Mastering the Patient Experience

What's up everybody? Welcome to another exciting episode of the navigating dental insurance podcast. I am your co-host today Jordan Comstock with me a special guest Deborah Nash. Deborah, what is up? How are you? >> I'm I'm well. I'm really well. Yeah. >> I'm excited to have you on the show today. >> Yeah, I'm excited to be here. >> We're going to talk We're going to talk a lot of insurance and all that fun stuff that you see every day. >> I do with my with my

clients and of course I mean a lot of people know that I'm you know so married to this southern bald dentist that hasn't been insurance he hasn't been involved in insurance for over 35 years maybe 40 now so Um yeah. But I do I help my other client I help my clients navigate their insurance situation. So I'm not anti-insurance. It's just it's how it's how you work with it and how you help the patients understand how we you work with it. That's the that's the key.

So it doesn't become the focal point. That's my whole premise. Hey, insurance is a great thing. Uh you know and in fact you know you know you always think you have to have questions with me. You know that I can have this conversation. So a lot of people here's my little history and this there's going to be a quick I get a prize. They might get a prize. >> [laughter] >> You know and so you probably know this. When was dental insurance first introduced to the

consumer? >> Was it in the 1970s? 1960s? >> How about 1957? >> 1957? I was completely wrong. It hasn't changed since the 1970s is what most people say. >> You know what? [laughter] It hasn't changed since 1957. Here's what's interesting. So Washington, Oregon and California added it as a supplement to the medical plan for unions. >> Mhm. [clears throat] >> In 1957. What do you think was the average allowance per year in 1957? >> Was it a thousand bucks? >> It was. >> Okay. >> It

was. A thousand dollars. Has it changed much? And the argument that insurance companies have is that and they what they say well 50 well here's the other interesting interesting factor. 50 only 50% of Americans have dental insurance. And I know a lot of doctors think well that entire 50% of the Americans who have it are in my office. Thank you very much. You're one of them. Um so 50% of Americans have dental insurance. >> Yep. >> And what insurance companies contend is that 17% of the

50% actually use insurance. >> Yes. Yeah. >> Use their dental insurance. So So then the question is the So their question is why should we have to change the maximum per year because it's not being used anyway? >> Jeez. Yeah. Yeah. >> That's their Isn't that interesting? It's It's sort of like three blind people describing an elephant and they're all standing in different locations. >> [laughter] >> Yep. Yep. Yep. >> Um you they're seeing it from a totally different perspective than >> Interesting. >> than the

patient, than the dentist, the dental practice, and then the insurance company. >> Yeah. >> We're they're all looking at it at different perspectives from different perspectives. So >> So how does a dental office navigate that? That's the That's the question. >> Yes. That is the question. Yeah. With that said, give our audience a little bit on on who you are. Most people know who you are. >> Oh. >> [laughter] >> Yeah. >> Um um but give a quick rundown on that and then we'll get into

all the details and the questions. Yeah. >> Um yeah. I'm saying you know that I've been in I've been in this industry since uh the mid '80s. I was actually recruited out of an audience by a major consulting firm. >> [snorts] >> Really? >> Yes. Yes. So, my dentist that I worked for In fact, you know, I'm a I'm a school teacher by by by degree, by you know, and I was a school teacher. Yeah, and I was recruited by my dentist to come work in

his dental office. That was sort of the interesting But all the bond issues failed and nobody was hiring a liberal arts school teacher. And back even back then, even back in the '70s, they were having trouble with team, you know, staffing in the dental office. You think it's a You think it's a crisis now, it was a crisis back then. At any rate, so he hired me. But I had a dentist who really loved this speaker. He's not He doesn't speak anymore, but he was part

of a lot of people don't know. Here's another little history. He was He was actually a a partner with Dr. James Pride and they developed the the Pride Institute. He was Really, Jim Pride was sort of the design um instructor how to build a dental practice to make it functional. And Dr. Phil Whitener was sort of the practice management expert. That And they partnered. That's how that all happened. At any rate, I had a I had a dentist who was truly a Phil Whitener groupie and

anytime Phil Whitener was close to where we were we were, we were going. Yeah. We're going. So, Phil, Dr. Whitener sort of said, "My gosh, I mean, how many times are you guys going to be here?" And anyway, um he recruited me to come and be a consultant for the Pride Institute and I was a Pride consultant until the until the mid-80s and I started my own company in 1985. Um because I wanted more control over the kind of consulting and coaching that I could do.

