Podcast (Dental)

What Dentists Might Consider When it Comes to PPOs

May 10, 2023

There are many external factors to consider when making the decision to sign a contract with a preferred provider organization (PPO). In this episode of The Art of Dental Finance and Management podcast, Art meets with Katie Fornelli and Matt Nelson from California Dental Association (CDA) to discuss what a PPO is and the evaluation process dentists should follow when deciding whether to sign up or stay in a contract with a PPO.


katie fornelli

Katie Fornelli
Director of Early Career Dentist Engagement
California Dental Association


Matthew Nelson
Practice Analyst
California Dental Association

Show Notes and Resources:

The Transcript

Art Wiederman: And hello, everyone, and welcome to another edition of The Art of Dental Finance and Management with Art Wiederman, CPA. I'm your host, Art Wiederman and welcome to my podcast on this beautiful March Thursday morning here in Southern California at the World Broadcasting Headquarters podcast here in South Orange County. We're not getting any rain today, which is nice. We're gonna get some on Friday, but All right, enough with the weather report, folks. I've got a great episode for you today. I have two of my dear, dear friends in dentistry from the California Dental Association today, Matthew Nelson and Katie Fanelli. We're going to talk about a couple of really, really important topics. Number one, what's going on in organized dentistry and what does CDA do and all that kind of stuff. But the gist of our conversation today is going to be talking to you about. The world of PPOs. And this has been a big, big topic with our clients, with dentists at the CDC. I talked to the CDA folks on a regular basis, and it has been one of the top conversation topics. Should I sign up for Pose? Should I stay with people or should I go out of network? We're going to have all that, and Katie and Matt are experts on this topic and we'll get to them in a minute. But I want to just get some business done before we get to them. First of all, I want to again thank our incredible marketing partner, Decisions in Dentistry magazine. Lorraine Kent and her team have just the best clinical content of any publication out there. You can get 140 continuing education courses for a very, very reasonable price. Go to WWW.DecisionsinDentistry.com and take a look at all the great stuff that they've got going on. I do want to share with you and we'll talk to Katie, Matt a little bit about that because we've got some live seminars coming up. And again, I'll let Katie and Matt tell you a little bit about that. In June in Northern California, for younger dentists who are trying to figure out what how do you want to take in your career? So we'll tell you a little bit about that. I do want to let you know that we will be at the California Dental Association. We not only do we have a booth and we are booth number 1472. I would love for any of you who are listeners of the podcast are going to be at CTA in Anaheim to come by, say hi, give me a high five fist pump handshake, whatever it is that suits your fancy. I'd love to meet you. I've gotten many, many emails. And from from you telling us that I think we're doing a good job on this podcast. So I'd love to meet you. I'm going to be giving two potentially three talks that are at CDA, so I'm real excited about that. So the CDA is middle of May and you all know when that's going to be. So if you're going to be out here for that down in Anaheim, we'd love to see you. Before we get to Katie and Matt, I want to reiterate again what's going on with this employee retention tax credit. The Internal Revenue Service came out on March 5th, I believe it was. And again, this this podcast will air probably about a month after so sometime in early April. But I r 2023 Dash 40 the topic that the IRS put out to the public, the title is I'm going to read you the first couple of paragraphs says IRS Issues Renewed Warning on Employee Retention Credit Claims False claims generate compliance risk for people and businesses claiming credit improperly. I'm just going to read two paragraphs from this from Washington, DC. The Internal Revenue Service today issued a renewed warning urging people to carefully review the employee retention Credit I.R.S. guidelines before trying to claim the credit. As promoters continue pushing ineligible people to file, the IRS and tax professionals continue to see third parties aggressively promoting these FRC schemes on radio and online. These promoters charge large upfront fees or a fee that is contingent on the amount of the refund, and the promoters may not inform taxpayers that wage deductions claimed on the business. Federal income tax return must be reduced by the amount of credit. Many of these promoters do not even ask you did you get a PPP loan? Because that has to be taken into account. Folks, I got something on my Instagram feed this morning and it said, Don't listen to your CPA. They don't understand I.R.S. And the reason that these promoters are getting very, very aggressive folks is that their window is starting to run out because you have to amend your second quarter payroll return until July 31st of 2023. So that's about three months from now. So once that window closes for the second quarter, three months later, the window is closed for the third quarter and then the 2021 windows have about a year left. But these promoters are coming aggressively, not only after Dennis, but every single type of business. Before we came on the air here, Katie was sharing with me that CDA is going to do a publication will be out by the time you listen to this podcast. But just promise me, be careful if you have a problem and someone is pushing you to do this and you're not sure, send me an email at ArtWiederman@EideBailly.com. You know, my office phone number is 6572793243. You know, I will. I will. Be the voice of reason. And I'm not going to get much more into this. But folks, you really want to be careful about this. It's kind of like I equate it to if someone called you up and said, Hey, I've got this. They don't know you. You don't know them. I've got this great investment opportunity where you can make $1,000,000. You know, would you sign up for that from an unsolicited phone call? I'd be very, very careful. That's all I'm saying to you. Okay. Let's get to our guests and our topic. My good friends from the California Dental Association, Katie Fanelli and Matt Nelson, we're going to talk again, as I mentioned, a little bit about organized dentistry, what's going on with K2. And we're going to spend the gist of our time on how PPOs work. So let me first tell you a little bit about both of them. Katie Fanelli is the director of Early Career Dentists with the California Dental Association. She has 20 years of industry experience and she offers career advice, education and practice management guidance to early career dentists. Previously a practice management consultant and coach. She has led hundreds of dentists and dental teams on topics such as leadership, strategic planning and practice systems. Matt Nelson. Matthew Nelson is a practice analyst with the CDA. He specializes in areas of practice management, dental insurance plan analysis and embezzlement. I hope he doesn't specialize in embezzlement. I think he meant he specializes in being able to find people who do embezzlement. He has. I know. I can assure you he does not specialize in embezzlement. He has lectured at CDA Presents and had at component Dental Society meetings. His current work with the CDA Practice support includes providing guidance and information directly to members. He has been in the dental field since 2015 as an office manager of a large group practice and in private consulting. Prior to dental, he worked in various leadership positions for large corporations that developed his ability to lead large and diverse teams, and he is a graduate of Cal State, graduate of Cal State University, Chico. And the reason they're on my podcast, folks, is they both laugh at my jokes. People that don't laugh at my jokes are not allowed on my podcast. Is that right, guys?

