Understanding Fee for Service with The Wyrick Outlook

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Welcome to the Hey Docs podcast with your host, Jill Allen. Today,
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I am welcoming back Megan and Bea, sisters and founders
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of the Wyrick Outlook. Megan and Bea worked with orthodontic
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practices on the financial and insurance side of the business.
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And today we're tackling a conversation that more doctors are
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starting to have, fee for service. Moving away from insurance
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can sound appealing, but it's a decision that requires a
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clear understanding of your numbers, your market, your patients, and
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the value your practice provides. In this episode, we're breaking
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down what fee for service really means and how to
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know if your practice is ready and what doctors should
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consider before making the transition. So let's get started. And
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now a word from the sponsors who make this podcast possible.
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that is go.solventum.com forward slash clarity to learn more. As
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a consultant, I work with orthodontic practices every day, and
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see it for yourself? Head to grayfinch.com forward slash Jill
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Allen for a special discount exclusively for my listeners. Megan B,
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I am so excited to have you guys back on
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Hey Docs. Thanks for being here today.
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Yes, definitely having us. Yeah, super excited to be here.
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Yeah. Third time. Third time now, we were just saying.
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Third time, it's not even a charm. It's just like
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a blessing, right? To get to hang out again together.
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So in the event that somebody did not catch one
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of our earlier episodes, would one of you want to
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just take the lead and give us a little bit
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of history about each of you, your backgrounds, and then
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what you guys do with the YRIC Outlook?
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Yeah, definitely. So for those of you that don't already know,
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we are two sisters. We are two sisters. It is
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not just the two of us on our team. We
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do have an amazing team that we get to work
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side by side with every single day.
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But we do support practices, I would say in three
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different ways.
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So we kind of break it down pretty simple to do,
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to train and to coach. So our to-do is we
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support practices through remote billing and insurance support for their practices.
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Our to-train is going to be our library of virtual courses.
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And then our to-coach is going to be kind of
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that private working together with practices, whether it's for a
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specific position within their practice or our group coaching, which
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would be kind of all the roles, I would say,
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within an orthodontic practice.
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Yeah.
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That's it in a nutshell.
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Yeah.
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I love it.
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I love it.
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I like the way you broke that down. I think
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that's perfect. And today, I want to lean into the
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insurance side of what you guys are doing on the
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to-do part of it. Because I think that this is
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the hard part, I think, of what all of us do.
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You know, as a consultant on what I do and
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what you guys do, like... This is the part of
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the business that is most important because it directly affects
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the financials in a business. And yet it's hard and
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there isn't a black and white in anything I feel
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like when we're talking about insurances and whatnot. And so
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I'm wondering if you guys can talk about some of
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the basics. Let's just start there. And when we're thinking
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about fee for service and what that means in an
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orthodontic practice and what do doctors need to be thinking
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about when they're thinking about their fees and they're thinking
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about insurance and they're thinking about how they set all
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of these different things.
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Let's talk about that a little bit. You know, something
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that we speak heavily on in our Confused or Confident
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course is understanding what it means to be a fee
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for service provider or an in-network provider. And so I
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think there's this misconception where you have to be in-network
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with insurances in order to collect on the benefit for patients.
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And that can't be further from the truth. You absolutely
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do not need to be in-network.
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And in fact, we're actually seeing a huge push for
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practices kind of that were heavily in-network, leaving-network. Get out! Yes, yeah.
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So I think understanding what fee-for-service is, to put it
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in a nutshell, it means that the practice doesn't necessarily
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have a contract. They're not in-network with particular insurance companies.
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So they can really control more of their fees, their
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treatment modalities that they're presenting on, and not necessarily bound by... insurance, contracts,
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handcuffs kind of thing. Bees from, what did I say earlier? 1984.
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1984.
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Right.
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They can essentially pick a fee that they feel is
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fair for their treatment and roll with that fee, right?
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They don't have to discount it in any way or
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make less when they don't have to. Yeah. Yeah.
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I think that you are so right that there is
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such a misconception about this. When I'm coaching my startups,
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you know, that's probably one of the first conversations that
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we have is, are we going to be in network
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or out of network? Are we going to credential or
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register with an insurance company. And to your point, I
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think so many doctors just have this assumption that, well,
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the only way I can get paid is to be
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in network. And to your point, that could not be
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farther from the truth. And I think that that is
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just such a fallacy out there where people do believe
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that if I'm not in network, I'm not going to
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get paid. And One of the things I always say
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to docs is, especially when it's a startup doc that's
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considering going in, I say, you need to think about
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that write-off like a marketing expense because you're basically nowadays,
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you are paying to be on that insurance's website and
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have your name acknowledged there. And so every time you
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do that write-off to be in network with that practice...
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It's basically like a marketing expense. And over time, I
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don't know how you guys feel about this, but I
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feel like practices will lose so much money in the
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long term unless they very specifically set their practice up
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to maybe be more of a higher volume practice, lower fees,
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higher volume or insurance. They just have to be really
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mindful of that when they're looking at the long term
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strategies for their practices.
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100%.
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Yeah.
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Yeah. And I think this push to go fee-for-service right
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now is so many doctors are scared that aren't heavily
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in network to make the jump out of network, right?
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They're fearful that, hey, I'm going to be losing my
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patients and nobody's going to want to come here anymore.
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And I always tell them, I'm like, hey, look, it
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is just like a marketing sort of write-off, but you
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can give that write-off to them regardless.
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If you're in network or out of network.
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Yes.
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So one of the things that we teach on for
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practices that come to us wanting to get out of
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network is we say, Hey, look, if you're nervous for
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this and you do see a dip in patients, there
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may be sure patients that don't choose you because you're
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not in network with their insurance. It's not going to
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be the majority of patients, but if that does happen,
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you can still honor a red shirt courtesy or whatever
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the courtesy is.
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That you want and give them that.
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Discount quote unquote for the treatment. So you just don't
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have to give it to everyone is I guess the
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caveat of that. Right. Yeah.