I didn't want I didn't want to be I didn't want it to be so um systemized that I couldn't veer off um from, you know, the cookbook or the manual, which was exceptional material, great material, great uh a a great product for for dental offices. But I wanted to be able to customize it. I wanted to create a more of boutique style consulting process for my clients. So, I started in 1985. Um then I started So, I started uh consulting and then from there stemmed off

into speaking and and um and writing and um doing you know, and that and since I've been doing ever since. Yeah. And then 1995, I married a fee-for-service Southern bald dentist and moved to >> Southern bald dentist. That's how you describe him. I married a Southern bald dentist. >> I married and you know, I always say and and it was funny because um he always says, "Do you always have to tell them that I'm bald?" And I said, "Well, I think they [laughter] they I think

they know. I think they can tell." >> It's pretty clear, bro. >> pretty pretty much know you're Southern, too. So, I think these two things are self-evident. >> Yeah, yeah. I'm just >> It's that a famous speech I all these things are self-evident. That's [laughter] a famous political speech. So, um yeah, and then and we started um in 1997. We were married in '95. And he already had a little tiny teaching center, but we started the Nash Institute for Dental Learning in 1997 that is focused

on um cosmetic and aesthetic techniques, direct, indirect, and full mouth rehabilitation. And then we also have a dental business school that we do two-day uh training like, you know, for dental teams. And then I also do a team communication workshop cuz a lot of so many people come to uh the clinical portion and they say, "I need to get my team to talk like that. I need to get my team How do I get my team to say that? How do I" And I said, "Well,

we can teach them." And so, we created a workshop to do that. And that's And we do that. >> And I would imagine those those soft skill trainings are is like really, really important for most uh practice office managers. Even the Even the practice owner should have some soft skills. >> Well, absolutely. In fact, um I do this thing in one of one of the things we'll have to about someday, I have these six critical questions that help your patients say yes. >> Okay. >> Um

two of them are from, you know, our our doc the doctor the questions that the doctors would ask. But when I first met Dr. Nash, um I'll be really formal. When I first met >> The bald one, right? The bald one, that's who you're talking about. >> Bald-headed southern guy. Um when I first met Dr. Nash um at an ADA meeting in Seattle, I was speaking and I and he told me who he who he was and what he did and I was West Coast. He's

you know, he's southern East Coast. And I said, you know, it's one thing to know how to do the treatment clinically. It's another thing it's another set of skills to know how to talk to the patients and help them understand, appreciate, and accept the treatment and want to pay for it. Those are two still different skill sets and actually they don't teach the second skill set in dental school. >> No. >> They have to kind of learn it trial by fire. >> Yeah. >> And so

now you've got sometimes you have a dentist owner who's trying to teach their team how to talk to patients when they really really never learned how to do it themselves. >> Yeah, they they and they don't know what they don't know. So, they don't know. >> Yeah. But but you know, what's really great now in in our industry is because actually, I mean, you always say, you know, make you know, how do you make um lemonade out of lemons? One of the things that the pandemic

did is it got people inspired people to go online and learn. I mean, it really did. >> Sure. >> So, I think there's more than learning um availability now than ever before. Um it's how it's applied and it's you know, it's one of the things and you know, how the doctor takes that doctors and team take it and apply it to their practices. But there's so much education that's available um to which doctors can subscribe doctors and teams can subscribe um that if they applied it,

um >> That's the key. >> it would it would help them. Yeah. Yeah. >> the key. They learn, but you need to apply, you know. >> Well, and I think sometimes, in fact, I was talking to to one of our other friends who's a consultant and a coach, and and we were talking about that, that sometimes um we we stop before we start. We say, "Oh, my team will never do that." Or you have team members who will say, "Our patients are different. Our practice is

different. Our you know, we work in a small town. Patients will never accept it. Our patients and it's like so they they stop before >> You're You're stopping before you even try. >> Yeah, they stop before they start. >> Yeah, that's interesting. >> Yeah. >> And let's get into it. So, um we were talking before we started the recording on some of the the things you're seeing in the the dental social media groups on insurance, all that fun stuff that happens every day there in those

groups. There's a There's a lot of information that we can take from those groups and talk about on a podcast or or an article, I've noticed. >> And there's a lot of information on in in all kinds of Facebook groups. I mean, oh my gosh. I mean, you know, I I wonder what I do in the morning cuz I'm an early riser. Like I was up at 4:00 this morning. And the next thing I know, I know. >> I wake up early, too. >> [laughter] >>

And next thing I know it's like 6:30, and I have been reading Facebook groups. I've been reading what's been going on, you know, with Nifty Thrifty and Dental Nachos and Kyle Summerford's Office Managers and A-D-O-M and you know, bringing all that information again and say, "Okay, here's what's happening in our dental world." And it's a there's a lot going on. >> There is a lot. I was on the I was on a podcast earlier today. Uh and the podcast was all about the AI shifts in

in with dental insurance, which I I'll I'll ask some questions of you there. There's a lot happening there on the AI side, too. Um which is interesting. But let's let's get started. I got I got my first question for you. >> Okay, I'll Okay, I'm ready. >> Yeah. Yeah. Um what do you what do you say when a patient or when a patient says, do you accept my insurance? How should we handle that in the in the dental office? I I see a lot of people

just reactively responding. What would you suggest? >> You know, it's interesting that you would bring that up because I was just training a team in Vancouver and I said, okay, if a patient calls and says, do you take my plan? Um, her first response is, unfortunately, we don't. Well, you've just lost this I mean, if that's the first thing that the >> bye. >> Okay, bye. Thanks. So, if they're shopping, so I think first of all, I think it's important two things that are important. Often

times dental offices lead with the question, hi, my name is Debra Nash and I'd like to make an appointment for cleaning examine and and x-rays or generally I like to establish my records and often times the first question is, do you have insurance or what insurance do you have? >> Yeah. >> So, how we start the we start the entire relationship all of about insurance and we spend and I say, well, I have Disney plan 2000. Oh, Disney plan 2000. Here's how we handle Disney plan

