Combating the Bureaucratic Empire of Dental Insurance

[Music] welcome to the navigating dental insurance podcast where we don't take from insurance companies here are your hosts Mr Jordan comto and Mr Ben Tu this podcast is sponsored by boomcloud Dental membership software www. boomcloud apps.com and ver Dental resources www. Veritas Dental resources.com enjoy the show what's up everybody and welcome to another episode of the navigating dental insurance podcast I am your co-host today Jordan comto with me as usual Mr Ben what is up dog what's up Jordan what's up everybody it's great to be

back we're relaunching the seot ppos and couldn't be any happier to to to kick this back off the ground yeah baby back yes New Seasons new episodes coming your way we're excited to be doing this podcast once again Ben always fun hanging out with you brother yeah absolutely love love talking about all things uh insurance and all things membership plans yeah absolutely today the episode title is combating the bureaucratic Empire of dental insurance one of my favorite title titles Ben I've been thinking me and Ben

had a call with Dr Mark coses uh yesterday and we we were talking on how complicated it is to make a buck in dentistry oh yeah so today we want to dedicate this podcast on making that easier for practice owners and office managers and then discuss uh our live event that we're going to be doing at the end so Ben I got a question for you what are ways from your perspective to help combat the bureaucratic Empire of dental insurance you know it's uh dealing with

insurance as everybody knows is is not the funnest thing it's not the easiest thing and we put way too much trust in what the insurance companies say yes so that's that's Ru yeah rule number one is you always have to remember that the insurance companies are not on your side you're are not um within their scope of who they are responsible for you're not one of them so it's funny when I when I get calls from clients and they say I called this insurance car and

they told me this and my immediate impression was and you believe that or my my first question was and you believed it and they said well yeah that's what they told me I like come on well that's that's problem number one in dentistry when it comes to insurance is we we put too much trust in the insurance industry that yeah they have no fiduciary responsibility over dentists you know they their their primary fiduciary is the patient right and and and so probably yeah when you look

at the uh shareholders yep that's that's that's their number one are the shareholders legally Yeah by law yeah they make it look like the the patients are their number one but um at the end of the day there the job of the insurance company is to deny deny deny you know PID the least amount of claims so so don't trust anything that they say yeah Ben why do why do you think they deny so much well it's it it's a model that's designed to um earn

dividends for investors and shareholders it's not it's not a model to provide care for the public at least dental insurance I make I might it sued by that statement but to the insurance industry show me that I'm wrong show me that your focus is number one patient care right and then and that includes compensation for the providers the D the the doctors that are performing patient care and they're the ones that are ignored the most you know when it comes to the Dynamics of insurance p

and providers and dentists or doctors right yeah the doctors are the ones that are ignored the most you know and so you know so so it's a business model it's not necessarily one that's Honorable in the sense that yeah we're going to create Insurance to take care of people take care of the public get people healthier no no no no it's more so the numbers work for us to have a really good model for investors so let's make let's make the numbers look good on Wall

Street and all the while we're neglecting what the patients need and what the doctors need to get you know so yeah it's a vicious cycle yeah it is a vicious cycle yeah so it's hard it's hard to make money because of insurance complicated number one we shouldn't trust uh everything in insurance companies say say so so think due diligence what whatever they say or do do some of your of your own due diligence oh yeah yourself yeah a good example is uh uh gosh ago we

had uh you remember Melissa Melissa Dunham yes she came out to several of our meetings or events yes what is she doing these days not sure I'm gonna reach out to her it's been a long time but she um so interestingly she had a fight with United Concordia because United Concordia was making a determination on on eobs explanation of benefit statements that were against their own policies and so Melissa pointed that out to United Kia and said hey on these buildups it it indicates that all

you need is XX and X in order to to unbundle the build up from the crowns and United Cordia said well no our policy say x and she's like no this she sent them a copy of their policy saying this is what you sent me as your policy and you know what United Concordia did what the next day they they edited that policy on the bill geez they changed not anymore we're we're changing yeah and so so that that that's what I mean by you don't

