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Understanding Fee for Service with The Wyrick Outlook · Hey Docs!

• 0:05
  Speaker 1: Welcome to the Hey Docs podcast with your host, Jill Allen. Today,
• 0:09
  Speaker 1: I am welcoming back Megan and Bea, sisters and founders
• 0:13
  Speaker 1: of the Wyrick Outlook. Megan and Bea worked with orthodontic
• 0:17
  Speaker 1: practices on the financial and insurance side of the business.
• 0:20
  Speaker 1: And today we're tackling a conversation that more doctors are
• 0:24
  Speaker 1: starting to have, fee for service. Moving away from insurance
• 0:28
  Speaker 1: can sound appealing, but it's a decision that requires a
• 0:31
  Speaker 1: clear understanding of your numbers, your market, your patients, and
• 0:36
  Speaker 1: the value your practice provides. In this episode, we're breaking
• 0:40
  Speaker 1: down what fee for service really means and how to
• 0:43
  Speaker 1: know if your practice is ready and what doctors should
• 0:46
  Speaker 1: consider before making the transition. So let's get started. And
• 0:50
  Speaker 1: now a word from the sponsors who make this podcast possible.
• 0:56
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• 1:27
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• 1:41
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• 1:45
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  Speaker 1: only all-in-one practice software built from the ground up, not
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• 2:02
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  Speaker 1: see it for yourself? Head to grayfinch.com forward slash Jill
• 2:15
  Speaker 1: Allen for a special discount exclusively for my listeners. Megan B,
• 2:26
  Speaker 1: I am so excited to have you guys back on
• 2:27
  Speaker 1: Hey Docs. Thanks for being here today.
• 2:29
  Speaker 2: Yes, definitely having us. Yeah, super excited to be here.
• 2:35
  Speaker 1: Yeah. Third time. Third time now, we were just saying.
• 2:38
  Speaker 1: Third time, it's not even a charm. It's just like
• 2:41
  Speaker 1: a blessing, right? To get to hang out again together.
• 2:45
  Speaker 1: So in the event that somebody did not catch one
• 2:49
  Speaker 1: of our earlier episodes, would one of you want to
• 2:51
  Speaker 1: just take the lead and give us a little bit
• 2:54
  Speaker 1: of history about each of you, your backgrounds, and then
• 2:58
  Speaker 1: what you guys do with the YRIC Outlook?
• 3:01
  Speaker 3: Yeah, definitely. So for those of you that don't already know,
• 3:04
  Speaker 3: we are two sisters. We are two sisters. It is
• 3:08
  Speaker 3: not just the two of us on our team. We
• 3:10
  Speaker 3: do have an amazing team that we get to work
• 3:13
  Speaker 3: side by side with every single day.
• 3:15
  Speaker 2: But we do support practices, I would say in three
• 3:18
  Speaker 2: different ways.
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  Speaker 3: So we kind of break it down pretty simple to do,
• 3:22
  Speaker 3: to train and to coach. So our to-do is we
• 3:25
  Speaker 3: support practices through remote billing and insurance support for their practices.
• 3:31
  Speaker 3: Our to-train is going to be our library of virtual courses.
• 3:34
  Speaker 3: And then our to-coach is going to be kind of
• 3:36
  Speaker 3: that private working together with practices, whether it's for a
• 3:41
  Speaker 3: specific position within their practice or our group coaching, which
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  Speaker 3: would be kind of all the roles, I would say,
• 3:48
  Speaker 3: within an orthodontic practice.
• 3:50
  Speaker 1: Yeah.
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  Speaker 2: That's it in a nutshell.
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  Speaker 1: Yeah.
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  Speaker 2: I love it.
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  Speaker 3: I love it.
• 3:53
  Speaker 1: I like the way you broke that down. I think
• 3:58
  Speaker 1: that's perfect. And today, I want to lean into the
• 4:02
  Speaker 1: insurance side of what you guys are doing on the
• 4:05
  Speaker 1: to-do part of it. Because I think that this is
• 4:08
  Speaker 1: the hard part, I think, of what all of us do.
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  Speaker 1: You know, as a consultant on what I do and
• 4:13
  Speaker 1: what you guys do, like... This is the part of
• 4:16
  Speaker 1: the business that is most important because it directly affects
• 4:20
  Speaker 1: the financials in a business. And yet it's hard and
• 4:23
  Speaker 1: there isn't a black and white in anything I feel
• 4:25
  Speaker 1: like when we're talking about insurances and whatnot. And so
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  Speaker 1: I'm wondering if you guys can talk about some of
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  Speaker 1: the basics. Let's just start there. And when we're thinking
• 4:37
  Speaker 1: about fee for service and what that means in an
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  Speaker 1: orthodontic practice and what do doctors need to be thinking
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  Speaker 1: about when they're thinking about their fees and they're thinking
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  Speaker 1: about insurance and they're thinking about how they set all
• 4:48
  Speaker 1: of these different things.
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  Speaker 3: Let's talk about that a little bit. You know, something
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  Speaker 3: that we speak heavily on in our Confused or Confident
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  Speaker 3: course is understanding what it means to be a fee
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  Speaker 3: for service provider or an in-network provider. And so I
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  Speaker 3: think there's this misconception where you have to be in-network
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  Speaker 3: with insurances in order to collect on the benefit for patients.
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  Speaker 2: And that can't be further from the truth. You absolutely
• 5:19
  Speaker 2: do not need to be in-network.
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  Speaker 3: And in fact, we're actually seeing a huge push for
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  Speaker 3: practices kind of that were heavily in-network, leaving-network. Get out! Yes, yeah.
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  Speaker 3: So I think understanding what fee-for-service is, to put it
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  Speaker 3: in a nutshell, it means that the practice doesn't necessarily
• 5:38
  Speaker 3: have a contract. They're not in-network with particular insurance companies.
• 5:43
  Speaker 3: So they can really control more of their fees, their
• 5:47
  Speaker 3: treatment modalities that they're presenting on, and not necessarily bound by... insurance, contracts,
• 5:56
  Speaker 3: handcuffs kind of thing. Bees from, what did I say earlier? 1984.
• 6:02
  Speaker 2: 1984.
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  Speaker 1: Right.
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  Speaker 3: They can essentially pick a fee that they feel is
• 6:08
  Speaker 3: fair for their treatment and roll with that fee, right?
