Should You Go Out of Network? Part 1: Where to Start

Thinking about going out of network but not sure where to start? On this episode of The Dentist Money Show, Matt and Christine share a strategic framework to help dentists evaluate one of the biggest decisions for their practice. They discuss the impact of rising PPO write-offs, how to determine whether going out of network aligns with your goals, and the key financial and operational factors to consider before making a move.

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Podcast Transcript

Matt Mulcock: Welcome back to the Dentist Money Show where we help Dentist make smart financial decisions and make work optional on your terms. I’m Matt, joined here with the beautiful and brilliant Christine Uhen I nailed it, Christine. How are ya?

Christine Uhen: Yeah. I love that introduction. Yes, you got that one down. Thank you. Good to be here.

Matt Mulcock: Yeah, good to have you. I’ve really practiced that intro because the first time I did it, I said brutal. So I was really concentrating. but super super excited to have you and to talk about a really critical topic here around to drop the PPO or not drop the PPO, or what going out of network, in network, what what are all the decisions that surround that? So before we get into this though, I do want to highlight that this show is brought to you by Dentist Advisors. It’s shocking how many people don’t know that at this point, but I’ve been told I need to be highlighting that. So it’s brought to you by Dentist Advisors, and a huge part of what we do at Dentist Advisors is education. And that’s why we did started this show now, almost 11 years ago. We just want to educate the dental space, and we’ve taken this to a next

Christine Uhen: Yeah.

Matt Mulcock: level of education, which with our Dentist Money Launchpad. So we just had our first cohort beginning of this year, went great. ⁓ and we’re doing another cohort this fall starting in September. So if you are at all interested, if you’re out there thinking I need another level of this, I need to something to help me kind of learn all the things that I did not know or was not taught about money in dental school. We’ve got the answer. You can go to dentistmoneunchpad.com. We are taking ⁓ early bird entrance right now. So you can get all the information there. So wanted to give that plug around helping all the young, the young dentists out there. So ⁓ Christine, again, this is I’m so glad to have you here. And whenever we talk about this kind of stuff, it’s it’s it’s just such a reminder of how lucky we are to have you on our team as our practice strategist with all of your knowledge around this.

Christine Uhen: That’s right.

Matt Mulcock: But let’s just jump in. How w where would you rank this ⁓ over your thirty years of experience in dentistry? Where would you rank this kind of topic around going out of network, how to do it, kind of as far as importance or just things that you hear from dentists? Where where does this fall?

Christine Uhen: Well, I and I’m really glad that we are having this conversation and sharing it with our listeners because it has been it has become not even just a topic of conversation and one of those, you know, cocktail party conversations of yeah, you know, I’m writing that that other such and such a company and how hard it is to work with them. This has become a a ⁓ major impact on the success of the dental practice particularly, you know, our clients, private practicing dentists, this is this is not even just a topic of conversation. This has become a business impact decision. And the clients in most recently in the last six months that I’ve been working with, some of them have had the the amount of write-off that I’m hearing about, and it used to be 25, 28, 30, 32% of gross production write-off.

Matt Mulcock: Yeah.

Christine Uhen: I have literally seen 42, 45, and 48% in network write-offs for offices for individual solo practitioner practices. That becomes an incredible obstacle to do the kind of dentistry they want to do, to pay the team to get the products and services they want to provide their patients without running at you know with roller skates on because they have to do a higher volume of services of actual care and and volume of patients to even have a viable business. So this is not this is moved from conversational and irritation to critical conversation of how am I successful as a business for myself, my family, my team

Matt Mulcock: Yeah.

Christine Uhen: And still have the quality of care for my patients. It’s it’s beyond, I mean, it’s a 12 out of 10 right now, in terms of let’s talk about this and let’s really strategically determine what I can do to manage this impact that’s affecting the business.

Matt Mulcock: Yeah. Yeah, it’s huge. And it it’s funny, Christine, when you’re going through that, I shouldn’t say the word’s not funny. ⁓ when you when you go through that, the thing that’s going off in my head is bur the word that came to mind was burnout. Like I think when we there’s such a correlation, ⁓ like that you said they’re kind of like on roller skates, but when I hear these figures, and we’ve talked about this internally now for the last several months around yeah, these around these write-off figures that are just growing.

Christine Uhen: Months it’s been top of mind. Mm-hmm.

Matt Mulcock: And kind of running in parallel to this, or you know, there’s a lot of I think not even correlation, I think there’s a lot of causation here around the result here. And one of the main problems here being burnout for dentists and this idea sometimes where we’re like you’re grinding and working for free. I mean, not not totally, but in some cases per patient, you might be. And that’s a huge problem. ⁓

Christine Uhen: Yes, yes. Yeah.

Matt Mulcock: The other thing I’ll highlight really quickly, Chris, is that this is so critical to talk about and bring to the forefront of dentists’ minds because I think it’s really easy for dentists, because of the complexity of their life, to get distracted with like optimization type problems. outside of the foundational problems being something like this. Like this very much fits to me as you describe it as we’ve talked internally, as a foundational problem that you’ve gotta face and a f and fix and and figure out before you start messing with things on the edges.

Christine Uhen: Yeah, exactly. So it’s just it’s become such a bigger impact. It’s not it hasn’t been the first lever lever, if you will, that we look at when it comes to analyzing a practice. But it’s moving up, if not to the top, close to the top. Optimization is is critical. Efficiency, effectiveness, you know, systems and processes and all of that. That’s important in managing the patients as they go through their experience with you. But if you don’t have time to even create an experience, then it’s Then it’s just keeping up, right? So there’s the grind part of it is I am gonna work with what I have. I am gonna choose the good product. I am gonna choose to stay in network because I wanna be that way. I wanna be available for my patients, which just means the only other lever I have is to work harder and faster on more people. So

Matt Mulcock: Yeah and if you have a forty eight percent write off, that’s as foundational a problem as it gets, right? I mean, how does it that is top of the list of things you gotta fix.

