My Experience Transitioning from an Insurance-Based Practice to a Fee-for-Service Practice

It was late 2018… and after a long, difficult assessment of our practice I had finally made the decision that I was no longer going to participate as an in-network provider for dental insurance companies anymore. I could bore you with all the various reasons and justifications, but this decision was a personal one for myself, my family, my staff, and my practice. At the time the decision was made, our practice revenue was approximately 50% fee for service, and 50% insurance driven. How could we possibly survive cutting 50% of our revenue? Well, this is how we did it…

First, we decided to go out-of-network with our largest insurance provider in the practice. If we could survive dropping the largest, the rest would be easy. Well, it was not easy…

The task is relatively straight forward. We contacted the insurance company and requested in writing that our doctors would no longer participate as an in-network provider. There were a few questions about why, etc. but ultimately our wish was granted. There was a mandatory 90-day waiting period where we would continue to function as an in-network provider, and at the conclusion of those 90 days, we were out. That was the easy part.

Now, the hard part… We made the decision to notify our patients in writing about the new direction our practice was taking. The response was swift and visceral. The raw emotions that this decision brought out were surprising to say the least. Some patients simply left for other practices. Some never said a word. Some felt the need to voice their displeasure with the decision. Some were downright mean and nasty. It was as if our business decision was a personal affront to their very being, and they were going to let us know exactly how they felt on the way out the door. By far, the emotional toll was the most painful part of the process.

If I had one regret, it was that I did not have a better response to the emotional component of the decision. Maybe I would not have sent out anything in writing. Perhaps this would have been better handled face-to-face with a conversation. However, I think it would have been unfair to not prepare patients for the reality of the situation prior to their arrival for an appointment. I still wrestle with this issue even after the fact, and I am not sure what I could have done differently.

The financial part was not nearly as painful or difficult. In fact, it was a breath of fresh air to get paid for the procedures and services we were providing. The financial result of trimming a significant portion of the patient base was minimal. Our overhead went down significantly as we were not shuffling as many patients through the door. Our labor was significantly reduced by eliminating the work associated with insurance calculations and collection issues. We were able to spend more time with the patients that appreciated us. Our “write-offs” disappeared. In fact, in less than one year we were generating the same amount of revenue as before with a 25% reduction in overhead. Whoa… who would have thought? Going out-of-network with the rest of the insurances was an easy decision after that.

We continue to submit all insurance claims on our patients’ behalf. In fact, a lot of patients are reimbursed a significant portion of their out-of-pocket expense, if not 100%. Oh, and a lot of those patients that felt the need to give me a piece of their mind… well, they came back. Once the emotional response had time to calm down, they realized that it was a business decision on our part, and that they liked coming to our practice. They did not all come back… and I am hopeful that those that left have found a dental home that suits all their needs.

In conclusion, the decision to go out-of-network with insurance providers was a personal one for me and my practice. Every practitioner needs to decide what works best for them. It was not easy, and we made mistakes along the way… but I am sure glad we did it.