Katie Fornelli:That's right. We were laughing on me. We were there with you.

Art Wiederman: You were that you were.

Katie Fornelli: Especially not embezzlement.

Art Wiederman: Yeah, exactly. You were laughing with me. Not at me, right? Correct. Well, welcome to the podcast, Katie and Matt. It's great. We've been talking about doing this for a long time, and I'm finally we glad we finally got to got to this. And I first want to thank you and not only the California Dental Association, but this is a national podcast. If any of you are listening who are part of organized dentistry or part of local and state societies, all of you who partake or participate in helping dentists and helping the dental profession through organized dentistry. Just thank you so much. It's the work that you guys do is so, so important for the great profession of dentistry. So welcome to the podcast and well, let's start out guys. Yeah, I talked a little bit about, you know, what you do to get a little more into detail about Katie, a little more about you were a consultant and then you were now you're working with the younger dentists starting up. Tell us a little bit about that.

Katie Fornelli: Great. Sounds good. Things are great introduction. That's correct. So that night we both have very similar backgrounds and we both are experts in managing dental practices and we both have been consultants and coaches in dental practices for my experience was with a large nationally recognized consulting firm. And then I've also independently consulted and coached for four dentists, and that started out as an office manager and in a large practice and then as well evolved into consulting our roles at CDA. And we really look at ourselves as the business hub for your dental practice. So we are in the practice support department, we are the practice management experts. My focus now, of course, as you mentioned recently evolved into early career dentists, but I have experience working with with practice owners and with associate dentists and helping practice owners, as you know, transitioned into practice ownership out of out of practice ownership when they're ready to retire and move into another phase of their career. And so what we offer is we're like I said, we're kind of like the the business hub. You can come to Cder, you can call us, you can email us, you can go on to CDA.org. We have over we have hundreds of resources and having to do with managing every business element of the dental practice. So if it's not clinical and if it's more on the business side, if it has to do with dental benefit plans, employment practices, practice management and regulatory compliance, we we have a team. It's not just me and Matt. There's there's eight of us who are all experts in managing dental practices and and and helping you navigate through all of those business decisions that impact you every day. And it's important to note you don't have to be a practice owner to contact us. And I get a lot of calls. Obviously my role with early career dentists, most of our early career dentists are associates, and when you're an associate in a practice, you're often an employee. So we represent our employee dentists we represent and dentists who are working as faculty at the dental schools. If you're working in a public health clinic at an in a more of a clinic environment, if you're working for a corporate dental practice, we we help you navigate all of those career decisions and anything that would impact you from the business side.