Christine Uhen: Well, and again, let’s let’s talk a little bit about gotta fix, right? So we we’re not here to say you need to go in or out of network, but the idea of if you’re not looking at this, this could be the one thing that would actually give you a heck of a lot of relief. Yeah. So this could be a solution to a lot of the other issues that are going on. One being burnout for sure. Yeah. Bringing that.

Matt Mulcock: Address. Sure, sure. Yeah, for sure. ⁓ okay, so we’re I guess I should have started with this too. We’re gonna ⁓ do this in two parts. we just think there’s so much here. ⁓ so we wanna take this episode as kind of a setup episode, and then ⁓ as opposed to bombard with a two-hour show, ⁓ try to take this in more ⁓ you know, bite-sized pieces. So let’s start there. How how do you set this up. How do you think about this foundationally as someone who, like you said, not like gotta fix, but is addressing this issue within their practice?

Christine Uhen: Well, just recognizing it in the first place. So we’re I’m gonna use a framework that we use at Dentist Advisors, right? First we have to get organized, right? And then we need to analyze the data that we’re gathering. Then we need to make decisions. So again, let’s just stop the decisions. I’m we’re gonna walk you through some processes on that decision. And then when I make that decision or if I do, what do I need to do? How do I make this big change of moving out of network with insurance plans? And that’s the action item right. There’s there’s my action plan. So that will most likely be our our part two, the action part. So get

Matt Mulcock: Yeah. And I I want you to know, Chris, the the Organize, Analyze, Decide Act, we before before your time here at Dentist Advisors, we used to have T shirts. They may have been the the w the worst T shirts we’ve ever had at DA, but they we had shirts. They’re now famous for for their for how how not great they were. But that’s what we always think about.

Christine Uhen: Well, and let’s stay within that framework because it works, right? And so that’s also too this is not something to go into lightly, even at 48% write-offs. Let’s just say where wherever you’re at, it is important to you’re you’re clearly feeling something that you know for some reason you’re feeling the need or it’s the hottest topic in your study club. But it’s like, yeah, let’s talk about this. So I want to make it really clear we’re not dropping anything. Okay.

Matt Mulcock: Yeah. Yep. I know you hate that. You hate when people say drop. I’ve stopped saying it because of you, which is good.

Christine Uhen: I hate that. No, you well, and it’s also when I know you said it today because I was gonna go, no, no, but that’s okay. This is because it’s so common. It’s it that’s the point. We have to be very strategic about this because part of successfully doing this is we all say the same thing on the team. We all but really the first and foremost, why are you doing this? Again, very much aligned with what we talk about with financial planning. Why?

Matt Mulcock: I did. And I changed it. Yeah.

Christine Uhen: What does success look like? What are we trying to achieve? Is it about more money? Is it about more patient, more, you know, being able to charge more, slow down, see fewer patients, see different service mix? What’s motivating this, right? So that’s going to get us started. And by the way, does going out of network align with that? So if you have a philosophy that you do want to be available for everybody, you want to be the local dentist, you want to not deny anybody, not turn anybody away, then going out of network with every plan might not be the choice for you. You may selectively go out of network. I have one office that I worked with that said I am not leaving the network with the teachers and the police, right? I want to be there for them. So I also want to be realistic that this doesn’t have to be all or nothing. We’re not

Matt Mulcock: Yeah.

Christine Uhen: dropping anything. There is a misnomer. And again, you’ve heard this before. Well, then I’m fee for service. I’m either in network or I’m fee for service. And that also means a lot of different things. Right. So you do have to be prepared and understand the cash flow implications. What do I need to collect at the time of service with your patients? But that’s all again, we’ll get to that on the action part. But why are you doing this is critical.

Matt Mulcock: Yeah. Yeah.

Christine Uhen: The one other critical piece here is that it takes every single person on your team being aligned with that. Because if the team is not committed to doing this and understand the why and believe in you and your why and and want to get behind that, then you’re going to have mixed messages. And the one thing the patient’s going to hear is Discord. They’re going to hear different messages.

Matt Mulcock: Confusion.

Christine Uhen: They’re going to be confused. And a confused consumer does not buy. Right. So a cons a confused patient will not move forward with care, stay in your practice, or refer others. Right. So the alignment of your team is critical. Behind you, with you, all rowing in the same direction. And that’s a critical piece of this. That again, you don’t want to go into this lightly without everybody.

Matt Mulcock: Yeah. Yeah. Well, and what I’m hearing from you, Chris, and I would imagine is a big problem here, is not off not even like resistance to the move within the team. It sounds like what you’re saying, and I I want to ask you when you see this I would imagine a lot of times it’s maybe just a fundamental misunderstanding of what is happening. And maybe even from the dentist, I I want to ask you from the from what you’ve seen. This idea, and again, we’ve joked internally with you and me when I say drop, because I say it. And well, and I think that so that’s the that’s what I wanted to ask you is where do you think this comes from? Just kind of vernacular that’s kind of just grown and people just say it. It’s like a saying now within dentistry, without much thought. We have a lot of these in in our just in our general English language, but versus dentist truly not.

Christine Uhen: Yeah. Well and it’s so does the whole industry.

Matt Mulcock: Understanding the difference between what being out of network versus full fee for service, like, is it truly a misunderstand? I’d imagine the team misunderstands that, but what about the dentist?

