated with navigating dental insurance companies’ reimbursement tricks. If you need additional support, reach out to a practice coach at info@bryantconsultants.com.