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  Speaker 3: They don't have to discount it in any way or
• 6:14
  Speaker 3: make less when they don't have to. Yeah. Yeah.
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  Speaker 1: I think that you are so right that there is
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  Speaker 1: such a misconception about this. When I'm coaching my startups,
• 6:23
  Speaker 1: you know, that's probably one of the first conversations that
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  Speaker 1: we have is, are we going to be in network
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  Speaker 1: or out of network? Are we going to credential or
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  Speaker 1: register with an insurance company. And to your point, I
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  Speaker 1: think so many doctors just have this assumption that, well,
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  Speaker 1: the only way I can get paid is to be
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  Speaker 1: in network. And to your point, that could not be
• 6:44
  Speaker 1: farther from the truth. And I think that that is
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  Speaker 1: just such a fallacy out there where people do believe
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  Speaker 1: that if I'm not in network, I'm not going to
• 6:51
  Speaker 1: get paid. And One of the things I always say
• 6:54
  Speaker 1: to docs is, especially when it's a startup doc that's
• 6:57
  Speaker 1: considering going in, I say, you need to think about
• 7:00
  Speaker 1: that write-off like a marketing expense because you're basically nowadays,
• 7:05
  Speaker 1: you are paying to be on that insurance's website and
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  Speaker 1: have your name acknowledged there. And so every time you
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  Speaker 1: do that write-off to be in network with that practice...
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  Speaker 1: It's basically like a marketing expense. And over time, I
• 7:21
  Speaker 1: don't know how you guys feel about this, but I
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  Speaker 1: feel like practices will lose so much money in the
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  Speaker 1: long term unless they very specifically set their practice up
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  Speaker 1: to maybe be more of a higher volume practice, lower fees,
• 7:34
  Speaker 1: higher volume or insurance. They just have to be really
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  Speaker 1: mindful of that when they're looking at the long term
• 7:40
  Speaker 1: strategies for their practices.
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  Speaker 3: 100%.
• 7:42
  Speaker 1: Yeah.
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  Speaker 3: Yeah. And I think this push to go fee-for-service right
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  Speaker 3: now is so many doctors are scared that aren't heavily
• 7:52
  Speaker 3: in network to make the jump out of network, right?
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  Speaker 3: They're fearful that, hey, I'm going to be losing my
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  Speaker 3: patients and nobody's going to want to come here anymore.
• 8:03
  Speaker 3: And I always tell them, I'm like, hey, look, it
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  Speaker 3: is just like a marketing sort of write-off, but you
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  Speaker 3: can give that write-off to them regardless.
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  Speaker 2: If you're in network or out of network.
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  Speaker 1: Yes.
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  Speaker 3: So one of the things that we teach on for
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  Speaker 3: practices that come to us wanting to get out of
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  Speaker 3: network is we say, Hey, look, if you're nervous for
• 8:23
  Speaker 3: this and you do see a dip in patients, there
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  Speaker 3: may be sure patients that don't choose you because you're
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  Speaker 3: not in network with their insurance. It's not going to
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  Speaker 3: be the majority of patients, but if that does happen,
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  Speaker 3: you can still honor a red shirt courtesy or whatever
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  Speaker 3: the courtesy is.
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  Speaker 2: That you want and give them that.
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  Speaker 3: Discount quote unquote for the treatment. So you just don't
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  Speaker 3: have to give it to everyone is I guess the
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  Speaker 3: caveat of that. Right. Yeah.
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  Speaker 1: So when you guys are talking with practices and seeing
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  Speaker 1: more and more doctors, cause I'm, I'm same way. I'm,
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  Speaker 1: I'm seeing a lot of doctors that are, you know,
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  Speaker 1: maybe just choosing right from the beginning, not to be
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  Speaker 1: a network or saying, Hey, maybe I'll start for a
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  Speaker 1: What do you see as, especially for doctors who've been
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  Speaker 1: in network, what is that that's really pushing them? Are
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  Speaker 1: they looking at their bottom line and going, wait a minute,
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  Speaker 1: like I've given way too much money away for every
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  Speaker 1: single person that walks in? Or what are you guys
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  Speaker 1: seeing there?
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  Speaker 3: I think what we're seeing really is just everything is
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  Speaker 3: getting more and more expensive. Overhead's more expensive, payroll's more expensive.
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  Speaker 3: So just to kind of keep up, it's really hard
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  Speaker 3: when you're limited by these insurance companies and these fees
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  Speaker 3: that you kind of have to stick with, right? And
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  Speaker 3: it's not that easy to get them to increasing, you know, yeah,
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  Speaker 3: it's not easy to get them to increase. You can
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  Speaker 3: keep trying and trying, trying, and it comes to a
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  Speaker 3: point where it's like, how much longer can I keep trying?
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  Speaker 3: And so we're seeing them wanting to kind of not
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  Speaker 3: feel that pinch, you know, of being stuck. There's not
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  Speaker 3: much they can really do. They want to be able
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  Speaker 3: to keep up, just keep up with the times and
• 10:04
  Speaker 3: keep up with the cost of everything rising. Another one
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  Speaker 3: too is that I feel like doctors want more control
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  Speaker 3: over their own fees, what treatment they're presenting and so on.
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  Speaker 3: So aside from, sure, the cost of everything increasing, They
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  Speaker 3: also want more control over, hey, I can charge this
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  Speaker 3: patient because it's a surgical case. I can charge them $ 7, 000
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  Speaker 3: if I want to, as opposed to being bound by
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  Speaker 3: what the insurance says.
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  Speaker 1: Yeah. Yeah. B, when you were talking about raising fees
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  Speaker 1: and Megan, to kind of piggyback off of what you're saying,
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  Speaker 1: I think that that is one of the hardest things
• 10:42
  Speaker 1: for doctors who are in network is, you know, all
• 10:45
  Speaker 1: their peers are out there screaming from the rooftops, raise
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  Speaker 1: your fees 3% every year, 5% every year, whatever. Right.
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  Speaker 1: But if you're an in-network doctor, sorry, that's not going
• 10:55
  Speaker 1: to happen. The insurance company, especially for a lot of
• 10:58
  Speaker 1: newer docs in who weren't maybe grandfathered into some of
• 11:01
  Speaker 1: the premier plans or whatnot out there, They're bound by
• 11:05
  Speaker 1: that PPO fee schedule. And it doesn't matter if they
• 11:08
  Speaker 1: want to raise fees or not. If the insurance company
• 11:11
  Speaker 1: didn't raise, you know, and we know that all PPO
• 11:14
  Speaker 1: fee schedules will maybe, maybe raise. I don't know if
• 11:17
  Speaker 1: MetLife has ever raised their fees, but, you know. Maybe
• 11:22
  Speaker 1: it has a thing with MetLife right now. Yeah.