Christine Uhen: Well, I would say it’s both of those, but it’s really the patient. That’s the that’s also who, you know, might be hearing this. So did you did you drop me? Are you dropping me? I heard that I can’t go see so and so. ⁓ Delta told me that you they dropped you or you dropped them or, you know, Blue Cross or whoever, whatever insurance company, right? So it’s out there. I honestly don’t know when that started. I’ve heard it for twenty plus years. it’s it’s been around. And the truth is

Matt Mulcock: Yeah.

Christine Uhen: You you do not have to turn your back on any patient. Don’t have to. At all.

Matt Mulcock: Yeah. And that should be really clear to your team, right? That should be f fundamental. Yeah.

Christine Uhen: Yeah, be foundational. And the truth is you also need to be able to get that message to your patients. Right. That’s the other critical piece of that. So that’s important to do that. And I also th one of the other big areas to get organized, ⁓ the team to get organized around our imagine before we do anything, imagine that you did not have to reduce your fees in any way. So you are charging your entire

Matt Mulcock: Yeah.

Christine Uhen: Full fee, UCR, what you have listed on your fee schedule. How does everybody feel about it?

Matt Mulcock: On the team.

Christine Uhen: How does everybody feel on the team that these are our fees? And how

Matt Mulcock: Do you do you mean there’s like resistance sometimes? Yeah.

Christine Uhen: There can be, this has been, well, because the write-offs have been so high, right? So think about that. I now, if my write-offs have been 30%, let’s just say. So if I’m billing 1800 on my UCR, maximum’s 1500, I’m writing off the three. But now we’re going to be billing that full 1800. How does the team feel about that?

Matt Mulcock: so it feels like there’s a huge Yeah.

Christine Uhen: Does what you’re doing in the office represent an increase in what the patient is going to see as a fee?

Matt Mulcock: Interesting. And that all comes back to framing. It’s huge. Yeah.

Christine Uhen: A hundred percent. But first the frame has to start internally, right? And if the if a team member has never really recognized that or doesn’t know that or doesn’t understand what the write-offs have done to the business, they aren’t gonna feel they I have seen it happen that they have not felt good that the fees went up. And the other side of that is if you are gonna go out of network, the experience in your office probably should change by going out of network.

Matt Mulcock: Yeah tell me more about

Christine Uhen: So if my well, think about this. If my fees in my office because I’m out of network are 30% higher than the the other dentist, the experience that happens in my office should have value to the patient. Because they will mo most of the time they’re paying it more. Again, nuances to that, but most of the time the patient is paying more. And so the value of what we’re providing.

Matt Mulcock: Got it. Yeah.

Christine Uhen: In addition to the excellent dentistry, right? Right or wrong, you know, the doc patients don’t necessarily can tell when you’ve got a super margin versus a good margin on a restoration, right? They know when it’s bad, but when it’s good versus great, they may not know the difference. But they will recognize you look me in the eye, you talk to me, you ask me questions, we’ve had a conversation rather than okay, you’re in for a crown, let’s go.

Matt Mulcock: Sure. Yeah. Yeah.

Christine Uhen: Which a higher volume-based practice has to do in order to be a successful business. All of that has to get thought through and worked out. So there’s that organizational piece of getting the team aligned on just even the concept of doing this. And are they ready to put the work in to make that happen?

Matt Mulcock: Yeah. Yeah, this is so good, Chris. So you started this whole discussion around this framework with, you know, we talk about organized being step one is is the why. I would imagine when we talk about the team, it’s getting them involved with that why. This can’t be brought down from on high of like, here’s our why, guys, as the leader of the, you know, of the business, and you know, being the dentist. I would imagine that a critical piece of this is again, ⁓ co-creating that why with the team. And then the other thing I’m hearing from you is education is huge. Anything else you’d add to this organization piece?

Christine Uhen: I don’t think so. Again, the alignment with the team to make sure again mission statements, the vision statements, the you know, the the critical actions, what are we doing? How are we supporting the mission? What is my role in the success of the practice? All of that is the leadership side that has to be aligned before we move forward. And then does this decision align with our mission? And most of the time it does. Yeah.

Matt Mulcock: Yeah. Yeah, usually it does. So that’s a really good point though. The the nuance and the framing around the proper messaging to the team. Cause if they’re not bought in on this, that fails right there. They’re not gonna they’re not gonna be able to communicate this. They don’t A understand it or B, they’re not behind it. Those are two really key points. I wanna ask you, I think something that gets misunderstood a lot, timing or sorry, time frame. So it the Dentist starts thinking about this. They start thinking, okay, I gotta get this organized. What what what should they be thinking about as far as how long this is gonna take to properly execute this? If they’ve even decided, okay, we’re gonna get behind this, we’ve co-created our why, we’ve we’re starting to educate everyone. We’re all on the same page, we’re gonna do this, we all agree. From that point to like executing. What does that look like? What should a dentist realistically be thinking about?

Christine Uhen: So we’ve got some believe it or not, we’ve got some very Urgent sense of urgency from some of our doctors of I need to do this now. I can now, I’ve done my analysis, I’m ready to go, I’m ready now. Can I just go out and network now? And the most successful offices that do this take 12 to 18 months of a process. Once the decision is made, and the timing of this is relatively two to three recall cycles.

Matt Mulcock: Now, yeah. Yeah.

Christine Uhen: So that I have a chance to talk to my patients one on one. I’m having conversations with them that very that start out with, I’m thinking about doing this and here’s why. And then the next cycle is I’m definitely doing this because of A, B, and C. And then the next time is when you come back again, we’re going to be in our out-of-network relationship. So when I’m ideally setting that up, it is 12 to 18 months. I have seen that and

Matt Mulcock: Yeah.