trust them because they can have a policy all they want but at the end of the day the American demo Association owns the CDT guidelines so when Insurance carries right policies that go against the CDT guidelines then you know at that point there's a there should be a dispute with the Ada saying hey you know you're leasing this to you know the CDT to United Concordia and they're changing the definitions which they're not allowed to do right yeah but in but insurance companies know that most

dentists don't know that that's the dynamic of the CDT that it's it's owned by the Ada and insurance carriers agree to abide by it but they change the CDT definitions for their own benefit all the time the insurance industry that is um so that example with Melissa kind of opened the door for me to dive into it further and holy smokes have I found all kinds of um unnecessary uh write denials yeah writeoffs for dental practices you know they're not getting paid and you know what

the averages so we've been we've been mining this data among our own clients do you know how like for a single doctor single location this number might might be too good to be true but the numbers are the numbers you know what the average write off is like unnecessary write-off or unnecessary loss of income when you're dealing with insurance annually is 300,000 oh every year 300,000 every year for a single practice yeah let's do some math on that because I've I've written some articles on this

too because it really bothers me so the average rof is $300,000 a year the the average dentist I looked it up practices for about 40 years MH so that is $12 million of writeoffs over your career in dentistry what could you do with that type of Revenue that comes to you right can you can you you can retire really well with that or you can reinvest into a bigger better practice right that generates more revenue and um sell the practice and retire that way too right

so I look at this a lot like holy smokes there's so much revenue wasted and and written off in the dental industry when it could be helping the practice owners and their team members and their patients it just goes it just disappears it's the invisible cost of Dentistry oh yeah yeah yeah that big right off um and and and a lot of the write- off is undetected that's that's the sad thing about when you're dealing with insurance is you don't know when they're making a mistake

and so and then there's so much other things that that bothers me yeah that's why I'm a big fan of like you know just doing a a cash fee or I'm Excuse me membership plan you know for your cash PA getting uninsured patients to switch over you know that's that's a that's a trend in the industry these days where people don't want to do business with insurance right dentists don't want to participate with insurance funny yeah it's funny Ben I've been I've been at this for

a while right in in the dental space and so of you I recently went to New York and to to an optometry conference because we've organically at boomcloud help help optometrists because it's the same problem over there and it's so sad to see these these business owners these entrepreneurs right that are in Optometry and dental struggle so much with insurance it's like holy smokes this is this has been a big struggle a big pain point for a while what are you going to do about it

you're just going to take it and right off the $12 million of your in your lifetime or career it's kind of crazy I know I know it's interesting diving in into other subsets of medicine it's like holy smokes the problems there are the same but they worse Dentistry has it better put together yeah Dentistry do compared to yeah I know and still we're still we're still lagging behind in terms of what what we should know about capturing all the revenue that you're entitled to as a

participating provider of Insurance you know it's it's a tough world but totally I'd say if you I mean so so the part that I learned Jordan with with that 300,000 is most dentists don't even know like you could have the best billers but the Dynamics of the dental practice where you have so many people wearing so many different hats right sure and sometimes it's hard to detect when you're being well when you're writing off something that shouldn't be written off it's hard to know because we

put too much trust in what the EOB says right thinking that okay that's the law that's the final word no it's not you know American Medical Association they they discovered that 19.3% of claims have errors on them meaning the insurance carrier processed them incorrectly yeah but when when I look on when I look at Dental so I'm I'm know I I mean um the process in which you can establish those findings as a legitimate study we're not there yet because that has to be done with

multiple organizations right comp study it but I've invited the competitors to study the same numbers so in dentistry the claims error that I've detected is almost pushing 40% for some practices it's more than that and you got to ask yourself Jordan are they really errors or are they intentional insurance company are they like yeah we'll throw it in there see if they see if they're paying attention it's like oh it was an honest bull crap like there's a pattern of you doing this like for since