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So when you guys are talking with practices and seeing
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more and more doctors, cause I'm, I'm same way. I'm,
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I'm seeing a lot of doctors that are, you know,
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maybe just choosing right from the beginning, not to be
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a network or saying, Hey, maybe I'll start for a
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What do you see as, especially for doctors who've been
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in network, what is that that's really pushing them? Are
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they looking at their bottom line and going, wait a minute,
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like I've given way too much money away for every
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single person that walks in? Or what are you guys
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seeing there?
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I think what we're seeing really is just everything is
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getting more and more expensive. Overhead's more expensive, payroll's more expensive.
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So just to kind of keep up, it's really hard
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when you're limited by these insurance companies and these fees
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that you kind of have to stick with, right? And
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it's not that easy to get them to increasing, you know, yeah,
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it's not easy to get them to increase. You can
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keep trying and trying, trying, and it comes to a
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point where it's like, how much longer can I keep trying?
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And so we're seeing them wanting to kind of not
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feel that pinch, you know, of being stuck. There's not
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much they can really do. They want to be able
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to keep up, just keep up with the times and
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keep up with the cost of everything rising. Another one
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too is that I feel like doctors want more control
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over their own fees, what treatment they're presenting and so on.
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So aside from, sure, the cost of everything increasing, They
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also want more control over, hey, I can charge this
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patient because it's a surgical case. I can charge them $ 7, 000
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if I want to, as opposed to being bound by
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what the insurance says.
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Yeah. Yeah. B, when you were talking about raising fees
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and Megan, to kind of piggyback off of what you're saying,
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I think that that is one of the hardest things
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for doctors who are in network is, you know, all
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their peers are out there screaming from the rooftops, raise
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your fees 3% every year, 5% every year, whatever. Right.
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But if you're an in-network doctor, sorry, that's not going
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to happen. The insurance company, especially for a lot of
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newer docs in who weren't maybe grandfathered into some of
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the premier plans or whatnot out there, They're bound by
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that PPO fee schedule. And it doesn't matter if they
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want to raise fees or not. If the insurance company
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didn't raise, you know, and we know that all PPO
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fee schedules will maybe, maybe raise. I don't know if
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MetLife has ever raised their fees, but, you know. Maybe
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it has a thing with MetLife right now. Yeah.
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There's some bad blood going on with my life right now.
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But you know what I'm saying, though? I think those
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are like the little things that I do really feel
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like really handcuff doctors. And when doctors get to a
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point in their career where they are really looking at
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the levers that they're pulling and their practices to really
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shore up that income to expense approach. category and they're
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looking at their P & Ls and whatnot. And I
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don't know how many doctors really go in and really
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evaluate patients into the practice from a referral directly from
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an insurance company to the amount of money that they
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write off by each company. I wish more dead. Gosh,
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me too.
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Yeah, we wish more dead, for sure. And to your
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point of having colleagues raise fees and we need to
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increase those fees. Yes, in-network providers are still bound by
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contracted rates, but it is important to raise those fees,
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even though the write-off gets bigger. Because then you can
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see at the end of every year, hey, I'm increasing
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my fees steadily. The insurance isn't increasing those fees. And
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my write-off has now jumped from $ 50, 000 to $ 100, 000. And
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is this still worth it? So I think that's a big...
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thing to point out too is that don't feel that
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you don't need to increase your fees because you absolutely
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do but the write-off is just going to be bigger
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and you'll see it at the end of the year
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when you're evaluating everything if it's still.
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Yeah worth it yeah Yeah, for sure. For sure. So
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I know we kind of started down this road here
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a little bit. I want you guys to just kind
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of talk about when you're working with practices and doctors
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are reaching out and they're saying, okay, I'm thinking I
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need to make a decision. I know I'm calling you
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because I need help with interns, but I'm thinking of
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making a decision to... get out of insurance, but I'm scared.
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What about my current patient base? What's that going to
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do to all of my clients that started and we
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were in network? Or what's that going to do because
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my competition is still in network or maybe my referral sources?
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Can you guys talk to that a little bit and
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maybe how you walk docs off the ledge maybe a
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little bit or just comfort them a little bit in
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what that decision process is going to look like and
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what they need to be thinking about?
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Yeah. So I think the first thing is definitely understanding
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your current landscape, taking a look at, hey, are patients
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choosing you because of insurance? How much are you writing
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off for each insurance company is going to help you
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make that decision. But then also making sure everything else
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is rock solid. And I think that's a big piece
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because we don't want a doctor to make a decision
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just because they're frustrated with.
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Fees not increasing with an insurance company.
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We want them to make a decision because it is
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truly best for the practice and everyone is on board,
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whether it's the team, the doctor, the patients, everyone knows
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kind of where... we're going with this. So making sure
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we have everything else in place. So the consultation process, right?
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Needs to be rock solid. Presenting fees needs to be
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rock solid. Answering questions, financial questions that come up with
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patients to team members. Having your team know how to
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answer those questions is another big one. And then also
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understanding too, kind of the competition. How many in your area...
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are in network with insurance companies and what's their reputation
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versus your reputation and so on. So there's kind of
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a lot to look at before we ever make that decision.
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And again, we don't want to make the decision just
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because we're frustrated with insurance companies, right? We want to
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make the decision because it's truly something that we want
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long-term for the practice.
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Mm-hmm.
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And when making that move, you kind of have to
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do it strategically.
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Yeah.
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It is a transition, right? So you don't want to
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get things too messy, but it might be a little
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bit rocky for a short period of time, for sure.
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So just kind of strategically looking at everything, make sure
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everything's lined up before jumping too quickly.
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Yeah, of course.
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Yeah, for sure. And I think your point about looking
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at your numbers, looking at your data, because what I
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tend to see is when I'm evaluating that with the
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doc and we're diving in and looking at that is
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they may go, oh, well, look how much I did
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in write-offs from Delta. But then when they look at
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their referrals, either they haven't done a really good job,
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their team doesn't do a good track of, you know,
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where their actual referrals coming from. Or again, they just
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look at one side of it, but not the other
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side of it. And there are some regions, you know,
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I want docs listening to this that... It may not
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make sense for your practice as an individual practice where
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it may make sense for somebody else's. But really, the
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devil is in the details. And your information that you're
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making these big decisions on is only as good as
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the person that puts in the correct information, right?