Christine Uhen: Most of them are choosing the twelve, right? I got two conversations and then I’m out, right? We’re we’re gonna move that up as as quick as I can. I’ve seen it and so the other real point of this too, and we’ll talk about this coming up next, is the decreasing the risk of losing patients. Again, keeping them aligned and educated, not confused, understanding the difference between the services they’re getting when they’re out of network, all of that takes time.

Matt Mulcock: Cause they want to go. Yeah. Yeah.

Christine Uhen: And adults need repetition in messaging. So there’s a lot that goes into training the team, learning, you know, overcoming objections, figuring out under you know, doing some research with the different insurance companies of how how are they? Are they gonna send me the check? Are they sending the patients the check? All of that investigation needs to be reviewed and planned for, much less the

Matt Mulcock: Yeah.

Christine Uhen: the marketing and growing the new patients’ phone skill. There’s just we’ll get into a I can lay out a good twelve month plan for you in the action piece of this. But yeah, twelve to eighteen months.

Matt Mulcock: Yeah. Chris, you’re down you’re down there in San Diego, Navy SEAL territory. I believe it’s the Navy SEALs or some military saying that’s slow is smooth and smooth is fast. So it when you say like I I th I believe that’s true. ⁓ I’m probably making it up, but it’s something like that. But when you say like and we see this where dentists see this problem, sometimes we’ve identified it for the first time. You know

Christine Uhen: I’ll I’ll I’ll say yes. Yes. Yeah. Okay.

Matt Mulcock: From our end, we’re, you know, they’re wondering what’s going on. And then we point out, well, one of the biggest issues we’re seeing is this massive write-off, and we’ve got to address that in some way. ⁓ and again, don’t don’t get it twisted. We’re not sitting here saying this is not a podcast of like go out of network, everyone. It’s just we need to address it. And to your point, they want to move quick. And I just when you’re saying this, it’s like, yeah, slow, slow sometimes is smooth and smooth is fast. You’ve got to be able to organize and plan around this.

Christine Uhen: Yeah.

Matt Mulcock: The last thing I want to mention from my end of our work of being the nerdy financial advisor, you’re so able to go in depth on the practice side, but from our side, as as advisors, I’m always thinking about not only organization specifically in the practice, but are you organized on the personal side and overall financial side planning side? To make a move like this, because the practice is a core is the cornerstone of everything to do in your financial life. It impacts everything in your financial life. So if you’re gonna be doing something that’s gonna impact the practice in any way, ⁓ and this might have a short-term negative impact at first, who knows? But you wanna make sure that you’re really organized on the personal balance sheet and cash flow and debt strategy and understanding all those things and how it integrates with your practice. This is not just a practice isolated decision, is what I’d say.

Christine Uhen: And that’s a really good point. And when we get into let’s go ahead and jump into the next phase, because this is what we mean by analyze is there’s some information that you can that you should have and in order to make some of these decisions. You know, and let’s back up for a second in terms of, you know, I want the first piece of analysis I would do is when’s the last time you tried to renegotiate your fees? Let’s be honest about that too. That it there is some effort and and

Matt Mulcock: Yeah, they analyze. Yeah.

Christine Uhen: Boy, do we have a couple of great resources? We’ve got a couple of of our partners that actually will negotiate on your behalf. And if they can’t get success, they will tell you you have nothing, nothing to lose by reaching out to someone that we would be able to connect you with that says, hey, let’s try this first. What if you could instantly get 10% and do nothing different because of how they’ve renegotiated or able to negotiate on your behalf?

Matt Mulcock: Yeah.

Christine Uhen: So that’s the first thing. You know, let’s let’s analyze that. Have we renegotiated our fees? Are you continuing to? Are your fees where they need to be set? So start with that. Are am I happy with my UCR fees? And could I renegotiate with any of the plans that I’m currently in? So there’s first and foremost.

Matt Mulcock: Yeah. Yeah. And I like that you’re saying when’s the last time you’ve done this? Because in most of our lives, but s certainly in Dentist’ lives, we’ve noticed a couple of years goes by, like a week, and all of a sudden they’re like, I just did that. ⁓ no, wait, I did that in twenty sixteen, you know? Yeah. So I think that’s a really good point. And I think that’s why when w when we s when I said at the beginning, you gotta if you have this massive write-off, you gotta fix I said gotta fix it, but when we say gotta address it.

Christine Uhen: Yeah. How long has it been? Yeah. Yeah.

Matt Mulcock: This is what you’re saying is it’s not just go out and network immediately. It’s hey, step one is maybe we just reevaluate your PPOs and your what what you’re getting paid.

Christine Uhen: Yeah. So and again, we do have resources we can we can help advise on that for sure. But then it is looking at so now we’re going to we’ve done our attempted renegotiations. We’ve done where we are definitely organized. We are ready to look at the different plans. So there are a few pieces of data that need to get addressed. And you can get this straight from your practice management software software is analyzing per plan how much

Matt Mulcock: Organize.

Christine Uhen: You are writing off because they are different per plan. You want to look at the total amount as well as the percentages that are being written off for each plan. That’s where some of the analysis stops. But some other things to think about are how many patients are on each of those plans and how much production is coming from each of those plans. Because when you’re looking at maybe you’ve got one plan that is at, again for round numbers, we’re going to say 50% write-off, but it’s only 20 people on that plan.

Matt Mulcock: Yeah. Not a yeah.