• 11:27
  Speaker 3: There's some bad blood going on with my life right now.
• 11:31
  Speaker 1: But you know what I'm saying, though? I think those
• 11:33
  Speaker 1: are like the little things that I do really feel
• 11:35
  Speaker 1: like really handcuff doctors. And when doctors get to a
• 11:38
  Speaker 1: point in their career where they are really looking at
• 11:41
  Speaker 1: the levers that they're pulling and their practices to really
• 11:44
  Speaker 1: shore up that income to expense approach. category and they're
• 11:48
  Speaker 1: looking at their P & Ls and whatnot. And I
• 11:50
  Speaker 1: don't know how many doctors really go in and really
• 11:55
  Speaker 1: evaluate patients into the practice from a referral directly from
• 11:59
  Speaker 1: an insurance company to the amount of money that they
• 12:03
  Speaker 1: write off by each company. I wish more dead. Gosh,
• 12:07
  Speaker 1: me too.
• 12:09
  Speaker 3: Yeah, we wish more dead, for sure. And to your
• 12:12
  Speaker 3: point of having colleagues raise fees and we need to
• 12:17
  Speaker 3: increase those fees. Yes, in-network providers are still bound by
• 12:22
  Speaker 3: contracted rates, but it is important to raise those fees,
• 12:26
  Speaker 3: even though the write-off gets bigger. Because then you can
• 12:29
  Speaker 3: see at the end of every year, hey, I'm increasing
• 12:32
  Speaker 3: my fees steadily. The insurance isn't increasing those fees. And
• 12:36
  Speaker 3: my write-off has now jumped from $ 50, 000 to $ 100, 000. And
• 12:38
  Speaker 3: is this still worth it? So I think that's a big...
• 12:44
  Speaker 3: thing to point out too is that don't feel that
• 12:47
  Speaker 3: you don't need to increase your fees because you absolutely
• 12:49
  Speaker 3: do but the write-off is just going to be bigger
• 12:52
  Speaker 3: and you'll see it at the end of the year
• 12:53
  Speaker 3: when you're evaluating everything if it's still.
• 12:55
  Speaker 1: Yeah worth it yeah Yeah, for sure. For sure. So
• 12:59
  Speaker 1: I know we kind of started down this road here
• 13:01
  Speaker 1: a little bit. I want you guys to just kind
• 13:03
  Speaker 1: of talk about when you're working with practices and doctors
• 13:06
  Speaker 1: are reaching out and they're saying, okay, I'm thinking I
• 13:09
  Speaker 1: need to make a decision. I know I'm calling you
• 13:11
  Speaker 1: because I need help with interns, but I'm thinking of
• 13:13
  Speaker 1: making a decision to... get out of insurance, but I'm scared.
• 13:18
  Speaker 1: What about my current patient base? What's that going to
• 13:21
  Speaker 1: do to all of my clients that started and we
• 13:24
  Speaker 1: were in network? Or what's that going to do because
• 13:27
  Speaker 1: my competition is still in network or maybe my referral sources?
• 13:32
  Speaker 1: Can you guys talk to that a little bit and
• 13:35
  Speaker 1: maybe how you walk docs off the ledge maybe a
• 13:38
  Speaker 1: little bit or just comfort them a little bit in
• 13:41
  Speaker 1: what that decision process is going to look like and
• 13:43
  Speaker 1: what they need to be thinking about?
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  Speaker 3: Yeah. So I think the first thing is definitely understanding
• 13:50
  Speaker 3: your current landscape, taking a look at, hey, are patients
• 13:55
  Speaker 3: choosing you because of insurance? How much are you writing
• 13:58
  Speaker 3: off for each insurance company is going to help you
• 14:02
  Speaker 3: make that decision. But then also making sure everything else
• 14:06
  Speaker 3: is rock solid. And I think that's a big piece
• 14:09
  Speaker 3: because we don't want a doctor to make a decision
• 14:12
  Speaker 3: just because they're frustrated with.
• 14:15
  Speaker 2: Fees not increasing with an insurance company.
• 14:18
  Speaker 3: We want them to make a decision because it is
• 14:20
  Speaker 3: truly best for the practice and everyone is on board,
• 14:23
  Speaker 3: whether it's the team, the doctor, the patients, everyone knows
• 14:27
  Speaker 3: kind of where... we're going with this. So making sure
• 14:31
  Speaker 3: we have everything else in place. So the consultation process, right?
• 14:36
  Speaker 3: Needs to be rock solid. Presenting fees needs to be
• 14:38
  Speaker 3: rock solid. Answering questions, financial questions that come up with
• 14:42
  Speaker 3: patients to team members. Having your team know how to
• 14:45
  Speaker 3: answer those questions is another big one. And then also
• 14:49
  Speaker 3: understanding too, kind of the competition. How many in your area...
• 14:55
  Speaker 3: are in network with insurance companies and what's their reputation
• 14:59
  Speaker 3: versus your reputation and so on. So there's kind of
• 15:02
  Speaker 3: a lot to look at before we ever make that decision.
• 15:06
  Speaker 3: And again, we don't want to make the decision just
• 15:09
  Speaker 3: because we're frustrated with insurance companies, right? We want to
• 15:13
  Speaker 3: make the decision because it's truly something that we want
• 15:16
  Speaker 3: long-term for the practice.
• 15:18
  Speaker 1: Mm-hmm.
• 15:19
  Speaker 2: And when making that move, you kind of have to
• 15:21
  Speaker 2: do it strategically.
• 15:22
  Speaker 1: Yeah.
• 15:23
  Speaker 3: It is a transition, right? So you don't want to
• 15:25
  Speaker 3: get things too messy, but it might be a little
• 15:28
  Speaker 3: bit rocky for a short period of time, for sure.
• 15:31
  Speaker 3: So just kind of strategically looking at everything, make sure
• 15:34
  Speaker 3: everything's lined up before jumping too quickly.
• 15:37
  Speaker 2: Yeah, of course.