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Yeah.
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Oh, yeah.
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Yes.
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100%.
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So if the referral source is insurance... Well, that's not
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going to tell you a whole lot, right? Versus if
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the referral source is Delta Dental or MetLife or United Concordia,
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you're going to have a lot more understanding. And so,
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and I think especially now with all our softwares out there,
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we should be able to really expand on that. And
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sometimes it is even, I don't know what you guys think,
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but sometimes it is doing a year's worth of data
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to really look at that to make sure that, okay,
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does this make sense that we're.
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Going to move out?
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Oh yeah, 100%.
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So once a doctor decides to make a change and
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they're like, all right, I'm going to do this. You know,
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I've talked to my team. We're all on board. We
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understand the why. What are you guys suggesting that they
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need to do, that they need to be prepared for financially, operationally?
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What does all of that look like? Because I think
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there is a big piece to this when we're ready
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to take that change and say, all right, as of
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January 1st, we're no longer a network. What do you
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guys suggest there?
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Yeah.
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So there's four parts that we suggest on when making
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this move. The first is going to be how confident
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are you? So your position, how confident are you with
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this move? And do you have that steady stream of
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referral sources like we've already touched on from other referral sources?
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So are patients coming to you from general dentists, word
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of mouth, little league, whatever it is, and not coming
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to you directly from insurance companies? So that referral source
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is definitely going to be a huge indicator. The next
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part is going to be communication. And there's three parts
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to communication we always look at. One is going to
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be communication with the insurance companies. Obviously, we need to
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tell them we're leaving in-network. But we also need to
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figure out how that insurance company is going to... What's
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going to happen.
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What's going to happen.
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Yes. So if we decide... If we decide to leave
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the network, yeah, are payments rerouted to the subscriber? Is
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there a lower lifetime maximum maybe? There's so many things
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that we want to have in that insurance conversation. The
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next one's going to be patient communication. So how are
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we going to communicate this to our patients and say, hey,
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we're leaving your network. Things remain the same.
349
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And....
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What boundaries are we setting? So let's say the lifetime
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maximum does drop. Are we writing those off, right? Most
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00:19:05.859 --> 00:19:08.390
doctors would say yes, because it was our decision to
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leave the network. So we want to write off if
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the lifetime maximum lowered or something for a patient we've
355
00:19:14.430 --> 00:19:16.589
already started. And then the third one is going to
356
00:19:16.609 --> 00:19:18.789
be team. So how are we going to communicate this
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with our team? And is our team confident in this
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move and fully capable of answering the these random questions
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00:19:26.319 --> 00:19:27.759
that are now going to be thrown at them. What
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00:19:27.779 --> 00:19:30.759
does this mean? You left my network. Can I still
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00:19:30.799 --> 00:19:33.299
come here? Why am I getting payments and you're not
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00:19:33.339 --> 00:19:36.740
receiving the payments anymore? All of those things that are
363
00:19:36.779 --> 00:19:40.490
going to happen when we leave network. I think definitely, yes,
364
00:19:40.569 --> 00:19:45.170
just the communication, especially for the team, front office, treatment coordinator,
365
00:19:45.210 --> 00:19:47.750
practice manager, everybody kind of plays a part in that.
366
00:19:47.849 --> 00:19:51.420
But something just as simple as a phone call from
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00:19:51.460 --> 00:19:52.640
a new patient, right?
368
00:19:52.660 --> 00:19:54.319
Do you guys take my insurance?
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00:19:55.180 --> 00:19:57.329
Really important to not say, no, we don't take your
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00:19:57.349 --> 00:19:59.769
insurance because we're not network. You know, we can word
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00:19:59.829 --> 00:20:03.460
things a little bit different to sound positive. 100%. sometimes
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00:20:03.500 --> 00:20:07.180
you get familiar with policies that are tied to certain employers.
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00:20:07.720 --> 00:20:09.900
And so you can kind of redirect and put it,
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00:20:10.279 --> 00:20:12.680
make it more a little bit positive.
375
00:20:12.700 --> 00:20:15.009
It's like, hey, well, let me take a look. Which
376
00:20:15.309 --> 00:20:16.369
one is, who's your employer?
377
00:20:16.450 --> 00:20:19.450
Oh yeah, it looks like we have many patients, you know,
378
00:20:19.470 --> 00:20:23.509
that are Googlers or Apple people or, you know. So yes,
379
00:20:23.589 --> 00:20:25.470
that's a great benefit. So you can always kind of
380
00:20:25.529 --> 00:20:29.509
flip it to make it sound more positive versus just, no,
381
00:20:29.569 --> 00:20:31.950
we're not in network. And I think that's definitely a
382
00:20:32.019 --> 00:20:35.980
first step in making the patient feel more comfortable coming
383
00:20:36.019 --> 00:20:37.599
into the practice, even at that point.