Art Wiederman:  It's the resources that you guys provide are amazing. And doctors, if you're in California or in any other state, take advantage of your state and local component dental societies. They are there to help you to be successful. Matt, what's your story? Do you laugh at my jokes? I know Katie Does Katie always do? Do you laugh at my jokes?

Matt Nelson: Yeah. Yeah, definitely. After you called me an expert embezzler, you know, I was like, I guess I need to read. Where is my bio? That's great. Well.

Art Wiederman:  You know, I always help doctors, you know, to improve their their and increase their net worth. I guess that's one way to increase your net worth. No, let's not do that. So what, what's your history in that?

Matt Nelson: Yeah, a lot of like Katie said, you know, I did a lot of leadership for big corporations before moving into the dental world and, you know, bringing that that leadership experience and training experience and and then getting to learn dental and then coming in now into CBA and being able to share that and create resources and and share with with our members. I think it's pretty rewarding when you, you know, you get a call from a member that probably didn't even know that, that the practice support division existed and then being able to give them everything they need to to either improve a process or fix a situation or whatever it is. And then to to see how how thankful they are to know that you had a little impact in assisting someone make their practice better. It's just it's extremely rewarding. And so, you know, being able to take this this like experience that that we've gained in, you know, managing practices or big practices are working in group own practices or working in consulting and seeing a little bit of everything and being able to share that experiences. It's very rewarding work.

Art Wiederman:  No, no, it absolutely is. And I again, I've been dentistry almost 40 years and what the societies do are amazing. So real quick, let's talk about advantages to organized dentistry. I don't see any disadvantages to being involved in organizing. It's all advantages. And what can a state organization do for its members? Guys, talk about that.

Katie Fornelli: Well, I think we're we're a little biased, obviously, but of course I am, too. But I think that, like Matt said, when you've worked outside of organized industry and you may not even realize all the things that we offer at K to come to come work for K and realize all of the different departments and resources and benefits that we offer. It really is. And it's it is impressive. So outside of our department of practice support and you know, we have we're the largest state association in the country. We represent 70% of dentists in California, which is really important because that makes us a much stronger voice legislatively for our members. We represent 27,000 dentists in the state of California. So our numbers are just, you know, sheer volume of numbers. It's it's quite impressive. And so obviously, we we offer advocacy and legislative action for our members. We offer practice support, which is, again, that business hub for your dental practice and education. You mentioned K Presents, which is our in-person live conventions. And I mean and they're and they're they're huge. We have 20,000 attendees at our Anaheim convention and so and then we offer another one in Northern California in the fall. And we have online learning. We have an online learning platform now where we have webinars and different modules that you can take and lots of online learning opportunities. And then as you I'm sure our know, we also are subsidiary of CDA, as is the dentists insurance company. And so you have access to all of the dentists insurance company products, which is your malpractice coverage in addition to all of the business related insurance needs that you have. So those are kind of the top four benefits. Of course, there's there's other benefits in terms of, you know, there's other tiers within those benefits in terms of education and what we do in practice support. And but I think the biggest benefit is that we we support dentists. Wherever you are in your career, I think that there's often a misconception that we only support private practicing dentists, and that's not the case. We we represent all dentists and who are members. We even represent the nonmembers in terms of advocacy and legislation. And that's an important thing to remember as well.

Art Wiederman:  So I was going to ask you that can dentists and again, we're a national podcast, can Dennis outside of California or non dentists be members of CTA?

Katie Fornelli: You can absolutely. We do have an affiliate and membership category and so we do have a lot of doctors who are members with their state association and we always encourage that you want to join your state's association. So every every state has their own state association and you're usually it's a tripartite membership. So I'm not going to go into what that is. But you're we're.

Art Wiederman:  We're we're.