Christine Uhen: That’s not as risky. If sixty percent of your revenue is coming from one plan that’s writing off 30%, you know, that’s a bigger risk. And then I need to actually do the math of production that’s written off, minus the how many patients could leave if I don’t do this well and don’t have an alternative plan to to

Matt Mulcock: It’s a bit risky. Yeah.

Christine Uhen: To keep those patients and or get more new patients not on that plan. So this is the data that literally this is now you’re talking about nerding out, right? This is this is gimme, gimme, gimme. This is where I love digging into all of this. And what this is is information. It’s not right or wrong. Nobody did anything good or bad, but really looking at what is at risk if and or when I make the decision

Matt Mulcock: Yeah.

Christine Uhen: That I am going to change my relationship with this insurance company. Write that down. Change my relationship with this insurance company. So that’s another key component that you really need to look at that. And there are times when doctors have done this analysis and not moved forward with going out of network. Not yet. Maybe not now.

Matt Mulcock: Yeah. Yeah. Yeah. Yeah, not yet. Or to your point, they’ve just gotten more clear on the little, you know, on on individual risks, to your point, around their patient base. Cause I’ve seen this too, where dentists have done this analysis and they’re like, ⁓ I’m gonna drop this plan or sorry, I did it. I just did it, Chris. I’m going to go out of network. I’m going to go out of network with this plan.

Christine Uhen: Yep, yep, yep, no. You caught yourself, I’m very proud.

Matt Mulcock: Because I’ve now realized through this analysis process that the risk is so low, you know, and they go like to the actual like what you just did, ⁓ you know, hypothetical, but they the actual data or analysis shows, my gosh, like I’m just losing money on this patient base and I’m gonna go ahead and drop go out of network with this particular I’m gonna get it at some point. I’m gonna get it. I know so much.

Christine Uhen: It’s hard, but see now we’ve we’ve just heard it so much that it’s become a vernacular that we are I and again, I am personally committed to making your yeah.

Matt Mulcock: I know you’ve helped me, but but to that point, that that’s why this is so important. And these steps build on each other, right? You’ve got to get the organization right. You’ve got to then go to the analysis piece and get really specific about these particular plans and how much risk you’re actually taking. And this is actually a really good point too, Chris, generally, around why it’s so in like why it’s so ⁓ important to ⁓ not take even us. General advice as specific advice, right? Because w you hear out their dentistry small and you’re hearing your buddy or your classmate from 20 years ago in school is going out of network or doing this or that. Well, they’re living in North Carolina and you live in New Mexico and the plan and your patient base and service mix is so different than them, but you hear them and like, you’re going out of network. ⁓ well, I’m gonna go out of network. But

Christine Uhen: yes, yeah.

Matt Mulcock: That’s why I love that you’re saying this analysis is so important to figure out your individual risk with your patients and the cer and and the the the procedures that you’re doing.

Christine Uhen: Yeah. Well, and definitely ⁓ the here’s another one that’s not as ⁓ let’s take this to a little more anecdotal than actual factual. Ask your team which ones are so difficult to work with. Because you want to talk about operationally. If I have to plans. sorry. ⁓ Well yeah, no, but the plans, there are some ty I mean it can be and it has never failed when I’ve worked with an office or had conversations about this.

Matt Mulcock: Yeah. Yeah. Patience or plans, Chris? Maybe both. Yeah.

Christine Uhen: Where the the administrative team in particular is like, yeah, let’s get rid of so-and-so plan because they make us submit three times and they’re always denying. And again, there’s inefficiencies in working with this company because it’s taking me three to four times of the administrative effort to actually get paid. And

Matt Mulcock: Yeah. Sure. And by the way, that matters. You should as a business owner, you should be calculating the time. Time is money, as they say. So, you know, and that’s a factor in how much it actually costs you, even if the actual reimbursement, let’s say it’s higher than another plan. But to your point, Chris, it’s taking you so much more administrative work and effort. That still might not be worth it. It’s a really good point.

Christine Uhen: Yeah. And and truly and they and it they just like to get in included in, you know, the analysis and the details and giving you feedback on that too. And that is critical because again, they’re part of the they’re a big part that ad well, the whole team, but administratively on both the front and the back side of the appointment, right? Everything from the phone call, the the checking in to the collecting. So they have some very good insights and they will have a big impact on the success of this. So

Matt Mulcock: Yeah. Yeah.

Christine Uhen: Yeah.

Matt Mulcock: Chris, what what other things should a dentist be thinking about in this analysis around not only like individual plans and whatnot, but what other things should they be thinking about as in this analysis step?

Christine Uhen: Couple other things that are coming to mind is the prediction of if you were to lose patients. So this also not everybody will be able to move forward with you, even with the perfect language, with the perfect, you know, alignment of your team, with the right marketing message, with the right financial options, all those things, not every patient will be able to afford to because they are you know, a family with four kids and even the fifty dollars per visit more is too much for them. Or they are very committed to, you know, budgeting, if they’re on tight constraints, you know, those sorts of things definitely impact the the patients themselves and how they’re making decisions of who they’re choosing for their provider. So we do also need to look at what is potentially how many patients you’re going to to really

Matt Mulcock: Yeah.