384
00:20:37.759 --> 00:20:42.039
Yeah. And now a word from the sponsors who make
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00:20:42.140 --> 00:20:48.690
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389
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You also get complimentary services to help you run and
392
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393
00:21:17.000 --> 00:21:20.579
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394
00:21:20.599 --> 00:21:24.279
your doors. That gives you flexibility to add more chairs
395
00:21:24.579 --> 00:21:29.099
as your cash flow grows. It's pretty smart. As an orthodontist,
396
00:21:29.140 --> 00:21:32.319
you care about getting all the little details right. And
397
00:21:32.519 --> 00:21:35.579
ADEC really got it right with this program. So if
398
00:21:35.720 --> 00:21:39.200
starting off with a big savings on ADEC equipment sounds
399
00:21:39.259 --> 00:21:43.119
good to you, the ADEC Smart Start is definitely worth
400
00:21:43.160 --> 00:21:45.880
a closer look. Just follow the link in the show
401
00:21:45.940 --> 00:21:53.900
notes to learn more. I love your point about educating
402
00:21:53.980 --> 00:21:57.329
the team on this so that they can answer the
403
00:21:57.390 --> 00:21:59.849
questions that they need to. Because I really think that
404
00:22:00.369 --> 00:22:03.039
just going back to how we started this talk is
405
00:22:03.680 --> 00:22:08.640
so many times our team members don't even really understand understand,
406
00:22:08.680 --> 00:22:12.579
unless they're doing the billing, what in-network or out-of-network means,
407
00:22:12.680 --> 00:22:16.180
or do we accept your insurance or not? And so
408
00:22:16.200 --> 00:22:20.250
I think if we take the time as a doctor,
409
00:22:20.269 --> 00:22:24.289
as an office manager, to really have that conversation with
410
00:22:24.329 --> 00:22:27.190
the team to say, okay, this is what this means.
411
00:22:27.450 --> 00:22:30.069
This is how it's going to affect. This is the
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00:22:30.230 --> 00:22:33.190
verbiage that we want to use. If somebody says, hey,
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00:22:33.269 --> 00:22:36.049
you know, I have Delta Dental. Do you take my insurance?
414
00:22:36.269 --> 00:22:36.910
Absolutely.
415
00:22:36.950 --> 00:22:41.380
We'd love to bill your insurance. Now, we know that maybe,
416
00:22:41.720 --> 00:22:45.619
like you said, the payments may be rerouted depending upon that.
417
00:22:45.779 --> 00:22:47.599
But the first thing is we just want to know
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00:22:47.660 --> 00:22:50.400
how to answer the questions. And I think that starts
419
00:22:50.480 --> 00:22:53.700
with educating our team and all the key players who
420
00:22:53.740 --> 00:22:56.930
could be involved in that. I want to ask you
421
00:22:56.950 --> 00:22:59.849
guys a little bit about, because I love that second
422
00:22:59.869 --> 00:23:04.299
part about communicating with the patient, especially anybody who is
423
00:23:04.480 --> 00:23:07.970
in contract. Because I have seen in the past, and
424
00:23:08.190 --> 00:23:10.130
you guys do this a lot more than I do,
425
00:23:10.150 --> 00:23:13.430
that a lot of times those insurance companies will send
426
00:23:13.470 --> 00:23:17.390
out little nasty grams. I call them scare grams to
427
00:23:17.529 --> 00:23:20.890
the patients that the sky is falling. Your provider is
428
00:23:20.930 --> 00:23:24.359
no longer in network. Your treatment is at risk. And
429
00:23:24.400 --> 00:23:27.160
we all know that that's not true. But I think
430
00:23:27.240 --> 00:23:30.220
it's kind of their scare tactic to almost make a
431
00:23:30.279 --> 00:23:36.019
provider feel like, something catastrophic is going to happen if
432
00:23:36.079 --> 00:23:39.400
they leave. And I'm wondering if you guys can talk
433
00:23:39.559 --> 00:23:42.700
about that. Talk about those scaregrams a little bit. Talk
434
00:23:42.740 --> 00:23:46.180
about what you guys are suggesting in that education process
435
00:23:46.220 --> 00:23:48.789
ahead of time to kind of diffuse it before the
436
00:23:48.890 --> 00:23:50.269
office is blowing up with.
437
00:23:51.069 --> 00:23:52.029
You know, what?
438
00:23:52.069 --> 00:23:52.490
Yeah.
439
00:23:53.869 --> 00:23:57.509
So we always recommend being proactive instead of reactive. So
440
00:23:57.650 --> 00:24:01.250
for any insurance company that we're dropping, we don't know
441
00:24:01.269 --> 00:24:03.630
what they're going to do, right? Insurance companies make up
442
00:24:03.650 --> 00:24:09.329
their own rules and abide by their own laws. And
443
00:24:09.450 --> 00:24:15.190
so we essentially want to be proactive. So I always
444
00:24:15.250 --> 00:24:18.450
recommend sending a letter that is basically going to explain, hey,
445
00:24:18.490 --> 00:24:21.529
we're leaving in network because....
446
00:24:22.289 --> 00:24:23.329
Things are increasing.
447
00:24:23.390 --> 00:24:26.130
We want to keep doing treatment at the level of
448
00:24:26.170 --> 00:24:29.190
service that you expect from us, yada, yada, yada, right?
449
00:24:29.569 --> 00:24:32.390
But we also want to say, hey, you may receive
450
00:24:32.430 --> 00:24:34.450
a letter from your insurance company. It is known to
451
00:24:34.549 --> 00:24:39.450
us that as we drop in network providers, that insurances
452
00:24:39.569 --> 00:24:42.069
may relay this information to you and try to scare
453
00:24:42.109 --> 00:24:44.210
you that you can no longer come here. And that
454
00:24:44.259 --> 00:24:47.700
is so far from the truth. Again, we're going to
455
00:24:47.740 --> 00:24:50.380
be wrapping up little Johnny's treatment. so on.
456
00:24:50.410 --> 00:24:52.359
If you have any questions, please call the office. So
457
00:24:52.740 --> 00:24:54.079
I think that letter.
458
00:24:55.380 --> 00:24:59.339
Being sent initially helps because then when they do receive
459
00:24:59.359 --> 00:25:01.509
that insurance letter, they can just say, yeah, it was
460
00:25:02.049 --> 00:25:04.410
something from the insurance. I'm not listening to it because
461
00:25:04.670 --> 00:25:08.049
I have the relationship with the doctor. So there's two
462
00:25:08.069 --> 00:25:11.630
more parts to kind of the approach as well. The
463
00:25:11.670 --> 00:25:14.900
next one's going to be the financial component to all
464
00:25:14.920 --> 00:25:19.500
of this. So We definitely want to not drop all
465
00:25:19.539 --> 00:25:23.369
insurance companies at once, right? And I think a lot
466
00:25:23.400 --> 00:25:27.069
of doctors, when they do this, they're frustrated with insurance
467
00:25:27.109 --> 00:25:30.289
and they're just like, I'm getting out, effective the new year,
468
00:25:30.849 --> 00:25:33.990
pull me out of every insurance company. And we definitely
469
00:25:34.029 --> 00:25:36.309
don't want to do that. We have to be strategic
470
00:25:36.390 --> 00:25:40.269
about who to drop, when to drop, how we're dropping.