plan 2000 patients and we spend 10 minutes talking about exceptions, limitations, deductibles, maximum >> nuance of insurance. >> And and then we wonder why the patients become so focused on on their insurance plan. Well, we we focused on it first. So, I think it's always of a do you take my insurance? I think the the auto response, I've never seen to um to uh to I don't I I was trying to find another word for lie. Um, tell the truth about whether or not you do

or take insurance, but there's a way there's a nuance of how you need to do it. So, >> Sure. >> we haven't taken insurance for 35 years and and I always respond by this and say, I would be happy to tell you how we handle insurance. >> Yeah, that's great. >> So, I will be happy to tell you how we handle insurance. Now, once again, in our practice, even though we are not in network, we are strictly fee-for-service, we have a lot of patients who have

Delta, who have MetLife, who have Cigna, who have all those plans. So, if they say, "Well, I have, you know, I do you take Delta?" You know what? We We do have patients in our practice who have Delta. Here's how we handle that. So, I'm not going to say, "Yes, we take all plans." Yes, we do we have patients in our practice who have Delta. Here's how we handle Here's how we handle that. And so, I think that's that's also important that rather than saying, "Unfortunately,

we don't." or "No, we don't participate." And the other thing we have to be careful about, and I was just reading this on one of the Facebook groups about denigrating the dental insurance to the patient. Because now, it's it's the dental insurance against us. And I don't want to create that environment. You know what? So, I say, "You know what? We will do our very best to help you receive whatever dental allowance, not benefit." And we never I want to avoid saying we're going to maximize

your benefits cuz it sounds like we're going to try and manipulate. We will do our very best to receive whatever dental allowance your employer has provided for you. Your employer bought a plan. So, you know, among under Delta, there are literally tens of thousands of different plans. Your employer selected a plan for for the employees. We will do our very best to help receive whatever allowance your employer has chosen. So, and that is, you know, so, and then I will go on to our philosophy of

how we handle that. And so, you know, one of the reasons that we do not we participate in an out-of-network relationship with that plan. You know, so, as in, we don't take your insurance or we're not in network, we participate in, you know, in and out of network relationship with that particular plan. Because the doctor decided several years ago, or the doctor decided that um it would be he or she or they, they would rather um adhere to their standard of care rather than try to

comply with this with the different exceptions, exclusions, and restrictions of any particular plan. >> Yeah. >> So they would they would like to make sure that all of our patients are receiving the same exceptional standards that our office can provide without the limitations, exceptions, or exclusions of any particular plan. And that's why we participate in an out of network relationship with them. >> And do patients resonate with that when you say, "Hey, we're out of network, but we the reason why we do this is cuz

we're unrestricted ourselves." Yeah. >> And I think we go back into also say, um we will file your claim electronically for you to receive um you know, for you to receive the reimbursement from your from your insurance company. There was a question that came up on a Facebook group that, you know, if the patient is if if we're if we are not in network, that means the patient is going to be receiving the check. >> Yeah. >> So the question came up, so um how should

we handle financial arrangements? Well, for me, I think that's fairly obvious. I mean, if the patient is going to be receiving the insurance check, then the patient should be paying the the the uh treatment charges at the time of care. So, and I think it also goes back to that the more matter-of-fact we are about it, that we're I'm sorry, but you know, this is how we have to do it. When the patient says, >> Oh, apologetic. Yeah, you don't need to be apologetic. >> Well,

there's a whole lot of office I mean, doctors even, Jordan, doctors apologize. If If I came in with a broken tooth, oftentimes the doctor would say, "I am so sorry, you're going to need a crown." I'm sorry. Your broken tooth, you're going to need a crown. >> No, >> I'm so excited to help you fix the problem. >> I have a solution. You came with a problem and I have great news. I have a solution. Yeah. So, there's that switch. So, so I also like to

make sure that the patient knows that you know what? You are very lucky that you have a supplement to your dental plan to your dental your dental treatment. 50% of Americans have some sort of supplement and you're among that group. So, it goes back to that. >> Mhm. >> Yeah. So, we'll do our very best to help you receive whatever supplement or whatever allowance your employer has provided for you. So, >> Yeah. That's great. >> Yeah. >> It's clean, simple verbage. >> We have you take

care of charges that your charges at the time of treatment. We have found that most insurance companies reimburse the patient within about 7 to to 14 days of um you know, of their care. Now, the patient may say, "Oh my gosh, I didn't realize I was going to have to pay out of pocket." Then what am I going to launch into? I mean, now we're kind of starting to talk about financial arrangements. You know what? If that is not something you expected, that we do have

we do offer um financing in our practice. So, we can absolutely we have resources for that. If that is something that is going to make it uh more comfortable for you. Absolutely. >> Yeah. We see that too on the with the with with the membership patients that incorporating that uh automatically talking about financing is really important because they're not you're not submitting claims, right? To the insurance company. You're just like, "Yeah, you're a member of our practice and you get you get benefits for uh finance

payments, right? For being a member." >> another cool thing. I have to tell you this story. I don't know I don't know if I've shared this with you. So, there was a woman who came into our practice and you know that our office we we're BoomCloud um subscribers. So, our patients are introduced to BoomCloud. And you know, we are fee-for-service. How and she came in and and and and I have to explain ethnicity because most people understand. She was a she's a very strong German woman.

