Thinking of becoming a fee-for-service dental practice? Start by developing “FFS habits”

Have you ever considered practicing dentistry without an insurance company looking over your shoulder? As dental insurance companies have pushed doctors to work faster and cheaper, practice owners have sought to reduce their reliance on in-network participation. Some are abandoning their restrictive or low-paying plans. Others, including myself, have moved completely out of network to an entirely fee-for-service (FFS) practice model.

In an FFS practice, your patients, not their insurance companies, are responsible for the cost of their care. Patients pay you at the time of service and any insurance reimbursements are sent directly to them. You can (and should) help them get a refund, but the onus is on them. You have the freedom to set your fees and the freedom to collect them. Does this sound too good to be true? Remember, your patients also have the freedom to leave you for a dentist who BEN accept their plan, so it’s important to be careful and measured when taking the first steps.

For some dentists, the idea of ​​dropping insurance networks may seem like wishful thinking. For others, it may seem like a sure ticket to disaster and bankruptcy. It is neither; it’s just another way to practice dentistry. Anyone who tells you it’s impossible just hasn’t done it.

You have to believe that your care has real value and that there are people willing to pay for it. FFS practices exist all over the country, not just in wealthy areas and big cities. Wherever you are in the country, there is always OTHER USEFUL FFS practices.

To be clear, there is nothing wrong with practicing online. Some of the best dentists I know go with multiple plans and are reluctant to change. You can provide quality care and earn a good income online. But it has become increasingly difficult to do so as insurance companies tighten the screws more every year. But I hate the thought that some dentists stay online out of fear or because they don’t know how to get started.

I do NOT recommend immediately canceling all your insurance contracts. This may be the kind of advice you see on Facebook or in online chat groups, but very few things in dentistry go well without careful planning.

If you’re interested in exploring whether FFS might be right for you, here are some tips based on my experience. These are the steps I took 10 years ago when I was preparing to get rid of my network participation contracts. I started by first picking up a few “FFS habits” that may not be part of an in-network dentist’s regular arsenal.

Insurance companies do not reward these habits; the real reward is an improvement in the quality and efficiency of the care you provide. They can also improve patients’ perception of value and your relationship with patients.

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Diagnosis and treatment plan all the patient, not just their insurance

If you know that an edentulous patient’s insurance company will only pay for one denture, do you still present the options of implants and an overdenture, or a full arch fixed denture? If an adult patient has a malocclusion, do you offer orthodontics? Do you offer fluoride spray to all adults with tooth decay, even though you know it will never be repaid? If you don’t, how would your patients know these things are available?

When I see a new patient now, I don’t know what insurance plan they have. I don’t even have to know if they have insurance at all. This is not important information in my treatment room now that I am off the grid. We all know that insurance companies put a lot of arbitrary limits on what they will reimburse. They have procedural exceptions, annual maximums, frequency limits, discounts and more. None of this has anything to do with the patient’s health; it’s just about saving money.

Unfortunately, many doctors have been conditioned to plan treatment around these limitations rather than what would benefit the patient. I once suffered from this disease. When I was in network, I was tempted to plan treatment this way because I didn’t have to explain to patients the many options that their insurance company I won’t cover. But now, when a colleague tells me “my patients won’t do anything that isn’t covered,” I can’t help but wonder how they know if they don’t ask.

When I was online, I deluded myself into thinking I was doing patients a favor by trying to save them money. But what I was really doing was shirking my professional responsibility to present them with all their options. I was also denying them the opportunity to say yes to what they really needed, even if they have to pay for it themselves. I stopped planning treatment this way before going off the grid and it resulted in better clinical outcomes for my patients and more production for me.

Slow down (when you can)

There is something I call a “culture of speed” that can develop in high-volume insurance practices, where everyone is pressed for time and where low rates must be met with higher volume. You see people moving fast, talking fast, and multitasking. No one sits down to have a conversation.

This may make you feel busy or in demand, but it can also make patients feel nervous and underappreciated. No one wants to be treated by a doctor who is in a hurry. Your patients don’t want to feel like a speed bump that’s slowing you down from the more “important” tasks in the office, especially if you expect them to pull out their wallet at the end of the appointment and pay you.

You can change this habit by moving fast between patients, but slowing down when you are with the patients. When you slow down, sit down, speak slowly, and look your patients in the eye, you communicate better. You can find out others things they might want or need. If you want to succeed offline, finding out what’s going on in a patient’s mind is just as important as finding out what’s going on in their mouth.

One of the reasons insurance companies reimburse so little for clinical exams is to encourage you to spend very little time on them. Do you think companies want you to take really comprehensive exams? They certainly don’t want to pay to treat the additional pathology you will discover. If you don’t give yourself enough time to properly diagnose, you can’t explore anything more than basic treatment needs.

Two of the main benefits I got from going offline weren’t money, but time AND FREEDOM. I no longer need to squeeze every productive second out of the day. I can take more time to talk with patients, which helps me diagnose better and plan treatment more effectively.

Learn good clinical photography

Start taking more and better pictures. Improve your photography skills with your intraoral camera and clinical camera system. Take before and after pictures, even of minor procedures. If you don’t have a good clinical camera with flash and macro lens, it’s a worthwhile investment. There are some great CE courses that can help you learn how to use camera equipment. A picture may be worth a thousand words, but it’s more than that. There are things your patient needs to know that are literally impossible to communicate verbally. The efficiency gains you gain from good clinical photography are undeniable.

Great photography also has tremendous value in patient care and marketing. It takes a little extra time to get it right, so it’s often overlooked. Pictures are a critical tool toward self-improvement because you’ll see things you might have missed. But pictures also communicate valuee in patients.

Beautiful, valuable things are photographed. We know this from the abundance of photos we see of sports cars, supermodels and exotic destinations. When you photograph your work, you are communicating that your work is beautiful and valuable. This sense of value is what will keep patients coming back after you no longer accept their insurance.

Adopting FFS habits not only prepares patients for you to leave the network, but also prepares them you ready to go offline. Many of us don’t fully appreciate the limitations that insurance companies place on our thinking. I didn’t realize it when I was on the net; it was a slow awakening. If you want to practice insurance-free, don’t have to learn these habits as hard as I did!