471
00:25:40.880 --> 00:25:43.660
Because if we pull the rug out from all of
472
00:25:43.700 --> 00:25:45.900
the insurance companies at once, it's going to be really
473
00:25:45.940 --> 00:25:49.420
hard for your team, really hard for patients. But also
474
00:25:49.500 --> 00:25:55.789
just navigating that is just a struggle for everyone. So
475
00:25:55.869 --> 00:25:58.819
I think if we start dropping, we have an approach
476
00:25:59.099 --> 00:26:01.940
of who we're dropping and when we're dropping and have
477
00:26:01.980 --> 00:26:04.700
a plan on how to do it is going to help.
478
00:26:05.039 --> 00:26:08.420
So reviewing again that data, looking at, hey, my fee
479
00:26:08.440 --> 00:26:11.660
schedules for this one is the lowest. We have the
480
00:26:11.700 --> 00:26:14.519
least amount of patients with this insurance provider.
481
00:26:14.559 --> 00:26:15.799
Let's drop this one first.
482
00:26:16.700 --> 00:26:20.650
Kind of doesn't cause that ripple effect of, leaving a
483
00:26:20.970 --> 00:26:25.349
mega insurance company like a Delta or MetLife, right? Yeah, yeah.
484
00:26:25.630 --> 00:26:28.130
We also want to make sure we have enough cash reserves, right?
485
00:26:28.170 --> 00:26:31.200
There is going to be a little bit of turbulence
486
00:26:31.460 --> 00:26:35.920
in leaving networks. So just making sure that we have enough.
487
00:26:36.099 --> 00:26:39.559
If there's any hiccups, right? Payments are rerouted to the subscriber.
488
00:26:40.119 --> 00:26:43.309
Payments stop for whatever reason because they're waiting on new claims.
489
00:26:44.049 --> 00:26:46.549
You name it, we've seen it. So just making sure, hey,
490
00:26:46.589 --> 00:26:49.309
we do have enough cash reserves in the bank. to
491
00:26:49.329 --> 00:26:52.190
be able to justify kind of that turbulence for the
492
00:26:52.210 --> 00:26:56.630
time being. The last one's going to be emotional. So
493
00:26:56.730 --> 00:27:00.849
making sure that you're emotionally ready for this decision, because
494
00:27:00.869 --> 00:27:04.170
you can think you're as ready as you are, but
495
00:27:04.759 --> 00:27:08.160
until you're actually in the weeds and pulling out of
496
00:27:08.519 --> 00:27:12.019
in-network contracts, we want to make sure that you as
497
00:27:12.039 --> 00:27:14.579
the doctor, as well as the team are emotionally ready
498
00:27:14.680 --> 00:27:17.569
for everything that's going to be thrown at you. So
499
00:27:17.609 --> 00:27:21.230
that short-term turbulence for the long-term gain, you have to
500
00:27:21.289 --> 00:27:24.349
keep reminding your team and yourself of that as well.
501
00:27:24.970 --> 00:27:29.390
Yeah. Yeah. Those are great, great suggestions. And especially, I
502
00:27:29.430 --> 00:27:33.009
think the cash flow piece is really important. In the end,
503
00:27:33.250 --> 00:27:35.809
the money will be there, but I think especially we
504
00:27:35.849 --> 00:27:38.190
know for sure there's at least one company out there
505
00:27:38.230 --> 00:27:42.589
that will reroute payments to patients. And if that was...
506
00:27:42.990 --> 00:27:47.400
I kind of think about insurance payments, patient payments, and
507
00:27:47.440 --> 00:27:50.680
then down payments as kind of three different revenue streams
508
00:27:50.960 --> 00:27:54.099
if we've been in network and accept payments into our practice.
509
00:27:54.660 --> 00:27:57.619
And so if you think about potentially, you know, if
510
00:27:57.640 --> 00:28:00.869
you're a big, heavy into one of the insurance companies,
511
00:28:00.960 --> 00:28:02.990
that is going to be one that's going to reroute
512
00:28:03.049 --> 00:28:06.829
patients to your point of cash flow value. You have
513
00:28:06.869 --> 00:28:11.099
to be prepared for understanding what that insurance company is
514
00:28:11.190 --> 00:28:14.759
going to do, because that could be maybe a difference
515
00:28:14.880 --> 00:28:17.960
of $ 20, 000 if you're a bigger practice, a month that
516
00:28:18.000 --> 00:28:21.359
you're expecting that was hitting your bank account every month
517
00:28:21.420 --> 00:28:25.200
in those payments. And now all of a sudden... It's gone.
518
00:28:25.549 --> 00:28:28.230
And it's not that you won't get it back, but
519
00:28:28.589 --> 00:28:30.890
they now just sent all that money to the patients.
520
00:28:31.089 --> 00:28:34.289
And now if you haven't had a plan for working
521
00:28:34.329 --> 00:28:37.250
with the patients on, hey, guess what? You're getting all
522
00:28:37.289 --> 00:28:39.809
that money. Now let's refigure out how we're going to
523
00:28:39.829 --> 00:28:42.769
adjust your payments. I love your idea of having a
524
00:28:42.809 --> 00:28:46.539
strategy there because that is something that's going to be
525
00:28:46.710 --> 00:28:50.259
really key and understanding what each company is going to
526
00:28:50.299 --> 00:28:52.779
do It's just going to make it less stressful. I mean,
527
00:28:52.839 --> 00:28:55.599
it's stressful enough to be in network or out of network,
528
00:28:55.900 --> 00:28:58.299
but it's in time you make a big change like that.