Katie Fornelli: Tripartite you're.

Art Wiederman:  Are you allowed to say that. Yeah.

Matt Nelson:  Right.

Katie Fornelli:Tribe five So.

Art Wiederman:  That sounds like a Jeopardy question. I mean I.

Katie Fornelli:Know. And when I go to the dental schools and I'm like, it's a tripartite and I just kind of get like the blinders on. So. Yeah, so it's a tripartite meaning you're a member of your local dental society, the state and the ADA. So it's a it's all one membership. And so we do say encourage you always to be a member of your state association. However, if you want to take advantage of some of the benefits we have in California, you can become an affiliate member. And what that would provide you with is access to our education, our access to CTA presents in Anaheim or in San Jose this year and access to our online learning platforms. So so it's a great option if you are not in California.

Art Wiederman:  And before I forget, let's talk about the courses that we're doing in Northern California. We've already completed the courses or by the time this podcast goes up on the Internet, we will have completed our two courses, the one we did in San Diego and the one we did in Riverside. But we have one on June 10th and June 22nd, I believe Are the dates so correct. Tell us about let's just talk about those courses and then we're going to get into the subject matter of peoples.

Katie Fornelli: Yes. So really excited to be offering these courses. So they are they are designed for early career dentists and as you mentioned, are it's really to identify your career path, what career path is best for you and what aligns with who you are as as a as a dentist, What do you want out of your career? We have art who's speaking on budgeting and guidance. We have my colleague Anders, who is going to talk about. Where the profession is going and using a lot of analytics and data about where the profession is currently and where the profession is headed. And then I'll be speaking on and different career paths and different career models and options for you as an early career dentists. And it's a great program. I'm really excited about it. And there we're it's really different. It's not in a conference room at a hotel. We're doing these really fun venues. Topgolf at a brewing company. It's we're making it really fun interactive. We have a full hour of networking so that you can mingle around the room, meet your colleagues and meet some mentors in dentistry, and then, of course, talk with the experts who are speaking at the program.

Art Wiederman:  So a lot of it. So they want to sign up for these because we do have limited space. I believe that they just go to Coorg. Is that what they do?

Katie Fornelli: Correct. Yes. So Coorg and under our events and our events page, so it's under virtual and live events under at Coorg and we have a landing page and they're called now and next and debt in dentistry mapping out your career. So there's a landing page for that. Yeah.

Art Wiederman:  Well I'm excited about that. And again, make sure if you do come to the CDA folks, I would recommend go to the CDOs. The CDA has a whole booth. It's not a booth really. It's an area near the front of the car on the conference floor. And you know what I would do if. I will bet you that most of you don't know. And by the way, this is not I'm not doing a paid commercial procedure. I just believe in what they do so much. Just go grab one of the folks from CDA and just say, Can you tell me what you do? And they will gladly tell you the different things. And you might say, I had no idea you did that. I had no idea there was this. I had no idea what they do, and there's just a lot of stuff. So I would encourage you. That's why they're there. That's why they put on the CDA Presents and all these programs. All right. So let's get into our topic, which is what I really want to talk about. What the three of us are very passionate about talking about is pose now. So let me give you a little bit of just a little statistics recent a recent survey by the CDA. Is there a theme there? A recent survey by the CDA on mind of the dentists shows that dental benefit plans this really interesting dental benefit plan decisions in negotiations is a top priority for CDA member, dentist and the ADA Health Policy Institute's most recent Economic Outlook and Emerging Issues in Dentistry poll found that one in six dental practices have dropped out of some insurance network since January of 2023, impacting 17 and a half percent of their patient base on average. So folks, just I'm just going to make a comment before we get started. Here is my experience is ever since the pandemic has kind of I'm not say, subsided because unfortunately, COVID 19 is here for the duration. But ever since our economy and our life has kind of gotten back to to normal, we are hearing Katy and Matt are hearing more and more about dentists starting to think about this topic. So let's let's get into this. First of all, give us, you know, post one on one, how do they work? What is a PPO? How does it work? How does it operate? Let's start with that.

Matt Nelson:  Yeah, you know, a PPO is usually an insurance that will allow the patient to pick their provider. They can go to that provider and there's an agreed upon fee schedule that's usually less than the doctor's usual and customary fees, but it's agreed upon fee schedule that the patients would get, you know, that cost. And in most cases the PPO will pay, you know, a percentage of the treatment towards that, leaving the patient a portion of pay as well.