Christine Uhen: not go with you. We’ll we’ll leave the office because of this decision. And this ties into what you were talking about with the personal financial side of things. Will there be a gap of a certain amount of productivity if we predict and we can look at 15%, 30%, 40% per plan? We can, we can absolutely this is where I can be helpful with that analysis of what if I lost 30% of my XYZ insurance companies patients. I know that’s gonna be forty thousand dollars a month sort of thing. And how am I gonna make that up? Or am I gonna make that up by insurance reimbursement being higher, right? I’m gonna get an increase in compensation because I’m not writing off the 30%. So those sorts of analysis of the risk of losing patients, but am I gaining enough in the increase in fees? So there’s there’s a lot of math and do not I can I say this? Don’t do this alone. Don’t do this alone. There’s, I mean, again, some of our docs are super absolutely could do this on their own, but we do also, this is a process. This is a huge impact on your practice. And there are fantastic, again, consulting firms that can walk you, coach you, coach your team on how to do this well. So

Matt Mulcock: Yeah, you can. You sh yes. Yeah.

Christine Uhen: Again, this is something that I would again, we’re happy to give you recommendations based on what your specific needs are and where you’re located. But really, we there’s a lot to this. And so this this analysis part should take a little while. It should absolutely be thought about financially on the personal side. What could I risk for a certain amount of time? If I take that 12 month period, can I put aside another $5,000 a month that in case something happened that I didn’t plan for, I do have the cash.

Matt Mulcock: Yeah.

Christine Uhen: on hand to be able to handle that personally. That’s a stress you don’t need on your personal life as you’re doing this. Yeah.

Matt Mulcock: Yeah. Totally. Yeah, it’s critical because like you you can’t Carl Richard says, we’ve mentioned on the show before that the only risk that matters is the one that you ⁓ that’s there after you’ve thought of everything else. Right. It’s like you can’t you can’t actually know the exact outcome of all of this. So yeah, to your point, this is yeah, exactly why we’re saying there’s more aspects of just the individual practice things. It’s are you set up w on the personal side with the cushion, if things don’t go the way you think they will.

Christine Uhen: Well, and some of that is looking at the service mix too. And so for example, you know, we can actually look at what are your current fees for the top maybe 25 procedures that you do, right? I have cool spreadsheets. And of these that I’m getting, you know, the in-network fees versus out of network fees, based on the number of procedures I’ve done over the last 12 months. This is the positive impact that’s going to happen if I just kept doing the same thing, not growing, not adding.

Matt Mulcock: Yeah.

Christine Uhen: But maintaining the productivity, I’m just getting compensated more. Right. So that’s where that trade-off is against the risk of what I’m going to lose. So those pro forma analyses are just really critical to have all that information. I know you might think that it feels that way. It might, you know, emotionally, this is, you know, the worst one. And yes, that impact is important. You know, the input from your team is important, but

Matt Mulcock: Yeah. Yeah. But that takes a lot.

Christine Uhen: The numbers don’t lie either. Yeah.

Matt Mulcock: Yeah. Yeah you mentioned you kind of alluded to part of this analysis would be maybe other things in the office they should be thinking about or or having as an alternative or as a backup plan. What what goes into those thoughts there?

Christine Uhen: Well so a couple of things. Financially, ⁓ there’s some recommendations of making sure, you know, people are looking at insurance as a method of payment. Right. So again, that’s important. And so it’s not that that’s not going to go away. That’s critical to say. That’s still there. That method of payment is still there. Now, if it turns out that it’s not a lot of benefit to the patient, if it’s more. Then they’re willing to pay. Could there be another alternative to insurance? So ⁓ this is another, it’s been, it’s been around for I won’t, I won’t say how many years, but the membership plans, right? They’re not all, they’re not an in-house insurance plan. They’re not, but it’s an alternative to an insurance plan. So it’s not in addition to, but instead of if they had an in-office membership plan that

Matt Mulcock: Yeah.

Christine Uhen: For X amount of dollars annually. So subscription models are also very good in terms of retaining patients and helping them move forward with care because there is a reduction in services on different procedures that are being done. The membership plans are a great thing to have in place. ⁓ Patients need to have affordability. They need to have a way, multiple methods to pay for their work. Insurance is one method of payment.

Matt Mulcock: Yeah. Yeah.

Christine Uhen: And I need to have an alternative to that if they are not able to stay within the the insurance plan, if they choose not to participate in that plan. So that’s that’s the alternative there. you also want to have make sure that there are other third party financing. Again, just making sure patients have choice when it comes to how they can afford their work.

Matt Mulcock: Yeah, that makes sense. Yeah. Chris, I’m curious before we get to the to the decide stage, I’m curious on the analysis piece. How much should be put in put into analyzing the relationship with the patients themselves? So you’ve talked we’ve talked about the plans and like the risk analysis of okay, I’ve got X number of patients. This is my write-off. This is the percentage of revenue. But I also I go to is there anything a dentist can be doing or should be doing? That part of it is just kind of like you it’s not a science necessarily, but analyzing the the relationship with that patient base or grouping their patient base around like, okay, again, forget the insurance, but just if we go out of network with this patient base, with these with this group, our relationship is this strong. Like, have you ever seen dentists analyze it from that angle?

Christine Uhen: I have seen doctors that are aware of I I think I mentioned my one of my clients that was wouldn’t do it to the teachers, wouldn’t do it to the police. So he knew which plans they were on, and he was not willing to change that relationship with that plan because he did want to be that person to that group of patients. So in that sense, and that is more anecdotal, certainly.

Matt Mulcock: Sure. Yeah. Sure.

Christine Uhen: But that also see that’s where we’re back to alignment with our mission. Is going out of network aligned with this one person said, no, it’s not because my mother was a teacher, right? Or whatever the reasoning behind that. That was important. That was part of his why of being in network with this plan, because of who was on that plan. So anecdotally, that’s got value a hundred percent. So that is and again.

Matt Mulcock: Yeah. Sure. Yeah, yeah. Sure.