529
00:28:59.059 --> 00:28:59.420
For sure.
530
00:28:59.700 --> 00:29:02.160
And the team also has to be comfortable with that, right?
531
00:29:02.200 --> 00:29:06.039
So having those financial conversations of, hey, it looks like
532
00:29:06.079 --> 00:29:08.519
Delta paid you last month and the check was cashed.
533
00:29:09.140 --> 00:29:10.700
How are we going to collect on that payment? Are
534
00:29:10.740 --> 00:29:12.380
we rolling it into the monthly payments?
535
00:29:12.440 --> 00:29:16.220
Are we collecting the lump sum? Because I feel like
536
00:29:16.240 --> 00:29:18.839
we almost have to have proof as a provider that,
537
00:29:19.799 --> 00:29:23.099
An insurance company paid the patient. So when that happens
538
00:29:23.200 --> 00:29:27.049
and they're rerouting checks to the patient, I always kind
539
00:29:27.089 --> 00:29:30.930
of still download the EOB from the provider portals, upload
540
00:29:30.950 --> 00:29:32.869
it into the patient's chart that shows that it was
541
00:29:32.910 --> 00:29:36.470
paid to the subscriber. So that way, when I'm following
542
00:29:36.529 --> 00:29:38.650
up with patients and saying, hey, it looks like Delta
543
00:29:38.670 --> 00:29:39.910
paid you a thousand dollars.
544
00:29:41.240 --> 00:29:43.759
They're not... Delta never paid me $ 1, 000.
545
00:29:43.640 --> 00:29:43.710
Yes.
546
00:29:43.740 --> 00:29:48.440
You know? So we have to have some sort of
547
00:29:48.759 --> 00:29:51.380
proof to that. And I don't know that it really helps,
548
00:29:51.519 --> 00:29:54.049
but I feel like it does in a way that
549
00:29:54.670 --> 00:29:59.509
patients now can't say that they didn't receive it. So... Yeah,
550
00:29:59.549 --> 00:30:02.170
it's almost like you were notified. Like, oh, Delta notified
551
00:30:02.250 --> 00:30:05.240
us that you received the second payment that we were
552
00:30:05.279 --> 00:30:08.880
expecting to receive. You know, please contact us. The other
553
00:30:08.900 --> 00:30:13.740
thing that's important too is for insurances, right, that do
554
00:30:13.960 --> 00:30:18.309
choose to pay the subscribers directly. One thing to consider
555
00:30:18.369 --> 00:30:20.369
always is to, if that's going to be the case,
556
00:30:20.450 --> 00:30:22.890
to not be allocating that within the contract.
557
00:30:23.450 --> 00:30:23.690
Yes.
558
00:30:24.170 --> 00:30:27.670
You know, so something that we see, so if we
559
00:30:27.769 --> 00:30:31.369
know that they're not going to pay us, that's totally fine.
560
00:30:31.869 --> 00:30:35.490
A lot of, I feel like doctors or practices feel like, oh,
561
00:30:35.619 --> 00:30:38.380
it's really hard because now the monthly payment's going to
562
00:30:38.420 --> 00:30:41.460
be higher. And then we can't deduct that what we
563
00:30:41.500 --> 00:30:44.279
thought was, you know, 1500 off and the fee looks
564
00:30:44.319 --> 00:30:44.740
too high.
565
00:30:45.039 --> 00:30:45.740
It's totally fine.
566
00:30:45.779 --> 00:30:48.180
Again, it's all just about like how you present it.
567
00:30:48.359 --> 00:30:51.099
So, you know, it's like, this is the treatment.
568
00:30:51.180 --> 00:30:54.539
You have an amazing benefit. It looks like you have $ 2, 000
569
00:30:53.779 --> 00:30:58.900
with Delta. They like to pay their, people directly. So
570
00:30:58.940 --> 00:31:00.599
this is how it's going to look, you know, we're
571
00:31:00.619 --> 00:31:03.720
going to receive, yeah, expect to receive those payments directly
572
00:31:03.740 --> 00:31:06.230
and always just be positive. And that's just how they
573
00:31:06.269 --> 00:31:09.490
do it for their people. Yeah. And to that point,
574
00:31:09.569 --> 00:31:13.509
it may be hard Initially, right, to sell, quote unquote,
575
00:31:13.549 --> 00:31:16.880
the treatment because you're not deducting the insurance benefit.
576
00:31:17.440 --> 00:31:21.680
But it is even harder to collect the money if.
577
00:31:21.680 --> 00:31:24.660
You deduct it and then have to chase that patient
578
00:31:24.700 --> 00:31:31.190
around every quarter or month to collect on those insurance payments. So, yep.
579
00:31:31.490 --> 00:31:34.890
Teach and communicate on the front end so that you're prepared.
580
00:31:34.910 --> 00:31:37.710
Because to this point, this goes back to everybody that's
581
00:31:37.789 --> 00:31:42.009
involved in this. If the treatment coordinator hasn't learned to
582
00:31:42.190 --> 00:31:46.849
change their spiel with whichever insurance we know we're not
583
00:31:46.869 --> 00:31:50.170
going to be holding an insurance ledger on anymore or whatnot.
584
00:31:50.619 --> 00:31:53.240
To your point, it's going to be hellacious for that
585
00:31:53.279 --> 00:31:57.039
financial coordinator that's trying to track it down. Because, yeah,
586
00:31:57.140 --> 00:31:59.940
once somebody cashes a check, they're like, I'm off to Disneyland.
587
00:31:59.960 --> 00:32:02.079
You know what I mean? Like, I'm not bringing that in.
588
00:32:02.140 --> 00:32:05.200
I just got $ 2, 000. It's Christmas in the mail. Which
589
00:32:05.259 --> 00:32:08.109
always bugs me that these darn insurance companies will pay
590
00:32:08.160 --> 00:32:10.509
out the patients no problem in full, but pay us
591
00:32:10.569 --> 00:32:11.329
in full? No way.
592
00:32:11.369 --> 00:32:12.130
Yeah.