History of Time goodness you know yeah so that's the big battle you know when you ask that question how to what things to focus on number one is don't trust it don't trust the insurance companies you trust if you want to trust you trust but verify trust but verify do your due diligence yeah what what other ways a practice could combat these issues that that you're seeing over overriding off too too much revenue yeah so to me um I I'm a big fan of the whole

part of the sort of navigating out of insurance if you can slowly replacing um strategically yeah strategically which you know we talk about that quite a bit on this podcast and with the other podcast that we do you know the the biggest part of that is that what we've been seeing so far is patients are staying with their dentists you know unless they don't have any out of network benefits that's where a membership plan would be perfect right sure where we do see this a lot

like a lot of Medicare programs senior citizens and I know that you talk about this quite a bit Jordan where how many how many people are retiring like every month or they're leaving their P plan uh I believe it's like last I heard um it was I think it was like 10 million leaving leaving a yeah leaving a PO plan because they're retiring like they're they're they're uh they're not getting their corporate benefits right so a lot of like seniors or and seniors sounds so weird

to say when when you're like 55 and up let's just say people are at that age need more dental care and I saw this at the when I worked at the dental lab we that was just a lot of our clients just patients that were 55 and older roughly um they came in from dental offices and often the they lose their insurance benefits because they're retiring or they're self-employed and retiring as well and aren't really paying for dental insurance you know at that that uh stage

of their life and they need more care and the dental dental insurance really doesn't do much for them for the care they need I think what if you need an implant I don't think you can even get that covered through Insurance yeah maybe one or half of one half of one yeah so and a lot of patients need more restorative work at that that age so um that's kind of the stats that I've heard is about 10 million retiring and then 20 in 2020 it accelerated

like crazy oh God I think 20 I think 20 24 to 30 million people retired earlier than planned on top of what what was you know the average yeah so the bucket the opportunity you know to help those patients just grew quite a bit because of of not getting they're not getting insurance right y some of them do obviously so that makes perfect sense because what we've seen among the retire es is that the Medicare plans in dentl have exploded they've they've they've really skyrocketed since

20120 interesting and I haven't been able to really put my thumb on it other than the fact that oh more and more dental plans are creating their Medicare Advantage Programs for senior citizens and consequently we're seeing more senior citizens on Medicare Advantage plans which to me is a big opportunity loss for dentists yeah does it cover much no I mean you're paying like 30 five 55 a month for A500 or $1,000 annual maximum yeah so it's the same it's kind of the same when you do

the math on that that's a fully insured plan so so for those of you that see a lot of Medicare patients this is one of the reasons I'm going to do a pitch on for membership plans your in a second mainly because thanks Ben so this is what I've been seeing is um Delta Human United Healthcare a b like almost every one of them Etna Sigma have created Medicare Advantage plans a lot of which have started around 2020 2021 and what you're seeing is a lot

of retirees leaving the PO space and going straight to the Medicare PL space which is basically the p and down um and the the loss ratios so the percentage of what Medicare patients pay because it's pretty much considered sort of sort of a fully insured plan right it's not a group plan you're fully ensuring that so out of that the funds that they pay for every dollar they pay for a Medicare dental plan between 40 and 60 cents actually go towards the benefits so the question

becomes just f yourself yeah yeah is that an efficient way to manage your dental care is to pay a third party six 40 to 60 cents on the dollar to manage your benefits rather than you should have 100% go go to the dentist by doing it their membership plan right so if you're a dentist and and you do see a lot of senior citizens I highly recommend the the development of a membership plan because that 40 to 60% that you're not seeing and plus a lot

of that the patient doesn't have to pay you could recapture a lot of that and have the membership fee for the patient be less what you're paying on the Medicare side of things and they'll get more Dentistry out of it right yeah it goes directly to the patient there's no fluff right you know unless the patient doesn't use it which that's their choice um but we when I think about this model especially with the the the baby boomer uh population you know retiring more and more

it's a massive a massive Generation Um and they still need Dental Care need help um I think when I do the research I do a lot of internet marketing research and I find that there's literally hundreds of thousands of people every month and I haven't even gone through all the key words that people are searching for that are searching for a dentist that takes uh that works with patients without insurance it's wild to me we're we're we've built on boomcloud we've built the the dental Marketplace