>> Okay. >> Older and she she says, "Deborah, I want to I want to be a patient here. I want to be a patient here, >> [laughter] >> but you don't take my insurance. Why am I paying my insurance for my insurance?" And I said, "You know, Elizabeth, I'm wondering the same thing. Your premiums probably cost you more than our in-office membership plan. So, wouldn't it make more sense for you rather than to pay and she doesn't work it you know, she's paying private rather than

paying for dental insurance, why I would think they would want to subscribe to our in-office membership plan because not only would it is it less expensive than your insurance premium, but then you also receive a 10% courtesy on our on our fees." And she said, "Why am I not doing that?" >> [laughter] >> I I don't know. Why aren't So, I think it's also using in-office membership as that means to say, you know, what are the you know, oftentimes when our patients even recognizes that um

insurance um is isn't as cost-effective as not subscribing to your to your um employer's plan and we'll be working with our in-office membership plan and actually they find out they they actually save money. >> Oh, yeah. >> Yeah. >> Yeah, it's way better. Um I know, I'm a new I'm a new membership patient today. >> you mentioned that. I had a patient call. Yeah, I had a dad call and he said, "Deborah, I'm thinking of putting my daughter on my my dental insurance." And I said,

"Well, let's talk about that for just a minute. So, your daughter is 15 and she's probably not going to need a lot of major dental treatment. I mean, you know, you guys are you just went to the the dentist and so, it's going to cost you how much to add her to your to your to your insurance plan at work. He said about $150 a month, something about that. And I said, >> Sure. >> Well, times 12. >> Yeah. >> So, wouldn't it be more cost-effective

to have her be have a membership plan in the office? It would cost you x amount of dollars. Um I mean, that's less that's more than a half 50% savings by He said she He said, "Oh my gosh." So, I think that goes back to having that person at the front desk not having a scripted pat answer all the time about insurance, you know, and >> Yeah, that's >> That's really critical to have Let's have a So, I think you can also even say, "You know

what? Let's have a conversation about how we handle insurance." In a very friendly way and a less officious way, avoiding the word our policy is. So, even if we're going to ask our patients, if you notice when I said, "We have you take care of the your charges at the time of care, we'll electronically file for you to be reimbursed by your insurance company." I didn't say, "Our policy is where you take charges at the time of care." >> Yeah, so let's talk about that. A

lot of a lot of practices I mean, I've been in the dental industry for a long time. Whenever I go visit a practice or or just hear them on the phone I'm when I'm in an office, they're very uh policy-focused. >> [laughter] >> How do we become less policy-focused and more patient-experience focused? >> Yeah. And I think that's absolutely in today's world, especially now, you probably You probably heard this term. I was talking to um another podcaster and I'm happy to mention his name cuz I

love him. I love talking to him. Kirk, I love Kirk Behrendt. >> Oh yeah, Kirk's awesome. >> Yeah. Yeah, so I just did a I was doing a podcast with him earlier and I said, "You know, we're living in what is called an experience economy." >> Yes. >> And what that means is that people are buying the relationship with their with that service or that company or that product as opposed to the transaction. >> Yeah. >> And so many times what we've done in in dental

history is we talk to the patient about the transaction, what we're going to do to them, what we're going to do for them. You know, all new patients get a full mouth series of x-rays and they get a comprehensive examination and they get an intraoral camera photograph and they'll do we'll do oral cancer screening and you'll be periodontally probed and then we're going to do give you a write up of a treatment plan for you, tell you what your insurance is going to cover and what

your out-of-pocket expenses are going to be and la la I know. But we sort of throw this up at them and we give them the menu of transaction. >> Yes. >> As opposed to >> That's industry jargon, right? That patients are like, "What?" >> I know. Yeah. Yeah, I mean, obviously the way we're talking about like, "You're going to be probed at your first visit." It's like, "Really?" We haven't even dated. >> [laughter] >> You know? And you want to probe me? I mean >> Jeez,

yeah. Chill out. >> like I'm going to be going to be gone into an an out of outer outer space experience and you're going to be taken up to some spaceship and being I'm going to be probed and then brought back down. I don't know. Um so I think it's important to say, "You know what? Really in our practice, one of the most important things that the really things we take pride on is the relationships we we develop with our patients." >> Mhm. >> What we

do what we do clinically is a byproduct of establishing relationship with you. We want you to feel comfortable and confident that you've chosen the right office for your care, someone you can trust, someone with integrity, someone who will be thoughtful. You know, and all that and and what we do, what we offer is beautiful dentistry. But more importantly, what we establish is relationship with our patients. >> Yeah, no, that's great. >> Yeah. >> I know I know every you can feel the difference. When you go