593
00:32:12.170 --> 00:32:16.829
Yeah. So I know we've kind of been talking about
594
00:32:16.869 --> 00:32:20.180
this a little bit, but are there any other mistakes
595
00:32:20.279 --> 00:32:24.160
that you tend to see practices make when they're kind
596
00:32:24.200 --> 00:32:26.730
of moving towards this fee-for-service approach?
597
00:32:28.019 --> 00:32:30.359
I feel like we've touched on a lot of them.
598
00:32:30.380 --> 00:32:33.220
I would just, yeah, really just kind of educate, yeah,
599
00:32:33.279 --> 00:32:36.039
their area. So I mean, every area is.
600
00:32:36.009 --> 00:32:36.950
Going to look different.
601
00:32:36.970 --> 00:32:40.910
You know, there's like military communities where insurances are going
602
00:32:40.930 --> 00:32:45.109
to make sense, maybe for those providers where some, you.
603
00:32:45.049 --> 00:32:47.619
Know, so you really have to figure out where you are.
604
00:32:47.740 --> 00:32:50.200
And just because you're like hearing and you're learning from
605
00:32:50.769 --> 00:32:54.150
your ortho friends in different states. You have to, you know,
606
00:32:54.190 --> 00:32:56.730
it has to make sense for where you're actually practicing.
607
00:32:56.750 --> 00:33:00.289
I think that's, that's important too. But I think we
608
00:33:00.329 --> 00:33:02.950
did do a good job kind of touching, I think
609
00:33:03.029 --> 00:33:07.519
on all the points really of things to consider when
610
00:33:07.539 --> 00:33:11.230
making that move. And again, I'm just gonna stress the
611
00:33:11.269 --> 00:33:15.430
little comment that Megan had made, a little short-term turbulence
612
00:33:15.569 --> 00:33:21.410
for long-term gain. I think that's the key takeaway.
613
00:33:21.430 --> 00:33:25.009
I totally agree with you on that for sure. And
614
00:33:25.089 --> 00:33:29.289
there's just nothing better than having a strategy around what
615
00:33:29.329 --> 00:33:32.569
this is gonna look like, especially for anybody who's gonna
616
00:33:32.609 --> 00:33:34.559
be pulling out. It's a little different when we're a
617
00:33:34.619 --> 00:33:37.470
startup and we're assessing whether we're gonna go in. But
618
00:33:37.920 --> 00:33:39.740
one of the things I always tell my startups is,
619
00:33:40.480 --> 00:33:43.019
if we start with that, it's a strategy for getting
620
00:33:43.059 --> 00:33:46.359
your practice going, but it's not a long-term strategy for
621
00:33:46.380 --> 00:33:50.119
your practice. And usually by about year three to five,
622
00:33:50.599 --> 00:33:53.099
you need to be getting out of those insurance companies.
623
00:33:53.500 --> 00:33:57.359
Unless again, there's a very specific reason, which there could
624
00:33:57.400 --> 00:34:00.589
be why we're staying in because it just doesn't make
625
00:34:00.680 --> 00:34:02.569
sense the way it used to 20 years ago, 30
626
00:34:02.569 --> 00:34:07.490
years ago. and why we needed to participate. And doggone it,
627
00:34:07.569 --> 00:34:09.690
they didn't use to cap our fees or we had
628
00:34:09.730 --> 00:34:11.340
a lot more room to play with, you know, in
629
00:34:11.380 --> 00:34:13.010
negotiating where we just don't anymore.
630
00:34:13.010 --> 00:34:15.199
100%, yeah.
631
00:34:15.719 --> 00:34:19.260
So if somebody wants to learn more about you guys,
632
00:34:19.380 --> 00:34:22.900
more about what you do, whether it's from courses to,
633
00:34:22.920 --> 00:34:25.860
I think I just need some direction on getting out
634
00:34:25.900 --> 00:34:29.099
of insurance, or I just want help with billing in general,
635
00:34:29.139 --> 00:34:32.099
like what's the best way that they can connect and
636
00:34:32.159 --> 00:34:32.780
reach out to you?
637
00:34:33.380 --> 00:34:37.760
We definitely say email, which would be info at the wyrickoutlook.com
638
00:34:38.199 --> 00:34:41.519
or just our website. We have our contact us ask,
639
00:34:41.940 --> 00:34:43.980
you know, a little bit about what your current situation
640
00:34:44.059 --> 00:34:46.030
is and then we can schedule a phone call. And
641
00:34:46.070 --> 00:34:49.210
then of course we have Instagram and we have Facebook
642
00:34:49.429 --> 00:34:51.030
and we check our message regularly.
643
00:34:52.150 --> 00:34:52.710
Regularly.
644
00:34:53.610 --> 00:35:00.429
We always like to shorten that, right? We check your
645
00:35:00.469 --> 00:35:01.309
messages often.
646
00:35:01.829 --> 00:35:05.429
Yeah, there you go. It's like, change that and spell
647
00:35:05.469 --> 00:35:06.150
check to often.
648
00:35:06.269 --> 00:35:09.889
That's great.
649
00:35:10.710 --> 00:35:13.369
And now a word from the sponsors who make this
650
00:35:13.449 --> 00:35:20.010
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651
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652
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653
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654
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655
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656
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657
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658
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659
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660
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661
00:35:56.409 --> 00:36:01.210
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662
00:36:01.309 --> 00:36:07.349
with SmileSuite because every smile deserves a suite of excellence. Well,
663
00:36:07.389 --> 00:36:09.260
you guys know how I like to finish this up
664
00:36:09.389 --> 00:36:11.679
and that's always with the little speed round. So how
665
00:36:11.699 --> 00:36:13.579
about I'll give each of you a question and then
666
00:36:13.619 --> 00:36:16.579
we'll finish it up for today. So Bea, how about
667
00:36:16.599 --> 00:36:20.820
we'll start with you first. What is your go-to strategy
668
00:36:20.900 --> 00:36:23.849
for getting unstuck when you are facing a tough problem?
