Dentaltown March 2023 - 14

PROFESSIONAL COURTESY
I was pleasantly surprised to find such an
opportunity to work for a dental insurance
company that owned its own dental offices.
Cigna Dental had hundreds, maybe thousands,
of dentists around the country who were serving
Cigna patients as " in-network " providers. In
hindsight, this was the dental insurance version
of dogfooding. If they had all these dentists
treating their patients, why not open a few dental
offices and serve their patients as well? It makes
sense because Cigna would have the ability to
streamline claims processing and the dentists
worked on salary. The model seemed to work for
many years, but two years after I started working
there, Cigna sold all seven offices to a DSO. I
guess a dental practice can't survive on dental
insurance alone!
The new ownership performed as you would
expect, and trying to make a random patient
population fit a production goal is not my kind
of dentistry. I immediately started looking for
another opportunity and I was blessed to be
hired by Dr. Howard Farran at Today's Dental.
The rest, as they say, is history.
An update on going out-of-network
Today, some 23 years after that turn of events,
I'm here to revisit the topic of dropping out of a
PPO network, which has experienced a resurgence
of discussion lately on Dentaltown's online
message boards. In my December 2021 column,
I said I was then in-network with four PPOs but
after Jan. 1, 2022, it would be only three. I'm here
a year later to say we had a successful transition,
but I'll caution anyone considering such a move
that it will take some time. A brief description of
the process I followed is in the box at top right.
At the one-year mark, I can report that I
have no regrets about the decision, and I was
pleasantly surprised by the number of patients
who are still with the practice. I will also add
that going out-of-network is not for everyone;
every practice is different and some are perfectly
happy with their current mix of network
participation.
A checklist for going
out-of-network
1. Analyze your current mix of PPO networks.
*
Decide which you can live without.
2. Notify the company you want to terminate
the relationship.
*
Anticipate a waiting period before you
are officially " out " of network.
3. Communicate immediately with patients
about your intention to leave.
*
4. Provide a smooth transition for patients.
*
Have this conversation in person with
as many people as possible-it's more
effective than sending a generic letter.
Allow patients to switch networks when
their open enrollment period begins.
5. Check your retention.
* Measure remaining patients in that
network after 6, 12, 18 and 24 months.
However, if your practice capacity is strained,
your reimbursements don't match the cost of
doing business or you want to tap the brakes,
then going out-of-network may be for you.
Consider a measured approach by dropping
one of the smaller PPOs in your practice first, to
gauge how well your team handles the transition.
My hygienists and the front office team did an
excellent job communicating with patients and
making notes in their charts so we could keep
track of who was notified. When patients asked
why I was going out-of-network, I'd simply reply
that as our expenses went up across the board,
reimbursements had not increased and leaving
the network was our only option.
Do you have questions or a story to share
about leaving an insurance network? Please
join the discussion associated with this article
online at dentaltown.com. You also can reach
me via email at tom@dentaltown.com. DT
MARCH 2023 | 14 | DENTALTOWN.COM
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Dentaltown March 2023

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