• 15:39
  Speaker 1: Yeah, for sure. And I think your point about looking
• 15:41
  Speaker 1: at your numbers, looking at your data, because what I
• 15:44
  Speaker 1: tend to see is when I'm evaluating that with the
• 15:47
  Speaker 1: doc and we're diving in and looking at that is
• 15:50
  Speaker 1: they may go, oh, well, look how much I did
• 15:52
  Speaker 1: in write-offs from Delta. But then when they look at
• 15:55
  Speaker 1: their referrals, either they haven't done a really good job,
• 15:58
  Speaker 1: their team doesn't do a good track of, you know,
• 16:01
  Speaker 1: where their actual referrals coming from. Or again, they just
• 16:05
  Speaker 1: look at one side of it, but not the other
• 16:07
  Speaker 1: side of it. And there are some regions, you know,
• 16:10
  Speaker 1: I want docs listening to this that... It may not
• 16:13
  Speaker 1: make sense for your practice as an individual practice where
• 16:16
  Speaker 1: it may make sense for somebody else's. But really, the
• 16:19
  Speaker 1: devil is in the details. And your information that you're
• 16:22
  Speaker 1: making these big decisions on is only as good as
• 16:26
  Speaker 1: the person that puts in the correct information, right?
• 16:29
  Speaker 3: Yeah.
• 16:30
  Speaker 2: Oh, yeah.
• 16:31
  Speaker 1: Yes.
• 16:32
  Speaker 3: 100%.
• 16:32
  Speaker 1: So if the referral source is insurance... Well, that's not
• 16:36
  Speaker 1: going to tell you a whole lot, right? Versus if
• 16:40
  Speaker 1: the referral source is Delta Dental or MetLife or United Concordia,
• 16:44
  Speaker 1: you're going to have a lot more understanding. And so,
• 16:47
  Speaker 1: and I think especially now with all our softwares out there,
• 16:50
  Speaker 1: we should be able to really expand on that. And
• 16:53
  Speaker 1: sometimes it is even, I don't know what you guys think,
• 16:56
  Speaker 1: but sometimes it is doing a year's worth of data
• 16:59
  Speaker 1: to really look at that to make sure that, okay,
• 17:01
  Speaker 1: does this make sense that we're.
• 17:02
  Speaker 3: Going to move out?
• 17:04
  Speaker 2: Oh yeah, 100%.
• 17:06
  Speaker 1: So once a doctor decides to make a change and
• 17:10
  Speaker 1: they're like, all right, I'm going to do this. You know,
• 17:12
  Speaker 1: I've talked to my team. We're all on board. We
• 17:15
  Speaker 1: understand the why. What are you guys suggesting that they
• 17:18
  Speaker 1: need to do, that they need to be prepared for financially, operationally?
• 17:23
  Speaker 1: What does all of that look like? Because I think
• 17:25
  Speaker 1: there is a big piece to this when we're ready
• 17:28
  Speaker 1: to take that change and say, all right, as of
• 17:30
  Speaker 1: January 1st, we're no longer a network. What do you
• 17:33
  Speaker 1: guys suggest there?
• 17:34
  Speaker 4: Yeah.
• 17:34
  Speaker 3: So there's four parts that we suggest on when making
• 17:39
  Speaker 3: this move. The first is going to be how confident
• 17:44
  Speaker 3: are you? So your position, how confident are you with
• 17:47
  Speaker 3: this move? And do you have that steady stream of
• 17:50
  Speaker 3: referral sources like we've already touched on from other referral sources?
• 17:53
  Speaker 3: So are patients coming to you from general dentists, word
• 17:56
  Speaker 3: of mouth, little league, whatever it is, and not coming
• 18:00
  Speaker 3: to you directly from insurance companies? So that referral source
• 18:04
  Speaker 3: is definitely going to be a huge indicator. The next
• 18:09
  Speaker 3: part is going to be communication. And there's three parts
• 18:12
  Speaker 3: to communication we always look at. One is going to
• 18:16
  Speaker 3: be communication with the insurance companies. Obviously, we need to
• 18:20
  Speaker 3: tell them we're leaving in-network. But we also need to
• 18:23
  Speaker 3: figure out how that insurance company is going to... What's
• 18:28
  Speaker 3: going to happen.
• 18:29
  Speaker 2: What's going to happen.
• 18:30
  Speaker 3: Yes. So if we decide... If we decide to leave
• 18:33
  Speaker 3: the network, yeah, are payments rerouted to the subscriber? Is
• 18:38
  Speaker 3: there a lower lifetime maximum maybe? There's so many things
• 18:42
  Speaker 3: that we want to have in that insurance conversation. The
• 18:46
  Speaker 3: next one's going to be patient communication. So how are
• 18:50
  Speaker 3: we going to communicate this to our patients and say, hey,
• 18:54
  Speaker 3: we're leaving your network. Things remain the same.
• 18:56
  Speaker 1: And....
• 18:58
  Speaker 3: What boundaries are we setting? So let's say the lifetime
• 19:01
  Speaker 3: maximum does drop. Are we writing those off, right? Most
• 19:05
  Speaker 3: doctors would say yes, because it was our decision to
• 19:08
  Speaker 3: leave the network. So we want to write off if
• 19:11
  Speaker 3: the lifetime maximum lowered or something for a patient we've
• 19:14
  Speaker 3: already started. And then the third one is going to
• 19:16
  Speaker 3: be team. So how are we going to communicate this
• 19:18
  Speaker 3: with our team? And is our team confident in this
• 19:21
  Speaker 3: move and fully capable of answering the these random questions
• 19:26
  Speaker 3: that are now going to be thrown at them. What
• 19:27
  Speaker 3: does this mean? You left my network. Can I still
• 19:30
  Speaker 3: come here? Why am I getting payments and you're not
• 19:33
  Speaker 3: receiving the payments anymore? All of those things that are
• 19:36
  Speaker 3: going to happen when we leave network. I think definitely, yes,
• 19:40
  Speaker 3: just the communication, especially for the team, front office, treatment coordinator,
• 19:45
  Speaker 3: practice manager, everybody kind of plays a part in that.
• 19:47
  Speaker 3: But something just as simple as a phone call from
• 19:51
  Speaker 3: a new patient, right?
• 19:52
  Speaker 2: Do you guys take my insurance?
• 19:55
  Speaker 3: Really important to not say, no, we don't take your
• 19:57
  Speaker 3: insurance because we're not network. You know, we can word
• 19:59
  Speaker 3: things a little bit different to sound positive. 100%. sometimes
• 20:03
  Speaker 3: you get familiar with policies that are tied to certain employers.