Art Wiederman:  Okay. So and they're all they're all different. So you go to insurance company, a fee schedule may be different than insurance B, you know, B's speed schedule. Does it matter? Like what, what what part of the country you're in or how many dentist how does that how do they determine what the fees are? And we're not going to get into specifics. But, you know, how do they determine.

Matt Nelson:  Yeah, you know, that I think some information that, you know, we don't have all that information. I think that's a lot of its proprietary information from the plans. Right. And, you know, we have heard in some cases it's geographical. So in areas where there's less participating providers and that with that plan in that community, there may be, you know, an increased fee schedule or in places where there are an abundance of of providers in one area, it might be a lower fee schedule.

Art Wiederman:  Okay. So, okay, now we know what to. TPO is Why would a dentist want to join a PPO? Let's talk about advantages and disadvantages.

Matt Nelson:  Yeah. You know, I think a lot of the advantages are that it is it's like free marketing. And so if you're trying to build up your patient base or trying to get patients in quickly, you know, a lot of times that is is one of the easiest ways to get grow. Your patient base quickly is to be to be in contract with them. So you're listed on the website or you're directed to that, that practice when you call your plan to find out who's close by. So I think, you know, growing your patient base quickly is a really good one. I think, um, you know, patients that have maybe like a lower patient portion that they need to pay, you know, that's another reason why they might want to go there to your practice.

Katie Fornelli: I see with associate doctors because I work with so many of the dental students who are graduating and getting ready to launch their career that they're presented with. Here are the five plans or the ten plans that the employer is asking them to contract with. And a lot of times they just it's part of the employment agreement and you just sign up for them because that's what you you do as an associate and you might be working in multiple locations. And and, you know, you just you sign up for all those plans as part of your employment agreement. And then, you know, you start you start working as an associate and you you get further into your career and when you go to start a practice or you go to go into a group practice situation or a partnership, you just kind of carry those, those plans with you. So so sometimes it's just like an early career decision and, and, and it's part of the job.

Art Wiederman:  Okay, So now I'll tell you some things we see is is, you know, when we have it's amazing to me that dentists are still starting practices all over the country on a regular basis. A lot there's a lot of new practice. And I think that's fantastic because that shows the entrepreneurial spirit of the dental profession. But we're also seeing dentists being told that when they start a practice that they should sign up because they have no patients, not they don't have patients with people, they don't have patients to treat. They start from zero. They've got this overhead that they've got to cover. So they need bodies in the chairs to cover their overhead to pay the bills. Right. So people say, Oh, you should just sign up with every single PPO. Is that a good idea? I know the answer to the question, but you tell me what you think.

Matt Nelson:  Well, I'm personally never a fan of the all or nothing. You know, like the always or never do this approach. But I think you've got to have a strategy in place. And I think you need to evaluate each plan individually and make sure that it actually works for you before you get into network with that. I mean, there's so many things to look at, like would be employer groups are in the area. You know, if you can live with those three schedules, look at the limitations and exclusions and see if those work for you. You know, there's so much that you need to evaluate with that. And it is a good way to get patients in quickly. I you know, you are contracted with the plans. It will help you, especially in a startup, grow that patient base quickly. But, you know, I think if you're taking that time to build a startup and design the practice the way you want the practice to be for you, you should also take that time with your contracts and make sure that the contracts represent what you want to represent in your in your practice, and not just sign up with all of them because then you're you're doing all this stuff to build a startup great in your vision. And then if you're just going to sign up with every single contract, then you're, you know, you're kind of off your vision on that part.