into a practice that's like policy focused versus like patient experience focused, you can completely feel the difference. >> You can feel the difference on the phone. >> Yeah, yeah. >> gosh, this is so funny and I wish I could I'm going to try and pull it up cuz I want to play it in one of my So, there's a something that came on Facebook and you know there's Larry David who's got that that comedian and he's in a restaurant. And he said and she Have you

seen this? It's hilarious and she said >> the most of Larry David's stuff, yeah. >> He says, "David, party of four?" He says, "Well, there are three of us." And she said, "Is your fourth person here?" And he said, "No." And she said, "I'm sorry, we can't seat you until your fourth person is here." And she said, "Why not?" And she said, "That's our policy." >> Yeah. >> And he said, "But >> And he probably >> But we're going to occupy the table. The three of

us are going to occupy the table." She said, "But our policy is that we will not seat you until the fourth person is here." >> Well, >> So, they they went into this circle of "But that's our policy." "But we're going to sit at the table." Uh the three of us will be there at the and And so, finally he he pulled somebody who was sitting at the bar and he pulled it He said, "Will you be our fourth person?" And so, he comes back and

he says, "Okay, we're party of four now." I mean, it's ludicrous. >> Yeah. >> And so many times we say, "All new patients have to you know, you are going to be receiving an email that will have your forms to complete. So, make sure you download those and complete them before you come in. Please arrive 15 minutes early and bring your insurance card with you. Please park in the blah blah blah." We give them all the rules and regulations of becoming a patient in the practice

as opposed to this is how we're going to make you feel while you're here. And we're going to make it as seamless as possible. Um we're going to I'm going to guide you through this so you feel well taken care of and you know you're in the right place. You know, and you know, insurance is let's face it, insurance isn't going to pay for everything. >> No, it's not. >> So, I I will buy from people that I like. I will buy from people that I

trust. So, at some point there is going to be a conversation about um whether or not the patient feels that they chose well. What I mean, once again, it it goes back to insurance. Um my husband is funny cuz when he's talking, he's typically talking large cases. >> Yeah. >> So, if the patient if the patient >> Cosmetic, nice cases, yeah. >> Yeah. Yeah, you know, full mouth rehabilitations and you know, composite bonding and and um so, if the patient says, "Well, what about my insurance?"

And he says, he says, "You know, I don't know a whole lot about insurance, but I think that most insurance companies pay about $1,000. That's their that's their kind of their annual allowance." And he says, "Is that Is a thousand dollars going to make a difference in choosing your care?" >> Yeah, that's great. >> Yeah, he I mean, he'll he'll he'll approach the question. Um >> Especially when you can get like a like you can finance it. And it's like, "Oh, no, insurance actually really isn't

a big deal. I can finance it if I needed to." >> Yeah. Yeah. So, that's why it's that's [clears throat] why they work really well together. So, dental insurance is not the financial answer for most patients. It's once again, it's an additive, it's a supplement, it's an allowance. It rarely, unless I am you know, if I am under contract with several, you know, you know, in-network, you know, PPOs and >> Mhm. >> then um then I am relying on insurance. And I'm also I mean, once

again, I'm not saying it's a bad thing, but you have to tell yourself that if I'm going to rely on insurance coverage, then I have to tell myself that I'm going to be taking anywhere from a 40 to a 55% cut in pay. >> Yeah. >> And if I'm going to do that, first of all, I need to make sure that I'm that I'm calculating that. Here was Here would have been my gross production. >> Mhm. >> Here was my net after insurance write-offs. Or after

write-offs. Here's my Here was my net. So, if I'm, you know, talking to associates or if I'm talking to team members, here was what our gross production was, but after write-offs, here was our net. So, I want to make sure that I'm, you know, apples and oranges. So, I have to tell myself that if I'm going to be writing off 40% to 55% because I'm working under contract, under certain plans, what am I going to need more of? Patients. I'm going to need more patients. >>

Yeah, yeah. >> choose to have fewer patients and and gain more more income with fewer patients or I am going to have to seek out more patients because I'm getting less of I'm getting less income and getting less reimbursement from the dentistry. I'm not saying one or the other is wrong, you just have to you have to you have to understand that and they will they will those practices will operate differently. The fee for service, less insurance dependent practice is going to operate differently from the

insurance dependent, totally insurance dependent or heavily insurance dependent practice. >> The other day, Deborah, I was on this topic of you're talking about patient cohorts. Um, this is what I do on the weekend when I'm bored, I guess. Um, >> [laughter] >> I'm like, "Hey, what are the differences between a PPO patient, like the financial, the geeky stuff, the business stuff, right? What are the what are the the differences between a a PPO patient, a cash paying patient, and a membership patient, right? And how you're

talking about this uh just triggered the this uh weekend exercise. >> [laughter] >> Okay. >> It wasn't a weekend exercise, I'm kidding. Uh I recorded a a a podcast a couple Fridays ago with Dr. Dan Nelson. And um he is one of our uh clients here at Boomcloud and has an amazing uh membership program that they've grown uh over in Idaho. And um we dig into all their data and we found that that PPO patients on average for his practice, and these are his stats, right,