• 20:07
  Speaker 3: And so you can kind of redirect and put it,
• 20:10
  Speaker 3: make it more a little bit positive.
• 20:12
  Speaker 2: It's like, hey, well, let me take a look. Which
• 20:15
  Speaker 2: one is, who's your employer?
• 20:16
  Speaker 3: Oh yeah, it looks like we have many patients, you know,
• 20:19
  Speaker 3: that are Googlers or Apple people or, you know. So yes,
• 20:23
  Speaker 3: that's a great benefit. So you can always kind of
• 20:25
  Speaker 3: flip it to make it sound more positive versus just, no,
• 20:29
  Speaker 3: we're not in network. And I think that's definitely a
• 20:32
  Speaker 3: first step in making the patient feel more comfortable coming
• 20:36
  Speaker 3: into the practice, even at that point.
• 20:37
  Speaker 1: Yeah. And now a word from the sponsors who make
• 20:42
  Speaker 1: this podcast possible. Are you thinking about opening an orthodontic practice?
• 20:49
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• 21:00
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• 21:29
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• 21:39
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• 21:43
  Speaker 1: a closer look. Just follow the link in the show
• 21:45
  Speaker 1: notes to learn more. I love your point about educating
• 21:53
  Speaker 1: the team on this so that they can answer the
• 21:57
  Speaker 1: questions that they need to. Because I really think that
• 22:00
  Speaker 1: just going back to how we started this talk is
• 22:03
  Speaker 1: so many times our team members don't even really understand understand,
• 22:08
  Speaker 1: unless they're doing the billing, what in-network or out-of-network means,
• 22:12
  Speaker 1: or do we accept your insurance or not? And so
• 22:16
  Speaker 1: I think if we take the time as a doctor,
• 22:20
  Speaker 1: as an office manager, to really have that conversation with
• 22:24
  Speaker 1: the team to say, okay, this is what this means.
• 22:27
  Speaker 1: This is how it's going to affect. This is the
• 22:30
  Speaker 1: verbiage that we want to use. If somebody says, hey,
• 22:33
  Speaker 1: you know, I have Delta Dental. Do you take my insurance?
• 22:36
  Speaker 3: Absolutely.
• 22:36
  Speaker 1: We'd love to bill your insurance. Now, we know that maybe,
• 22:41
  Speaker 1: like you said, the payments may be rerouted depending upon that.
• 22:45
  Speaker 1: But the first thing is we just want to know
• 22:47
  Speaker 1: how to answer the questions. And I think that starts
• 22:50
  Speaker 1: with educating our team and all the key players who
• 22:53
  Speaker 1: could be involved in that. I want to ask you
• 22:56
  Speaker 1: guys a little bit about, because I love that second
• 22:59
  Speaker 1: part about communicating with the patient, especially anybody who is
• 23:04
  Speaker 1: in contract. Because I have seen in the past, and
• 23:08
  Speaker 1: you guys do this a lot more than I do,
• 23:10
  Speaker 1: that a lot of times those insurance companies will send
• 23:13
  Speaker 1: out little nasty grams. I call them scare grams to
• 23:17
  Speaker 1: the patients that the sky is falling. Your provider is
• 23:20
  Speaker 1: no longer in network. Your treatment is at risk. And
• 23:24
  Speaker 1: we all know that that's not true. But I think
• 23:27
  Speaker 1: it's kind of their scare tactic to almost make a
• 23:30
  Speaker 1: provider feel like, something catastrophic is going to happen if
• 23:36
  Speaker 1: they leave. And I'm wondering if you guys can talk
• 23:39
  Speaker 1: about that. Talk about those scaregrams a little bit. Talk
• 23:42
  Speaker 1: about what you guys are suggesting in that education process
• 23:46
  Speaker 1: ahead of time to kind of diffuse it before the
• 23:48
  Speaker 1: office is blowing up with.
• 23:51
  Speaker 3: You know, what?
• 23:52
  Speaker 1: Yeah.
• 23:53
  Speaker 3: So we always recommend being proactive instead of reactive. So
• 23:57
  Speaker 3: for any insurance company that we're dropping, we don't know
• 24:01
  Speaker 3: what they're going to do, right? Insurance companies make up
• 24:03
  Speaker 3: their own rules and abide by their own laws. And
• 24:09
  Speaker 3: so we essentially want to be proactive. So I always
• 24:15
  Speaker 3: recommend sending a letter that is basically going to explain, hey,
• 24:18
  Speaker 3: we're leaving in network because....
• 24:22
  Speaker 2: Things are increasing.
• 24:23
  Speaker 3: We want to keep doing treatment at the level of
• 24:26
  Speaker 3: service that you expect from us, yada, yada, yada, right?
• 24:29
  Speaker 3: But we also want to say, hey, you may receive
• 24:32
  Speaker 3: a letter from your insurance company. It is known to
• 24:34
  Speaker 3: us that as we drop in network providers, that insurances
• 24:39
  Speaker 3: may relay this information to you and try to scare
• 24:42
  Speaker 3: you that you can no longer come here. And that
• 24:44
  Speaker 3: is so far from the truth. Again, we're going to
• 24:47
  Speaker 3: be wrapping up little Johnny's treatment. so on.
• 24:50
  Speaker 2: If you have any questions, please call the office. So
• 24:52
  Speaker 2: I think that letter.
• 24:55
  Speaker 3: Being sent initially helps because then when they do receive
• 24:59
  Speaker 3: that insurance letter, they can just say, yeah, it was
• 25:02
  Speaker 3: something from the insurance. I'm not listening to it because
• 25:04
  Speaker 3: I have the relationship with the doctor. So there's two
• 25:08
  Speaker 3: more parts to kind of the approach as well. The
• 25:11
  Speaker 3: next one's going to be the financial component to all
• 25:14
  Speaker 3: of this. So We definitely want to not drop all
• 25:19
  Speaker 3: insurance companies at once, right? And I think a lot
• 25:23
  Speaker 3: of doctors, when they do this, they're frustrated with insurance
• 25:27
  Speaker 3: and they're just like, I'm getting out, effective the new year,
• 25:30
  Speaker 3: pull me out of every insurance company. And we definitely
• 25:34
  Speaker 3: don't want to do that. We have to be strategic
• 25:36
  Speaker 3: about who to drop, when to drop, how we're dropping.