Katie Fornelli: Yeah, I agree. One thing. So that night we do a presentation and Matt is going to be doing this course in Anaheim. For those of you who are going to be at K Presents and it's called to contract or not to contract, and we start that course with encouraging the doctors in the room to define your practice model. And so good decision or bad decision really comes down to what is the desired practice model that you're trying to achieve and does the plan contract align with that practice model? So so we all you know, we hear from a lot of doctors that say, I want to be a fee for service practice. Okay, well, where is your practice located? What are the patient demographics? What are the employers in your area? And do you have a lot of unions? Do you have, you know, a lot of individual and small business owners that do not provide dental benefits to their to their employees? So it it's important to look at what is the practice model, what is your desired practice model? Do those two things match? Can you switch the practice model if that's not your desired model? And a lot of you know, of course, we're in California. I mean, we we talk to doctors every single day are two and they may want to switch their practice model and move toward more of a fee for service practice model. But there are areas in California where it is really challenging and I won't say impossible, but their patient demographics will not sustain a fee for service practice. And so that's that. So good or bad all comes down to those external factors when you're looking to purchase a practice or start a practice from scratch. And I think that those are decisions you need to make before you even start the practice. And, and, and those are going to impact whether it is a good decision or a bad decision to contract with the plan.

Art Wiederman:  So I have a question, and I think a lot of dentists may be a little confused about this. So if you are not in network with an insurance plan, that does not mean that you can't treat that patient and that does not mean that that patient is not going to be able to use their insurance benefits. Right. Talk about it just quickly. Let's let's talk about if a dentist chooses not to go with plan A and a patient who is who has that insurance, they come in and, you know, you say, well, we're not contract, but we can still help you with that and file the forms and you're still going to be how does that work? And I know all the plans are different, but in general, if you're not in-network with a plan, that patient is still going to get benefits from that plan, right?

Katie Fornelli: Correct. In most instances that is the case. You do have to read the plan contract because there are plans and they're there epos exclusive providers and where they could exclude the the employer and the employer group or the patient from going to an out-of-network provider. So this is where it review your contract and we offer a service and it's through the ADA where you can have your contract before you sign it. You can't have signed it. We will review the contract for you and will highlight things such as if it's at EPO or if there's any limitations or exclusions. So it's really important to know your contract. But in most instances, a PPO means that the patients can go out of network and seek services from out-of-network providers. There may be limitations, though, to the maximums or certain procedures that you can obtain from out-of-network providers.

Art Wiederman:  And again, it's it's like with anything in life that you sign up for, if it's you sign a contract to finance the purchase of a washing machine, read the contract. Right?

Katie Fornelli: Exactly right.

Matt Nelson:  There's something else to mention to is just on. A lot of the plans do require that you are at least listed as a registered provider. It doesn't mean you sign up as a contract. It just means that you sign a form saying I'm going to be a non participating provider or an out-of-network provider, and you have to at least get yourself registered on their database. Or they could just completely denied the claim altogether. So it is important to reach out to each plan. And you know, some of them it's a form, some of them it's just sending in your W I think it's a W9 sending in one of the W-9 forms saying I wish to be an out-of-network provider with the plan. So each plan's a little different. Just got to make sure that you let them know before you send in any claims. Yeah.

Art Wiederman:  Now, I also know that when you sign up with a PPO, in many cases you're signing up with multiple peoples. I think the term train is you. I'm a big fan of the TV show The Big Bang Theory and Sheldon loves trains. So I think of trains, right? So talk about that. So if you sign up with. Insurance company X, you might also be contracted with insurance company Y, Z, ABCD. Right. How does that work?

Matt Nelson:  Yeah, it's the network Lisas. Sometimes they can, you know, networks can can build their base by going in and individually contracting with each doctor. Or sometimes they can get into like an affiliated network where, you know, it contracts you with, with multiple plans at once. And in many contracts that we're seeing now, which is why it's really important to if you are a CDA member to to to take us up on what Katie was talking about with the contract analysis is that we're seeing many contracts now or they're automatically putting you into these network leasing situations where you are contracted with many, many plans. And if that's not what you want to do, it's important to to either call the plan to get more clarification or have it removed or the network to have it removed.

Art Wiederman:  So I want to ask something about that because I've seen this. So when someone signs up for Plan A and the contract signs them up for five or six or ten or 100 other plans, I've seen in some cases and some doctors have told me that in some cases that the the reimbursement to the doctor is going to be, in some cases the lowest fee schedule of any of those plans. Is that have you seen that?

Matt Nelson:  Yeah, that's most commonly what we hear is that it's going to be paid out on the lowest fee schedule of all the plans. However, recently we've started hearing from some members that the least situation is actually paying more than the individual plan. Okay, it's. Limited, and we've only heard it from a few people right now. So it's still really important that, again, like for your unique situation or where you're at, that you you do the analysis and you really analyze the contract and what the fee schedules are going to be before you sign that contract.