to start to capture all those patients searching and funnel them through um to our practices at boomcloud that have membership plans right we're trying to capture it for our practices because we can do Nationwide marketing we're really great at it online and it's fascinating how many people are searching for you know dentists that don't that will do help them without dentist without insurance right and another thing I'm thinking Ben like the co like you and I and Mark talked last night on this it's really it's

really bothering me the amount of um it costs money to acquire new patients we all know this you have to do marketing and you have to convince the patient to work with your practice right oh yeah yeah so marketing and sales in the traditional business model um so there's a cost to acquire patients and then what's really bothering me is the cost to maintain the patient and and to the cost to continue to the cost to continue to acquire new revenue from one those patients meaning

the admin costs to to work with insurance it kind of bothers me because typically how uh great business models work is you you you pay the cost acquired through your marketing and sales teams and then you may have like a like in boomcloud for example we have a support team um but that doesn't cost me any any new money to um generate Revenue you know our our subscription from our software doesn't cost me new money it's just it's a static cost where in Dental it's it's

a dynamic cost that every time a new patient comes in there's a cost to acquire that that new revenue from that patient it really bothers me meaning your customer acquisition cost is never relieved um over a period of time right and that really bothers me because of what insurance does to practice owners and if you're a practice owner if you think the way I I'm thinking here you would be really bothered too because that's not how it should work you should be able to acquire patience

and not have these new costs to you know generate that revenue and make sure you get paid and make sure you're not getting uh tricked by the insurance companies you know it's kind of wild to me so yeah I think one of my ways to combat is two things you gotta you've got to turn on a marketing engine that actually produces new new patients I'm a mar I'm a marketing guy I love marketing it's all I do here uh with my marketing team at boomcloud so

you need good marketing period um and all marketing is is education and and content to to um Inspire the the patient to work with you yeah that's all it is it's pretty simple absolutely no I love that I I think that's huge there all those things that you mentioned and the last thing that sort of comes to my mind Jordan on on that question that you um sort of theme for this episode is you know the we've been sort of beat up on this whole concept

of wage inflation right there's that too there's a lot of inflation in dentistry yeah oh yeah every industry dentistry in particular has been hit very hard yeah and the number one so the number one struggle that I've been hearing across the country in terms of of bent practices is the inability to find Qualified people um to me it's more so the inability to offer a wage that is in the CR of what people are looking for right which is very high and and very uncomfortable a

good example is hygiene so hygienists um the wages a lot of times when you stack that up against a typical hygiene visit um you're you're e either breaking even or losing money right sure um and to me it's a mistake simply because when you look at hygiene the the number one thing that's missing with hygiene is the coding side of things I've been to so many hygiene lectures and you know that whole Dynamic of understanding patient interaction you know the clinical components especially with parodontal protocols

um but the one thing that's really missing with hygiene is coding is the interaction and pairing are they just not doing coding they're not doing it properly and and majority of practices so so a good example is um you know some hygienists uh on a daily basis would make anywhere between um $600 to ,000 in revenue for the practice right um um and and that's that's under the limitations of a poo plan right where some hygienists make3 to $500 an hour because of the the the

fee limitations when you're in netor with insurance but when you look at it correct like when you when you when you're actually billing correctly on hygiene side of things it's not uncommon to see hygienists produce 2500 to 5,000 5,000 is sort of on the anomaly higher end um for some some somebody's might be listening and say no that's our Norm well well you're you're doing better than most yeah you're above but you know the hygiene production on a daily basis doesn't it doesn't always have to

be limited by the the contractual limitations of insurance and fees it's more so how you're coding and how you're communicating and conveying with patients sure that really allows you to produce at that 2500 level or more on a daily basis and you know what you know I'm not the authority on hygiene but I am somewhat good with coding yeah that's what I hear yeah I understand on the street right yeah so what we're gonna do is we're gonna bring on Jen Jen is a one hygiene