Christine Uhen: That may or may not be the dentist that knows that, but definitely checking in with the administrative team probably has a good handle on like that group of patients.

Matt Mulcock: Yeah, for sure. Yeah, and maybe there’s not a way. I just the again, z that totally makes sense of just I’m not gonna go out of network with this group. But I’m even thinking from another angle of saying, if I were to go out of network with this group of patients, have I done the work to analyze my strength of relationship with those patients to know that that my risk of losing them is actually lower or higher or whatever that may be.

Christine Uhen: That’s a really good question. And unfortunately, I’m gonna tell you that we’re as we’re wrong as much as we’re right on that sense of things. They’ve been with me forever. They’re not going anywhere. Versus the patients that you think are difficult and they’re Yeah, doc, I love ya. You know, I mean it just those sorts of things are yeah, I’d say they’re 50-50 in accuracy of that. Now

Matt Mulcock: Yeah. Totally.

Christine Uhen: I would love to say that every doctor has a strong relationship with every patient. And if it’s not the doctor, somebody on the team does. And you really, really hope that. You really, really do. And I do feel that most of our clients in particular, you know, are working on that constantly. But this is also what’s critical for that 12 to 18 months. You gotta make sure. Right? We are having these conversations. We’re talking to our patients about this. I want you to know I’m being transparent with you. I’m being honest with you. I want

Matt Mulcock: Sure. Yeah, of course. Yeah.

Christine Uhen: You to stay with us and here’s why I’m doing it. And if that if your why matches the patient’s why, you’re gonna be fine. And you won’t know that until you have that conversation. Yeah.

Matt Mulcock: Yeah. Yeah, it’s a good point. Yeah, that’s a good point. You take that time to uncover that with your patient base, even though it’s never gonna be a hundred percent, but you can at least get maybe a bit more scientific.

Christine Uhen: I will say I will say I’ve gone through this with many, many, many clients. And every single time we’ve done it, they’ve been surprised with so and so or you know, I can’t believe they said they wouldn’t stay. They’ve been here third generation, you know, sort of thing. And and vice versa. I’m so pleased, you know, I this one I was worried about and and yet they did stay.

Matt Mulcock: Yep. Yep. Or maybe I wish that one was gonna leave and yeah. ⁓ yeah, dang it they stayed. Yeah. ⁓ yeah. So third kind of part of this ⁓ is decide, the decide part of the structure here, the framework. What goes into this part?

Christine Uhen: There is a little bit of shocks. Thought that would get him out of here, you know, again. I kid, I kid, yeah. But This is also where, you know, having support going through this is important. Someone who can run those numbers with you and and you can have that conversation of what if and what about and talking to your personal financial planner about can I have I feel I need to protect this much before I go out of network. When can I have that? What does that look like? So it is definitely bringing in some really powerful advisors that you trust to walk you through this. This is not something to ask, you know, some I I would not encourage you to do this on a a peer-to-peer level. ⁓ just because everybody is different, so uniquely different. ⁓ I think it’s been eye-opening as you look at this data and realizing where you have opportunity to do more of in terms of the service mix. So I think you might be looking at, wow, I did I thought I did more buildups than I have. I I can’t believe I don’t do bone graphs when I do extractions or or opportunities there to look at from growing within and what that would do to the productivity. ⁓ there’s a whole nother side of What if What if I choose not to? What if my decision is to not move forward? Because I’m not ready to do that. There may be a point here in this decision piece where when I have this many patients, when I’m at this much productivity, when I’m at less impact of productivity on this insurance plan, then I’ll be ready to do it. So with any of those, I’m not ready to do all of it. Maybe I’m only going to do

Matt Mulcock: Yeah.

Christine Uhen: one, two, or three plans to start. Maybe I’ll do that for the first six to twelve months because there’s less impact. There’s less risk. As I grow in that success, I’m ready to go to some of the bigger impact ⁓ insurance companies and and and address those issues. That decision, none of it’s wrong. I I think that’s the point we are trying to make here is you owe it to yourself from the business side to realize this is a lever that we need to look at.

Matt Mulcock: Yeah. Yeah.

Christine Uhen: And assess if it should be, you know, they should all be pulled, one or two pulled, renegotiate. Maybe I need to work on growing more productivity before I risk re losing any. Maybe I want to grow my new patient base that doesn’t have anything to do with that insurance company. Maybe I want to limit my schedule on a daily basis and only see twenty percent of my day can have that many patients. So I can afford there’s a little. Trial run. So maybe for six months I reduce the impact and say only half the patients can in hygiene can be of this insurance company. Do we have enough patients to fill in the gap without that 80% of the day being filled with that insurance company? So without the analysis, without looking at this, you can’t make a really good decision. And the other point of that decision is whatever you choose to do, you’re at least making.

Matt Mulcock: Yeah.

Christine Uhen: A choice, and you’ve done it with good information.

Matt Mulcock: Yeah. That’s a key point there, Chris, because I think there’s a risk in this stage of the game for Dentist, which is falling into the purgatory of indecision. Right. They’ve done the organization. They’ve they’ve at least said the first decision they’ve made is I need to go down this road of understanding this better. So that’s great. You’ve organized, you’ve you started to analyze and get really detailed, and then started to maybe game plan. You have that information and now you’re able to decide. But I think the biggest risk in this stage that we’ve seen is that, and I love that you highlighted that not doing anything is still a decision that can be made intentionally. But I think in any business decision or life decision, if you’re going to decide I’m not doing anything right now, there’s a difference in doing that out of paralysis because you’re just like, I don’t know, and I’m gonna think about it every day for the next two years and second guess everything versus saying, okay, I’m making this from a grounded, sober place and very pragmatic place. And I’m going to set a time frame to revisit this in 12 months. And I until then, I’m gonna go all out and focus on all the other areas of my business or

Christine Uhen: And second guess myself every day.