Art Wiederman:  Know that that's really, really important. So I am, as I've told my audience, for four and a half years now, I'm required by law to do math since I am a CPA and this is the art of dental finance and management. So let's talk a little math here. I know there's no averages or there's no scoreboard here, but what are you guys seeing as far as ranges go for the reduction from UCR fees that these plan and we know that they're all over the board. It depends on the plan, depends on the area, depends on whether it's raining or snowing or hailing or a hurricane or whatever. But what are you guessing?

Matt Nelson:  Yeah.

Katie Fornelli: Look at what we usually see. Anywhere from 30 to 50% off. All right, UCR. But again, like you said, it's it's going to vary based on the patient demographics, based on the volume of contracted providers in a particular region. And of course, we're in California, so rural areas, we don't have as many as the rest of the country or other parts of the country. So. But it is going to depend on the population, the ratio of patient to provider.

Art Wiederman:  Right. So the you know, if you're talking about a large metropolitan area with a dentist, not going to say on every corner, but lots of dentists in a particular city, it's less likely that they're going to be high. They might be lower because it's supply and demand.

Katie Fornelli: So right now and it also depends on the the UCR for the area and how often dentists are increasing their fees and also how often they are submitting their fee schedules, their UCR fee schedules to the plants. So and that's a big factor.

Art Wiederman:  So talking about you wouldn't say something that.

Matt Nelson:  Yeah, I was just going to say I have heard, you know, a number of calls from from members that have actually set their UCR to be their highest fee schedule to match their highest fee schedule. And so I did want to just take this minute to remind everybody that your issue should be separate. It shouldn't be what your highest fee schedule is.

Art Wiederman:  I have I have seen that also, and I have explained that to dentists and they were shocked when they heard that. And they thanked me because when they found out that they could have a regular UCR schedule, we added six figures to the top line. That's always a nice thing. How about negotiating with these insurance companies? Well, let's say you're a dentist and you get in the fee schedule and you're in it for six months and you say, Wow, this is really low. Can you go in and negotiate? What's your experience been with negotiating the fees? Did they do that?

Matt Nelson:  It hasn't been great. Can I be honest? There's just a lot of a lot of plans that are saying take it or leave it. There's a lot of plans that say we evaluate fees on an annual basis internally and make adjustments as needed. Sometimes I have asked like, okay, cool, when was the last time you made an adjustment and it's like 2014 or something? 2013. So it hasn't been great. You know, we've been working with, with, with the consultant that has had some luck with negotiating network leasing contracts. So there's been a little bit of judgment there. But there we've seen some plans when I was in consulting before. I do remember a couple the smaller plans in our area that that did negotiate. And it was really because, you know, the pushback was that I you know, I did the research and found that it was 4% of the patient base and that the you know, the doctor decided that they would rather be out-of-network than then take that. And so, you know, there was a negotiation process there, which was helpful. So, again, like understanding your your demographics and your numbers and having the tools you need to go into those conversations prior is critical.

Art Wiederman:  You know, that's important. And again, I know know in California is the probably you guys are the largest state dental society. I would think you're in the top two probably and and again all the state dental societies I've talked to many directors of those societies, they're they're all just they're all on the same page. They won't help dentists, but some don't don't have maybe some of the resources that you guys have. So if you have this service you were talking about Katie and Matt, where you can analyze a PPO contract. Can you do that for people that are out of California that maybe they don't have access to that in their state?

Katie Fornelli: We can do it. We have it's we have both access to this service for members and members of CDA. If you are outside of California and you're a member of your state association and then you've become an affiliate member of CDA, you could receive this for member pricing. And if you're not a member of CDA, we have different pricing. Let me back up until a little bit about the service, if you don't mind.

Art Wiederman:  Sure. No.

Katie Fornelli: It's. So we so we have what included with your CDA membership are tons of resources on this topic on our Web site. And so we have a checklist that's called evaluating a dental benefit plan. And it walks you through the questions that you would want to ask yourself. And we've we've approached it from two perspectives. Either you're thinking about contracting with the plan and you have questions about whether this is the right fit for my practice or not. We have that is one set of questions on the checklist. And then we have another set of questions. If you are already in contract with the plan and you're you're trying to decide, is this the right plan moving forward for my practice. So we've kind of broken it out by new contract or existing contract that is a resource available to all CDA members in addition to tons of other resources and access to our practice analysts we were finding. Go ahead.