for his practice, >> Yeah. >> he spent like roughly around $400 a year. You know, with the practice or the year we looked at it. Then we looked at cash patients, they spent about $900. That's interesting. Well, we know why. You just said it. The 40 to 50% discount, right? And I would imagine they gave a discount to the the cash paying patients. But interestingly enough, the we looked at uh case acceptance for each cohort. The PPO patient case acceptance was about 30%. Yes, I'll do

the treatment. Cool. Yeah, you're use you're using the the benefit, the the allowance. >> Right. >> That makes sense. The the the cash patient said yes about 20 to 24% of the time, right? To to treatment. Cuz they didn't have an allowance. They don't have things, right? >> Right. >> Um and then we looked at the membership patient, they spent on average $2,200 a year. That's including the subscription, right? And they said yes to treatment about 40 per 40% of the time. So, I'm like, "Oh,

that's really interesting. Why is that, right?" Well, we know that that um PPO plan helps patients say yes to treatment because of the allowance, the limited allowance, right? But after that, they can't really go they don't really go past that. And you made a comment earlier in the podcast that insurance companies they don't The reason why they haven't increased it from like 1,500 to 2,000 or 300 allowances cuz like, "Well, nobody uses it." My theory is that well, it's cuz you guys designed a plan that

has limits. >> Right. [laughter] >> So, the patient of course isn't going to use all of it because of the limit the limiting and the red taping and all that fun stuff you guys do. It's almost like you've been in business. Insurance companies have been in business for some time. They they know what they're doing. >> Well, >> They've perfected their business model. >> And I remember back in the day, way back in the day, um insurance companies their goal was to make at least 30

cents on the dollar. >> Okay. >> Yeah, and then when when it when it dropped down to they were only making 14 cents on the dollar, they said, "Okay, we got to fix something." >> Sure. >> Because think about it. I mean I mean and and once again, hey, more power to them, but if you take a look at the annual income and the annual salary for a CEO of an insurance company and the annual income of a private practice dentist, >> Yeah, drastic difference. >>

Very different. >> Like shockingly. >> [laughter] >> Shockingly different. Yes. Yeah. And overhead different and building is different. >> That's the biggest >> They are what they are. And you know what? I will say this. Once again, I'm going to um Um I belong to a group called the Academy for Private Dental Practice. It's a great organization and it's been around for 60-plus years. They have a meeting every year um in March. >> Yeah, I think we've been to it a couple times with you. >>

This um this year it's going to be in Tucson. Last year, one of our keynotes was the incoming, who's now the current president of the ADA, Bret Kessler. Dr. Bret Kessler, he's a very he's a um uh inspirational. He truly was. I mean, he was very impactful speaker. One of the things he said about insurance, and I I embraced it. I understand. And he said, "Regardless of what you want to say, bad or good about insurance and >> Sure. >> um it did bring people to

dentistry who may not have sought dental care." >> Yeah. Sure. >> So, he said, "You know, you have to cuz you know, a lot of people um are not thrilled that Delta is all over the ADA site, the you know, the ADA page." And there was a dental school, I just saw this on Facebook this morning. I geek out between 4:00 and 6:30 in the morning and >> Yeah, we all geek out. >> And read I read all these the Facebook groups and you know, blah

blah blah. And apparently there's a dental school and their dental clinic is called the Delta Dental Clinic at that particular school. >> Okay. >> And um who I mean, who subsidized that? >> Yeah. >> Oh. >> Sure. >> Got insurance companies subsidizing uh dental schools. It it's not that it's it's not that it's dental dental insurance dental insurance is not going to go away. >> It's not. >> Help you learn to communicate what it will and will not do for your patients. >> I love it.

>> And what you expect it to do. And once again, I think you have to be realistic. Um you know, if you have a high volume low fee practice, I mean I have this client I have a client in uh in Iowa and she said, you know, I'm busy. She is now dropping plans. She said started her practice 3 years ago and she's a Boom Cloud client. She started her practice 3 years ago. She brought she she needed to build it quickly and she brought people

in because she participated on these in all these plans and then she realized I am booked out and I think I saw her February maybe and she says, I'm booked out until December but I'm not making any money. >> Oh, wow. She's booked out for uh for this till December. >> money. She's back She's booked out until December but she's not making any money because she was participating in these plans and so she was um accepting the fee that was on these plans. So I remember

being in her office and she was talking to um a patient and I believe it was um a removable partial denture and you know that cuz you're a lab guy. Lab person. >> Yeah. Yeah. I'm envisioning how to create it right now. >> So yeah, so yeah, put your lab hat on. So what is a lab fee for a um upper removable partial denture? What's the lab fee for that? >> Oh, jeez. Now you're testing I've been eight I've been like 9 years out of the

dental lab. I don't even know that. >> But on the average [clears throat] >> A few hundred, I don't know. >> Oh, I know. I'm going to say it's probably four or five hundred dollars, right? >> Yeah, probably. Yeah. >> removable partial denture? >> Yep. >> Um >> All in with all the all the stages, yeah. >> Yeah. >> Um her that plan is going to reimburse this doctor $660 for this removable partial denture. >> Okay. >> She is going to the patient's going to have