• 25:40
  Speaker 3: Because if we pull the rug out from all of
• 25:43
  Speaker 3: the insurance companies at once, it's going to be really
• 25:45
  Speaker 3: hard for your team, really hard for patients. But also
• 25:49
  Speaker 3: just navigating that is just a struggle for everyone. So
• 25:55
  Speaker 3: I think if we start dropping, we have an approach
• 25:59
  Speaker 3: of who we're dropping and when we're dropping and have
• 26:01
  Speaker 3: a plan on how to do it is going to help.
• 26:05
  Speaker 3: So reviewing again that data, looking at, hey, my fee
• 26:08
  Speaker 3: schedules for this one is the lowest. We have the
• 26:11
  Speaker 3: least amount of patients with this insurance provider.
• 26:14
  Speaker 2: Let's drop this one first.
• 26:16
  Speaker 3: Kind of doesn't cause that ripple effect of, leaving a
• 26:20
  Speaker 3: mega insurance company like a Delta or MetLife, right? Yeah, yeah.
• 26:25
  Speaker 2: We also want to make sure we have enough cash reserves, right?
• 26:28
  Speaker 3: There is going to be a little bit of turbulence
• 26:31
  Speaker 3: in leaving networks. So just making sure that we have enough.
• 26:36
  Speaker 3: If there's any hiccups, right? Payments are rerouted to the subscriber.
• 26:40
  Speaker 3: Payments stop for whatever reason because they're waiting on new claims.
• 26:44
  Speaker 3: You name it, we've seen it. So just making sure, hey,
• 26:46
  Speaker 3: we do have enough cash reserves in the bank. to
• 26:49
  Speaker 3: be able to justify kind of that turbulence for the
• 26:52
  Speaker 3: time being. The last one's going to be emotional. So
• 26:56
  Speaker 3: making sure that you're emotionally ready for this decision, because
• 27:00
  Speaker 3: you can think you're as ready as you are, but
• 27:04
  Speaker 3: until you're actually in the weeds and pulling out of
• 27:08
  Speaker 3: in-network contracts, we want to make sure that you as
• 27:12
  Speaker 3: the doctor, as well as the team are emotionally ready
• 27:14
  Speaker 3: for everything that's going to be thrown at you. So
• 27:17
  Speaker 3: that short-term turbulence for the long-term gain, you have to
• 27:21
  Speaker 3: keep reminding your team and yourself of that as well.
• 27:24
  Speaker 1: Yeah. Yeah. Those are great, great suggestions. And especially, I
• 27:29
  Speaker 1: think the cash flow piece is really important. In the end,
• 27:33
  Speaker 1: the money will be there, but I think especially we
• 27:35
  Speaker 1: know for sure there's at least one company out there
• 27:38
  Speaker 1: that will reroute payments to patients. And if that was...
• 27:42
  Speaker 1: I kind of think about insurance payments, patient payments, and
• 27:47
  Speaker 1: then down payments as kind of three different revenue streams
• 27:50
  Speaker 1: if we've been in network and accept payments into our practice.
• 27:54
  Speaker 1: And so if you think about potentially, you know, if
• 27:57
  Speaker 1: you're a big, heavy into one of the insurance companies,
• 28:00
  Speaker 1: that is going to be one that's going to reroute
• 28:03
  Speaker 1: patients to your point of cash flow value. You have
• 28:06
  Speaker 1: to be prepared for understanding what that insurance company is
• 28:11
  Speaker 1: going to do, because that could be maybe a difference
• 28:14
  Speaker 1: of $ 20, 000 if you're a bigger practice, a month that
• 28:18
  Speaker 1: you're expecting that was hitting your bank account every month
• 28:21
  Speaker 1: in those payments. And now all of a sudden... It's gone.
• 28:25
  Speaker 1: And it's not that you won't get it back, but
• 28:28
  Speaker 1: they now just sent all that money to the patients.
• 28:31
  Speaker 1: And now if you haven't had a plan for working
• 28:34
  Speaker 1: with the patients on, hey, guess what? You're getting all
• 28:37
  Speaker 1: that money. Now let's refigure out how we're going to
• 28:39
  Speaker 1: adjust your payments. I love your idea of having a
• 28:42
  Speaker 1: strategy there because that is something that's going to be
• 28:46
  Speaker 1: really key and understanding what each company is going to
• 28:50
  Speaker 1: do It's just going to make it less stressful. I mean,
• 28:52
  Speaker 1: it's stressful enough to be in network or out of network,
• 28:55
  Speaker 1: but it's in time you make a big change like that.
• 28:59
  Speaker 3: For sure.
• 28:59
  Speaker 2: And the team also has to be comfortable with that, right?
• 29:02
  Speaker 3: So having those financial conversations of, hey, it looks like
• 29:06
  Speaker 3: Delta paid you last month and the check was cashed.
• 29:09
  Speaker 2: How are we going to collect on that payment? Are
• 29:10
  Speaker 2: we rolling it into the monthly payments?
• 29:12
  Speaker 3: Are we collecting the lump sum? Because I feel like
• 29:16
  Speaker 3: we almost have to have proof as a provider that,
• 29:19
  Speaker 3: An insurance company paid the patient. So when that happens
• 29:23
  Speaker 3: and they're rerouting checks to the patient, I always kind
• 29:27
  Speaker 3: of still download the EOB from the provider portals, upload
• 29:30
  Speaker 3: it into the patient's chart that shows that it was
• 29:32
  Speaker 3: paid to the subscriber. So that way, when I'm following
• 29:36
  Speaker 3: up with patients and saying, hey, it looks like Delta
• 29:38
  Speaker 3: paid you a thousand dollars.
• 29:41
  Speaker 2: They're not... Delta never paid me $ 1, 000.
• 29:43
  Speaker 4: Yes.
• 29:43
  Speaker 3: You know? So we have to have some sort of
• 29:48
  Speaker 3: proof to that. And I don't know that it really helps,
• 29:51
  Speaker 3: but I feel like it does in a way that
• 29:54
  Speaker 3: patients now can't say that they didn't receive it. So... Yeah,
• 29:59
  Speaker 3: it's almost like you were notified. Like, oh, Delta notified
• 30:02
  Speaker 3: us that you received the second payment that we were
• 30:05
  Speaker 3: expecting to receive. You know, please contact us. The other
• 30:08
  Speaker 3: thing that's important too is for insurances, right, that do
• 30:13
  Speaker 3: choose to pay the subscribers directly. One thing to consider
• 30:18
  Speaker 3: always is to, if that's going to be the case,
• 30:20
  Speaker 3: to not be allocating that within the contract.