hygiene coach that we use been and she's and the best thing about Jen in terms of this discussion is that she's a hygienist but she's also a coder she's a biller for both dental and medical and and so when you have that understanding um you could easily see the vision as a practice owner and how to get the hygiene department on a per hygienist basis to be profitable with today's wages but also with the right billing and and coding protocols which to me is a missed

opportunity in 99.9% of the dental practices out there Ben I would imagine that because I hear uh people talking or or practice talking that hygiene isn't isn't profitable but it like you said it can be oh yeah and what I've seen at least with our practices that Implement a membership plan and a way to combat not only insurance issues but wage inflation um is to increase your predictable recurring Revenue um because that that could pay for your costs rather quickly we have practices that I've seen

uh sore from a half a million dollars a year to in predictable recurring revenue from their membership plan to over a million yeah you know and I never thought that would happen when I when I started boom Cloud I I had no no expectations which is always good right yeah you're always happy with low expectations right that's right um but let me um to combat uh wage inflation and dental insurance you scale your membership plan and make your your hygiene uh Department profitable right that's an

aspect of it in addition to the the the proper coding and and just production if your hygienists aren't producing like you you got to look at those numbers and make sure they're producing more they're they're bringing in more Revenue than what what it costs right back to acquiring customers and you know making sure that your your Revenue per patient is is covered and not you know break even that's not a fun business to run trust me I've ran one of those before you know stressful business

model can't you can't even have fun on vacation because you're so no that yeah it's that's not fun so Ben let's let's talk about our event we're doing with Mark cosy we'll be posting some links in our show notes for the live event and then of course the recording but Ben why don't you talk a little bit about that we had a fun meeting yesterday with Mark yeah absolutely so we're going to uh the webinar is going to be on April 22nd which is a Monday

and it's going to be in the evening from Mountain Time perspective from 4 P PM mountain time to 6 P p.m mountain time that's 6 p.m M uh Eastern to 800m Eastern and then 3 pm Pacific to um 5:00 P p.m Pacific uh I think I missed Central but I think you guys can you can figure it out yeah Google it Google it yeah and so so the topic that we've decided to cover well there's a few so the the main theme is increasing income without

increasing production so yes Dr cus Mark cus is GNA be hitting on that well extensively in the sense of his professional I he used to own 10 practices yeah you know and and he still so he sold his 10 practices and now he runs a coaching business that still does uh you know 10 million plus a year probably a lot more than that you know it's a big business you know as a nonclinical entity it's quite impressive what he's been able to build and then Jordan

and I are sort going to hit on of course there's there's tie-ins to the the expert components of what Jordan is an expert at which is membership plans but the theme is combating the bureaucratic Empire of dental insurance exactly how Jordan introduced our our episode for today and you know and the idea is to to teach uh dental practice owners how to take home more money without increasing treatments you know just looking at the existing patient base the ex existing numbers that you have and that's

a smart way to grow yeah exactly so even from like um and we and hopefully we'll have Jen on our our hygiene coder and hygienist um to sort of talk about to kind of wet wet your appetite on a lot of things that we're going to talk about during this webinar in the sense of really capturing the low hanging fruit that already exists um helping you identify the low hanging fruit that you cannot see from an insurance perspective and a membership plan and just a general

business perspective as well so so yeah so you'll see those uh registration links in fact once we have that we'll post it uh under the show notes for this episode so just stay tuned on that or you can email us um uh at our well we'll post our email addresses in the show notes so that you can get a hold of us if you want to follow up on the registration link for that but yeah check out check out Jordan's website boom cloud.com my website veritos

dental resources.com and I think uh I'm not sure uh is if Mark's going to post it on his website but what website does he use these days is it the true Dental success.com yeah true devil success.com to learn more about that event coming up on April 22nd April 22nd baby all right with that said thank you so much for listening to the episode today Ben both Ben and I are super pumped to be back recording episodes on the navigating dental insurance podcast with that said we

hope you guys have a rocking day thank you [Applause] [Music] everybody what