Matt Mulcock: Patient experience and all those, all the things, the endless list of things. But I’m not going to think about this again until that 12 month mark. Those are two very, very different things because the risk here is that at this stage, it now just becomes this weight and this distraction. And then everything else starts to suffer. And that’s what I would not want to see.

Christine Uhen: And that’s where you’re you know, that that wraps it back beautifully into the let’s not send you down the burnout path, right?

Matt Mulcock: Yep. Yeah, definitely. And I love what you said is that there is no real this is where I think a lot of dentists get in trouble is they think there is a right and a wrong decision. And most business decisions don’t work like that. Most life decisions don’t work like that.

Christine Uhen: Yeah. They all are nothing is also ⁓ the misunderstanding that this is not going from I’m insurance, you know, driven to I am now fee for service and and it’s cash paying and everybody pays in full before I do anything. Those that’s an option, but that doesn’t have to be the option, and that is not the definition of going out of network with insurance. Yeah. And again, it what’s

Matt Mulcock: Yep. Yeah. Yep. Yeah, definitely.

Christine Uhen: This is I’m grow I’m thinking back to our you know practicing on your terms, right? The theme of our summit this this last June, that you you get to define that. You get to define this. Don’t let an insurance company define you, right? That you have to do these fees, you have to do it at this pace, you have to charge this amount. Well, dock on it. Not everybody wants to be that.

Matt Mulcock: Yeah. Yeah. Totally.

Christine Uhen: Be yourself, charge your fees, be good with what you are charging, feel confident in that, and then show the patient that it’s worth it. Right.

Matt Mulcock: Yeah. And the flip side of that too, Chris, is or feeling like you have to go out of network. We’re not saying you have to. Maybe you don’t. Maybe you do this analysis and you’re like, f for whatever reason, you’ve decided it doesn’t make sense for what your terms are for your practice. Great. That great. There’s no right or wrong way to do this. And I think there’s the I I heard this somewhere at some point, totally not original, but this idea of like stop.

Christine Uhen: Yeah.

Matt Mulcock: thinking there’s a right decision and just make the decision you made right. Like spend your time, spend your time, whatever way you decide, making that decision the right decision for you. And I think two again, I just can’t emphasize this enough that at this stage, there’s just such a risk of getting overwhelmed and just not really making a decision and then floating kind of in this

Christine Uhen: No

Matt Mulcock: distraction and stress and so again if it’s not do anything that’s okay just do that with intention and a time frame if it is do something the next part of this that we’ll hit on the second part here we’re gonna tease it as they say we’re gonna tease the next episode but the last part of this is act and the reason we’re gonna put this on the second episode Chris is because so much goes into this right

Christine Uhen: There’s a lot to this to do it well. You could, I mean, granted, if you wanted to send a letter to all of your patients, I will share with you this happened to me. 1989. We decided we were going, we were going to drop our biggest plan. And we sent the letter to every one of our several thousands of patients that were in network with that plan. You want to know what happened?

Matt Mulcock: Yeah. It’s a good year. And I’m sure it went really well.

Christine Uhen: The phone rang off the hook. That’s all it did was make all these patients call us. What is this? What does this mean? And so we did we were reactionary, we were backpedaling versus being proactive and getting in front of this and managing that. So we’ve learned a lot since nineteen eighty nine. And and we’re

Matt Mulcock: Yep. Yep. Yeah. Yeah. That was good tuition to pay to be able to now be here and share this wisdom. So

Christine Uhen: Yes, yes. I’m happy that ⁓ we’re in a much better place to have the conversation in advance. And then we’re again helping you make the right choice for you.

Matt Mulcock: Yeah. So let’s summarize this really quick. The framework is to get organized, to analyze, decide, and then act. We’ve covered the first three. The second part of this will talk a lot more about acting and what that actually means. Okay, we’ve decided to act. Now what are we gonna do? Anything that you wanna add, Chris, to find to finish this up around. The organize, analyze, or decide part of this framework.

Christine Uhen: Think so. I think we’re good with Again, without getting into the action part of things, I’m gonna say we’ve got this covered. So it is about being intentional. That’s another very popular word that we like to use at Dentist Advisors because it is making better decisions, not the best decision. It’s making the right decision for you. And again, so going back to let’s help you practice on your term.

Matt Mulcock: Yeah. Yeah, love it. Love it. Maybe that’ll become our new tagline. Seemed to go over well. So we like it. Yeah, we we like it. So Chris, this is awesome. We’re gonna leave it there on those words of wisdom. ⁓ I’ll just say that if you’re out there listening, struggling with this part of your business or making this decision or needing help or any other part of your your business or your financial life in any way, we’re here to help.

Christine Uhen: It did go over well. Yeah. I don’t know. Yeah, we do.

Matt Mulcock: Dentist Advisors, we talk to hundreds of dentists all over the country. This is all we do. We live and breathe dentistry. And we would love to hear your story and see how we can help, even if it’s just sending you in the right direction. we’re here to help. You can go to dentistadvisors.com, book the click on the book free consultation button, and you can talk to one of our friendly advisors on your schedule. So we’d be happy to talk to you. But for now, Chris, thank you so much for being here and sharing your words of wisdom. Everyone, thanks for listening. Till next time, take care. Bye-bye.

Christine Uhen: Bye y’all.

Keywords: dental practice, out of network, insurance plans, practice management, patient retention, financial planning, burnout, practice strategy

Practice Management