669
00:36:24.849 --> 00:36:27.469
It's definitely going for a walk. I just will put
670
00:36:27.510 --> 00:36:30.309
on my headphones and go for a walk. That's definitely
671
00:36:30.389 --> 00:36:32.900
it for sure. And sometimes I do that multiple times
672
00:36:33.500 --> 00:36:33.760
a day.
673
00:36:35.559 --> 00:36:38.599
I'm right there. I'm right there. All right, Megan, here's
674
00:36:38.639 --> 00:36:40.920
a good one for you. All right. If you could
675
00:36:41.219 --> 00:36:46.090
add one unconventional perk to every workplace, what would you
676
00:36:46.130 --> 00:36:46.460
want to add?
677
00:36:47.050 --> 00:36:51.400
Oh, I love this. I love this one. Dang, I
678
00:36:51.440 --> 00:36:53.139
feel like we should have swapped mine and Brittany's. I
679
00:36:53.579 --> 00:36:54.900
have one if you don't.
680
00:36:55.099 --> 00:36:55.920
Okay, go ahead.
681
00:36:56.500 --> 00:37:01.300
Unconventional perk would be house cleaning, weekly house cleaning for
682
00:37:01.380 --> 00:37:05.199
all of the team members. I feel like, oh my gosh,
683
00:37:05.239 --> 00:37:08.260
if that's something that, well, one that I had or
684
00:37:08.320 --> 00:37:10.289
something that we could do for our team, that would
685
00:37:10.329 --> 00:37:11.829
be a huge perk.
686
00:37:11.889 --> 00:37:14.750
I mean, imagine working and then you.
687
00:37:14.630 --> 00:37:16.630
Just go home to a clean house all the time.
688
00:37:16.670 --> 00:37:17.429
That would be amazing.
689
00:37:18.000 --> 00:37:19.820
Yeah. Ooh, I love that. I love that.
690
00:37:20.119 --> 00:37:21.840
You know, I don't mind house cleaning so much. I
691
00:37:22.199 --> 00:37:23.019
could clean the house.
692
00:37:23.719 --> 00:37:26.360
It's the cooking. Brittany and I are different in that.
693
00:37:27.010 --> 00:37:29.139
I don't like cooking. She loves cooking.
694
00:37:29.329 --> 00:37:33.829
I like cleaning. She doesn't like cleaning. So we kind of.
695
00:37:34.929 --> 00:37:35.590
There you go.
696
00:37:36.170 --> 00:37:36.929
There you go.
697
00:37:36.969 --> 00:37:40.150
So you can have a chef or a house cleaner.
698
00:37:40.469 --> 00:37:41.429
Oh, I like that.
699
00:37:41.449 --> 00:37:42.449
I would have a chef.
700
00:37:44.599 --> 00:37:45.380
I would want both.
701
00:37:45.579 --> 00:37:48.590
I'm just saying I want both.
702
00:37:48.829 --> 00:37:52.190
It would definitely be helpful. All right.
703
00:37:52.250 --> 00:37:54.469
We'll ask one more. Both of you can answer this
704
00:37:54.550 --> 00:37:57.150
or one of you. What is one piece of advice
705
00:37:57.190 --> 00:37:59.250
you wish you had followed earlier in your career?
706
00:38:00.309 --> 00:38:03.369
I think one piece of advice would be that you
707
00:38:03.389 --> 00:38:05.969
don't have to do everything, right? And it will come
708
00:38:06.010 --> 00:38:09.929
with time. So I feel like starting up a business
709
00:38:10.010 --> 00:38:12.679
is really, really hard. And you feel the pressure of,
710
00:38:12.820 --> 00:38:13.539
I got to do this.
711
00:38:13.579 --> 00:38:14.079
I got to do that.
712
00:38:14.099 --> 00:38:16.780
And you're pulled in all these different directions. And you
713
00:38:16.800 --> 00:38:19.739
just have to know that it's going to come with time.
714
00:38:20.159 --> 00:38:23.579
So just give it time and don't stress about it.
715
00:38:23.619 --> 00:38:27.619
It'll eventually get there. That's a good one. That is
716
00:38:27.639 --> 00:38:29.800
a good one. And it might be a little bit
717
00:38:29.880 --> 00:38:34.059
somewhat similar. I kind of feel like sometimes less really is.
718
00:38:34.820 --> 00:38:35.099
more.
719
00:38:35.360 --> 00:38:39.500
So trying to keep things very simple and do less,
720
00:38:39.579 --> 00:38:43.699
but less, like really, really good less, you know, versus
721
00:38:43.760 --> 00:38:47.449
trying to dabble with too many things. And I just
722
00:38:47.469 --> 00:38:48.329
feel like less is more.
723
00:38:48.750 --> 00:38:51.210
Do a couple things really, really, really well.
724
00:38:51.030 --> 00:38:52.989
And just focus on that and roll with that.
725
00:38:53.469 --> 00:38:55.750
Yeah, I love it. I love it. Well, guys, it
726
00:38:55.829 --> 00:38:58.289
is always such a pleasure having you on Hey Docs.
727
00:38:58.329 --> 00:39:01.250
You're my insurance gurus and I just, I appreciate what
728
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you're doing in this space out there and especially how
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you're helping so many practices. So thanks for being on
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00:39:07.489 --> 00:39:09.659
Hey Docs again. Third time's a blessing.
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And until next time.
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All right.
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All right.
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Bye. Thank you. Bye. Are you ready to start a
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00:39:19.380 --> 00:39:22.389
practice of your own? Need a new fresh set of
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00:39:22.550 --> 00:39:25.989
eyes or some advice on your existing practice? If so,
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00:39:26.230 --> 00:39:32.900
reach out to me, Jill Allen, at www.principal.com. you like
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what we're doing here on Hey Docs and want to
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hear more of this awesome content, be sure and give
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us a five-star rating on your preferred listening platform and
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subscribe to our show so you never miss an episode. Remember,
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new episodes drop every Thursday. See you next week.