to come back how many times for that denture? >> Yeah, times that >> many how many visits? So, the doctor after paying lab might might net not before overhead, not before personnel, not before rent, not but she might net three hundred and some dollars after insurance after she pays her lab bill. >> Yeah, and then and then she's got to have yeah, the hours from employees, supplies, and all that stuff, yeah. >> She's got to turn the lights on. She's got to put the key in

the door. >> There's some There's some removable dentistry that like when when the practices get there, their check from the insurance company, they're underwater already. >> Yeah. So, I always say to the patients, you know, once again, we'll do our very best to help you receive whatever and if it Well, it doesn't work, we'll go back to If the patient says, "How much do you charge for?" Same thing, "Do you take my insurance?" We always We always say, "I'll be happy to tell you how we

handle insurance." We I avoid saying, "Unfortunately, we don't." or "What insurance do you have?" "No, we're not in network." They're going to hang up the phone. I'm not going to say we take we accept all insurances without limitation. So, you know, "I'll be happy to tell you how we handle insurance and we can talk about that plan." and we can say, "This is the This is the relationship we have with that plan. We are in an out-of-network relationship with that plan." But I think it you

know, it even goes back to "How much do you charge for?" Same thing, you got a telephone shopper and and back in the day when we heard that there was a patient on the telephone who was shopping. It was like, "Oh, it's a shopper. A shopper." >> Sounds like a buyer. >> [laughter] >> Yeah, yeah, exactly. They're a buyer. >> Yeah. >> We'd say things like, "I'm sorry, we don't quote fees over the phone. Neener neener neener." Or, "You can't We can't quote a fee over

the phone until you come in for a complete examination and x-rays and then we'll sit down and tell you what you need." >> Yeah. >> You know, you know, once again, I'd be happy to discuss our fees with you. >> Yes, I'd have Yes. >> Before I do, can I ask you a couple questions? And then what I'm getting around to, do you know, how did you What inspired you to call us? I mean, it sounds like you're looking for the right >> curious. >> Yeah,

so tell me a little bit more about what you're looking for. Um what When I'm asking questions, I'm in control. >> Yes. >> So, but I also think if you're getting ready to talk about your fees, it's, you know, our fees are based on three things. Our fees are based on the the skill required to do it right, the time it takes to do it well, and the materials that we use, the laboratories with whom we partner, um the quality of care that we seek to

provide our patients so that we know that you're going to be satisfied with your end result. >> Yeah. >> So, fees are based on skill, time, and materials. And so And I will actually even say to the patient, >> I love that. Fees are based off of skill, time, and materials. And quality. You can add quality there, too. Yeah. >> Um well, you once again, skill to do it well, time and the the time it takes to do it right means >> [laughter] >> The time

it takes to do it right means quality. Um and then I will say to the patient, you know, if you're looking for the practice with the lowest fee possible, we may not be the practice that you choose. Cuz that's not what That's not what That's not what we're known for. >> Yeah, we want to make sure that you've got quality. >> Yeah, yeah. >> You know. >> So, we would rather, you know, what in our our feeling is, whether you paid $400 or $4,000, if you

aren't happy, you paid too much. And if you didn't receive If you didn't feel that you were taken care of in the manner which you that you should come to expect, then then we'd we would rather explain our fees once than after ever and then ever have to apologize for your experience in our office. >> Yeah. Oh, absolutely. I love that. >> And it kind of it marries into even talking about insurance once again. Yeah, um yeah, we're we're just not going to let the the

exceptions or exclusions or limita- limitations dictate the quality of care that we know we can provide. >> Yeah, that's so good. >> The note that we know we can provide. >> The opposite of that is years ago when I was at the dental lab, I remember receiving a a lab slip that said it said this word for word, "Please fabricate the cheapest crown possible because of the patient's uh peop- the insurance, right?" >> Right. >> And I'm like, "Geez, doc. >> [laughter] >> Like, one, if

I were the patient and I saw that, I would be angry. >> Yeah. >> Cuz I'm like, "I want quality things whatever you you from from medical professionals. I don't want the cheapest thing." And this is me as a patient. There's definitely patients out there that want the cheap things, right? >> here's But here's the other reality of that and I will I will um I don't even know where I heard this. It might have been one of my clients. It might have been my brilliance

one night. I don't remember, but [laughter] people who don't have a lot of means need the best because they can't afford to do it over. >> [laughter] >> That is so good. >> Think about it. >> Say that one more time. That was great. >> Yeah. People who don't have the means or people who are who, you know, who don't have a lot of money actually actually should be getting buying the best because they can't afford to buy it again. They can't afford to do it

over. >> Yeah. >> So, once again, I mean, uh I mean, I used kind of an analogy when we first built our house and you know, years ago, I chose the cheapest landscaper. >> Sure. >> I had to have it redone. >> Yep. >> Because they took shortcuts, short changes. They didn't unbind They didn't unbind the ball at the bottom of the trees. The trees died. I mean, they didn't grade the soil properly. They didn't create French drains where needed French drains needed to go. I

was naive. I didn't know. So, when it all kind of failed, it's like I kind of got what I paid for. >> Yeah, often the cheapest thing is becomes the most expensive thing. >> How duh. >> Because of the do-over, the redo, or whatever it may be. Yeah, that's actually I love that. I love I love that phrase. That was really cool. >> other thing, too, and I love this was this was from one of my clients. This is so funny. So, I had a I

did some work. I also do some work like with with plastic surgeries and surgeons. And I have a client in Seattle. Um he's a plastic surgeon and he does very, very very well. He's got an entire >> [laughter] >> He has an entire wall of Chihuly glass. >> Okay. >> A entire wall of his glass collection. And when you get off the elevator, before you walk in his door, he has a Chihuly glass piece that's probably 4 ft long and 3 ft high in this case.