• 30:23
  Speaker 4: Yes.
• 30:24
  Speaker 3: You know, so something that we see, so if we
• 30:27
  Speaker 3: know that they're not going to pay us, that's totally fine.
• 30:31
  Speaker 3: A lot of, I feel like doctors or practices feel like, oh,
• 30:35
  Speaker 3: it's really hard because now the monthly payment's going to
• 30:38
  Speaker 3: be higher. And then we can't deduct that what we
• 30:41
  Speaker 3: thought was, you know, 1500 off and the fee looks
• 30:44
  Speaker 3: too high.
• 30:45
  Speaker 2: It's totally fine.
• 30:45
  Speaker 3: Again, it's all just about like how you present it.
• 30:48
  Speaker 2: So, you know, it's like, this is the treatment.
• 30:51
  Speaker 3: You have an amazing benefit. It looks like you have $ 2, 000
• 30:53
  Speaker 3: with Delta. They like to pay their, people directly. So
• 30:58
  Speaker 3: this is how it's going to look, you know, we're
• 31:00
  Speaker 3: going to receive, yeah, expect to receive those payments directly
• 31:03
  Speaker 3: and always just be positive. And that's just how they
• 31:06
  Speaker 3: do it for their people. Yeah. And to that point,
• 31:09
  Speaker 3: it may be hard Initially, right, to sell, quote unquote,
• 31:13
  Speaker 3: the treatment because you're not deducting the insurance benefit.
• 31:17
  Speaker 2: But it is even harder to collect the money if.
• 31:21
  Speaker 3: You deduct it and then have to chase that patient
• 31:24
  Speaker 3: around every quarter or month to collect on those insurance payments. So, yep.
• 31:31
  Speaker 1: Teach and communicate on the front end so that you're prepared.
• 31:34
  Speaker 1: Because to this point, this goes back to everybody that's
• 31:37
  Speaker 1: involved in this. If the treatment coordinator hasn't learned to
• 31:42
  Speaker 1: change their spiel with whichever insurance we know we're not
• 31:46
  Speaker 1: going to be holding an insurance ledger on anymore or whatnot.
• 31:50
  Speaker 1: To your point, it's going to be hellacious for that
• 31:53
  Speaker 1: financial coordinator that's trying to track it down. Because, yeah,
• 31:57
  Speaker 1: once somebody cashes a check, they're like, I'm off to Disneyland.
• 31:59
  Speaker 1: You know what I mean? Like, I'm not bringing that in.
• 32:02
  Speaker 1: I just got $ 2, 000. It's Christmas in the mail. Which
• 32:05
  Speaker 1: always bugs me that these darn insurance companies will pay
• 32:08
  Speaker 1: out the patients no problem in full, but pay us
• 32:10
  Speaker 1: in full? No way.
• 32:11
  Speaker 3: Yeah.
• 32:12
  Speaker 1: Yeah. So I know we've kind of been talking about
• 32:16
  Speaker 1: this a little bit, but are there any other mistakes
• 32:20
  Speaker 1: that you tend to see practices make when they're kind
• 32:24
  Speaker 1: of moving towards this fee-for-service approach?
• 32:28
  Speaker 3: I feel like we've touched on a lot of them.
• 32:30
  Speaker 3: I would just, yeah, really just kind of educate, yeah,
• 32:33
  Speaker 3: their area. So I mean, every area is.
• 32:36
  Speaker 2: Going to look different.
• 32:36
  Speaker 3: You know, there's like military communities where insurances are going
• 32:40
  Speaker 3: to make sense, maybe for those providers where some, you.
• 32:45
  Speaker 2: Know, so you really have to figure out where you are.
• 32:47
  Speaker 3: And just because you're like hearing and you're learning from
• 32:50
  Speaker 3: your ortho friends in different states. You have to, you know,
• 32:54
  Speaker 3: it has to make sense for where you're actually practicing.
• 32:56
  Speaker 3: I think that's, that's important too. But I think we
• 33:00
  Speaker 3: did do a good job kind of touching, I think
• 33:03
  Speaker 3: on all the points really of things to consider when
• 33:07
  Speaker 3: making that move. And again, I'm just gonna stress the
• 33:11
  Speaker 3: little comment that Megan had made, a little short-term turbulence
• 33:15
  Speaker 3: for long-term gain. I think that's the key takeaway.
• 33:21
  Speaker 1: I totally agree with you on that for sure. And
• 33:25
  Speaker 1: there's just nothing better than having a strategy around what
• 33:29
  Speaker 1: this is gonna look like, especially for anybody who's gonna
• 33:32
  Speaker 1: be pulling out. It's a little different when we're a
• 33:34
  Speaker 1: startup and we're assessing whether we're gonna go in. But
• 33:37
  Speaker 1: one of the things I always tell my startups is,
• 33:40
  Speaker 1: if we start with that, it's a strategy for getting
• 33:43
  Speaker 1: your practice going, but it's not a long-term strategy for
• 33:46
  Speaker 1: your practice. And usually by about year three to five,
• 33:50
  Speaker 1: you need to be getting out of those insurance companies.
• 33:53
  Speaker 1: Unless again, there's a very specific reason, which there could
• 33:57
  Speaker 1: be why we're staying in because it just doesn't make
• 34:00
  Speaker 1: sense the way it used to 20 years ago, 30
• 34:02
  Speaker 1: years ago. and why we needed to participate. And doggone it,
• 34:07
  Speaker 1: they didn't use to cap our fees or we had
• 34:09
  Speaker 1: a lot more room to play with, you know, in
• 34:11
  Speaker 1: negotiating where we just don't anymore.
• 34:13
  Speaker 3: 100%, yeah.
• 34:15
  Speaker 4: So if somebody wants to learn more about you guys,
• 34:19
  Speaker 4: more about what you do, whether it's from courses to,
• 34:22
  Speaker 4: I think I just need some direction on getting out
• 34:25
  Speaker 4: of insurance, or I just want help with billing in general,
• 34:29
  Speaker 4: like what's the best way that they can connect and
• 34:32
  Speaker 4: reach out to you?
• 34:33
  Speaker 3: We definitely say email, which would be info at the wyrickoutlook.com
• 34:38
  Speaker 3: or just our website. We have our contact us ask,
• 34:41
  Speaker 3: you know, a little bit about what your current situation
• 34:44
  Speaker 3: is and then we can schedule a phone call. And
• 34:46
  Speaker 3: then of course we have Instagram and we have Facebook
• 34:49
  Speaker 3: and we check our message regularly.
• 34:52
  Speaker 1: Regularly.
• 34:53
  Speaker 3: We always like to shorten that, right? We check your
• 35:00
  Speaker 3: messages often.
• 35:01
  Speaker 1: Yeah, there you go. It's like, change that and spell
• 35:05
  Speaker 1: check to often.
• 35:06
  Speaker 3: That's great.
• 35:10
  Speaker 1: And now a word from the sponsors who make this
• 35:13
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• 35:26
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• 35:30
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  Speaker 3: Curious?
• 35:51
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• 35:56
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• 36:01
  Speaker 1: with SmileSuite because every smile deserves a suite of excellence. Well,
• 36:07
  Speaker 1: you guys know how I like to finish this up
• 36:09
  Speaker 1: and that's always with the little speed round. So how
• 36:11
  Speaker 1: about I'll give each of you a question and then
• 36:13
  Speaker 1: we'll finish it up for today. So Bea, how about
• 36:16
  Speaker 1: we'll start with you first. What is your go-to strategy
• 36:20
  Speaker 1: for getting unstuck when you are facing a tough problem?
• 36:24
  Speaker 3: It's definitely going for a walk. I just will put
• 36:27
  Speaker 3: on my headphones and go for a walk. That's definitely
• 36:30
  Speaker 3: it for sure. And sometimes I do that multiple times
• 36:33
  Speaker 3: a day.
• 36:35
  Speaker 1: I'm right there. I'm right there. All right, Megan, here's
• 36:38
  Speaker 1: a good one for you. All right. If you could
• 36:41
  Speaker 1: add one unconventional perk to every workplace, what would you
• 36:46
  Speaker 1: want to add?
• 36:47
  Speaker 3: Oh, I love this. I love this one. Dang, I
• 36:51
  Speaker 3: feel like we should have swapped mine and Brittany's. I
• 36:53
  Speaker 3: have one if you don't.
• 36:55
  Speaker 2: Okay, go ahead.
• 36:56
  Speaker 3: Unconventional perk would be house cleaning, weekly house cleaning for
• 37:01
  Speaker 3: all of the team members. I feel like, oh my gosh,
• 37:05
  Speaker 3: if that's something that, well, one that I had or
• 37:08
  Speaker 3: something that we could do for our team, that would
• 37:10
  Speaker 3: be a huge perk.
• 37:11
  Speaker 2: I mean, imagine working and then you.
• 37:14
  Speaker 3: Just go home to a clean house all the time.
• 37:16
  Speaker 3: That would be amazing.
• 37:18
  Speaker 1: Yeah. Ooh, I love that. I love that.
• 37:20
  Speaker 2: You know, I don't mind house cleaning so much. I
• 37:22
  Speaker 2: could clean the house.
• 37:23
  Speaker 3: It's the cooking. Brittany and I are different in that.
• 37:27
  Speaker 3: I don't like cooking. She loves cooking.
• 37:29
  Speaker 2: I like cleaning. She doesn't like cleaning. So we kind of.
• 37:34
  Speaker 1: There you go.
• 37:36
  Speaker 3: There you go.
• 37:36
  Speaker 1: So you can have a chef or a house cleaner.
• 37:40
  Speaker 3: Oh, I like that.
• 37:41
  Speaker 2: I would have a chef.
• 37:44
  Speaker 3: I would want both.
• 37:45
  Speaker 1: I'm just saying I want both.
• 37:48
  Speaker 3: It would definitely be helpful. All right.
• 37:52
  Speaker 1: We'll ask one more. Both of you can answer this
• 37:54
  Speaker 1: or one of you. What is one piece of advice
• 37:57
  Speaker 1: you wish you had followed earlier in your career?
• 38:00
  Speaker 3: I think one piece of advice would be that you
• 38:03
  Speaker 3: don't have to do everything, right? And it will come
• 38:06
  Speaker 3: with time. So I feel like starting up a business
• 38:10
  Speaker 3: is really, really hard. And you feel the pressure of,
• 38:12
  Speaker 3: I got to do this.
• 38:13
  Speaker 2: I got to do that.
• 38:14
  Speaker 3: And you're pulled in all these different directions. And you
• 38:16
  Speaker 3: just have to know that it's going to come with time.
• 38:20
  Speaker 3: So just give it time and don't stress about it.
• 38:23
  Speaker 3: It'll eventually get there. That's a good one. That is
• 38:27
  Speaker 3: a good one. And it might be a little bit
• 38:29
  Speaker 3: somewhat similar. I kind of feel like sometimes less really is.
• 38:34
  Speaker 1: more.
• 38:35
  Speaker 3: So trying to keep things very simple and do less,
• 38:39
  Speaker 3: but less, like really, really good less, you know, versus
• 38:43
  Speaker 3: trying to dabble with too many things. And I just
• 38:47
  Speaker 3: feel like less is more.
• 38:48
  Speaker 2: Do a couple things really, really, really well.
• 38:51
  Speaker 3: And just focus on that and roll with that.
• 38:53
  Speaker 1: Yeah, I love it. I love it. Well, guys, it
• 38:55
  Speaker 1: is always such a pleasure having you on Hey Docs.
• 38:58
  Speaker 1: You're my insurance gurus and I just, I appreciate what
• 39:01
  Speaker 1: you're doing in this space out there and especially how
• 39:04
  Speaker 1: you're helping so many practices. So thanks for being on
• 39:07
  Speaker 1: Hey Docs again. Third time's a blessing.
• 39:11
  Speaker 2: And until next time.
• 39:14
  Speaker 1: All right.
• 39:14
  Speaker 3: All right.
• 39:15
  Speaker 1: Bye. Thank you. Bye. Are you ready to start a
• 39:19
  Speaker 1: practice of your own? Need a new fresh set of
• 39:22
  Speaker 1: eyes or some advice on your existing practice? If so,
• 39:26
  Speaker 1: reach out to me, Jill Allen, at www.principal.com. you like
• 39:32
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• 39:46
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