I mean, it's amazing. Well, my client's mother goes to this doctor and I was talking to him, Norm, and I said, "Oh my gosh." He said, "You know, my mother's not wealthy." And I said and um I said, "She's not." He said, "No, but you know what? Poor people like nice things, too." >> Yeah, they do. >> And it's like >> And there's ways for them to get it. >> Well, [laughter] then why would you treat anyone Why would you treat anyone differently based on what

what you assume their financial status to be. Because I could sing that I don't have money and I do, and I could sing that I do have money and I don't. >> Yeah, you're absolutely right. >> Treat everybody the same and you're and you won't be in trouble. >> Oh, I love that. Man, there's a lot of good one-liners in here. >> [laughter] >> This is great. No, I love it. Deborah, this has been really fun. >> Thanks. >> Um I've lost track of time. I

don't even know when we started. I know it's just been great. >> think it's like it goes back to I would hope that what would happen is is I think it's important for team members to hear this because they've got we've got to get out of the mindset of all patients are insurance driven, all patients are financially driven, all patients can or can't afford. I hear so many times and you probably hear it too, you know, our patients are different, our practice is different, patients will

never they never would go for it. We tried that before. We've heard that before. It's like, "Wow." Um so once again, is what I what we started at the top of the hour. >> Yes. >> So you're stopping yourself before you start. And you know what? If you think you're going to fail, you're right. If you think you're going to win, you're right. >> Yeah, either way, yeah, you're right. Such a good That's such a good saying. Deborah, you got a website. I'm on it right

now. You've got these power tips for powerful dental practices, it looks like. >> Yes. >> Um how do people learn more from you cuz I've taken a bunch of notes here and it's like I scribble a lot when I'm talking and um but they're so valuable and and and and I say that because a lot of what you're saying is universal that I can apply to even my own company. I'm not a dentist. I don't own a dental practice, but I am a in a customer

business and everything you said here can apply to, you know, my own company. And how how do our listeners get more from you? >> Oh, that's so fun. >> [laughter] >> They can go on my They can go on my website and request more information. They can I can actually I would be happy to throw out my cell phone. I don't have a meter on it. I mean they can call me on my cell phone, they can text me. Um I think they I'm getting ready

to do a virtual I was doing a zoom training for an office at the first part of December and she actually heard me speak and then she went on and say, "Hey, would you do would you do a zoom workshop for my team?" So I'd like to have them hear you. Um my cell phone number is 704 904 3459. If you miss a digit and and say 3458 you're going to call Ross and he won't know what to say. You know what I always >> The

bald the bald guy will be clueless. >> The bald guy will say call call call it. You know what now you know what now when I give out a phone number here's what I often I see isn't that isn't that an O? Isn't that O a zero? It's a it's a 70. >> Yeah, zero. >> It's so funny how many people we all say O. It's not an O, it's a zero. 70. >> Yeah, yeah. >> [laughter] >> Thanks for clarifying. >> I I always say

zero. People always repeat it back to me and they say O and I go, am I right or they right? Does it matter? It's a zero. >> [laughter] >> That's awesome. Yeah, I uh >> punch it in but >> I'll put your I'll put your your website as well in the show notes. Yeah, reach out to Deborah. She's amazing. >> my dental business school too and I'm doing one I'm doing New Jersey, California and Charlotte. Um there's dental school two day. >> We we should have

you do a session here in Utah at at our office here. I think that'd be cool. >> Oh my gosh, I should. >> You should. So many practices here in Utah, Deborah. >> Oh, and so many practices are in Utah and so many dental companies are >> In Utah. >> Yeah. >> They're all in Utah and you all kind of know you know, you kind of mingle. >> Yeah, we're all on the same street. It's funny like literally I can throw a rock and I can

hit Solutionreach. I can throw another rock and I can hit I can hit Weave and I can throw a little another rock with a little bit more thrust and I can hit Dental Intelligence. They're all We're all here. It's weird. It's the I have to say it's It's probably the fluoride in the water that's created so many dental tech companies here in Utah. >> Well, okay. And without offending anybody, and I say this, and we won't get into any sort of religious things, it's probably because

Jesus did visit the American >> [laughter] >> That's it. You nailed it. You nailed it. That's the That's the reason. >> I heard. I mean, I was talking to Jesus. Jesus is in Utah. >> Yeah, Jesus is in Utah, too. >> Yeah. [laughter] So >> That's so funny. I love that so much. Go to Deborah's website, book her, go look at her speaking schedule, register for her business courses. She's amazing, as you've just witnessed on the show today. With that said, we hope everyone has a

rocking day. >> See you. My dog says goodbye. >> [laughter]