Art Wiederman:  No, you go ahead.

Katie Fornelli: Okay. So we were finding that there were quite a few members who were coming to us and saying, That's great that you have this checklist, but I don't want to crunch the numbers. I want somebody else to do it for me. So Matt and I, with a small team of analysts at CDA, we created a new service which is benefit plan consulting, and it is a limited consulting service. It's not full scope consulting. And I like to always preface that, you know, we're not we're not going to do like a 12 month contract. It's a limited contract. You can ask us to evaluate a single PPO and contract. And what we do is are you and I have had many conversations about very data metrics driven. We look at the data, we look at the metrics. And that and I approach this, this is a business decision for your practice. This is no dis no different than any other practice system that you'd evaluate in the dental practice. We look at the data and the metrics, which is why it's really important that your practice management software have good data and good metrics and good analytics and you're entering the information so that it's it's clean when we when we need to pull those analytics and then we do an evaluation of how the plan is performing in your practice. And we don't compare it to any other plans, we don't compare it to any other provider. It's a individual decision and it's based on the individual relationship that that dentist has with that plan. And then we provide the doctor with a comprehensive report that we call a treatment plan. And essentially what it has in it is our findings. This is how the plan is performing in your practice. And this is this is the projected impact should you decide to go out of network with the plan. So and then we have a consultation with the doctor. We go over the findings, we go over all of the recommendations for the practice. It includes practice system recommendations that Matt and I have, you know, learned over the years from our consulting experience. And then the decision is ultimately, of course, the doctors to decide if they want to stay in network with that plan or go out of network with the plan. But at least the doctor is given all of the educational tools to make that decision.

Art Wiederman:  That's great. Now, I just I'm going to give you guys an opportunity. So if anybody is interested in your checklist or this service that you provide, what's the best way to get a hold of you guys and contact you?

Katie Fornelli:They go to CDA.org and they can go to our practice support page on CDA .org. We have a landing page as well for benefit plan consulting. There's a quick questionnaire that they can fill out and it submits it to one of us, one of us analysts, and then we respond to that questionnaire to inquire further to see if the doctor understands that service has any additional questions, and then we can explain the service in a little bit more detail.

Art Wiederman: Sounds good. All right. I want to get into the to the one of the really important topics, which I think everybody listening is is interested to hear your comments on. So, okay, so we've joined BPOs were NPOs and we wake up one day and we say not feeling the love for PPOs or this PPO or that one. So let's talk about the evaluation process. But these calls you up and says, I'm thinking about getting out of X, Y, Z, or I'm thinking about getting all of mine, I'm thinking about blowing up my whatever it is, right? What is the process to decide? So you guys are consultants or coaches. That's what your process is. What's the first step when someone calls you and I'm sure you get you said you're getting a lot of calls like this. What do you do? Well, let's let's start that conversation and figure out and tell everybody, what do we do? How do you start?

Katie Fornelli: Yeah, I think that and I approach this a little bit differently just because we're, you know, have different backgrounds and obviously different personalities. But my first question to the doctor is what's driving this decision? And and I ask that question because often there's a lot of emotional feelings around PPO contracts. And so I my first thing is to establish that and while it feels emotional and there are a lot and I fully acknowledge the emotionality behind some of the PPO contracts and the way it makes you feel as a as a practice owner or as a provider, it's it really is a strategic business decision. So once we've established that, then we move into the analytics. I start with one what is your practice model asking those questions? What is your desired practice model? Let's look at the patient demographics. So if we're looking at, you know, what are the things that we're evaluating patient demographics and income of patients and employers in the area, unions in the area per patient ratio per provider and some of the other numbers we're looking at. What percentage of your active patients are contracted with this plan? What percentage of your new patients over the last 12 months are contracted with this plan? How is that going to not only impact your active patient ratio, but how is it going to impact your incoming new patient ratio? Are we seeing an increase in contracted patients coming into your practice or a decrease? And so that's why it's important to not just look at active patients, but to look at that the the new patient ratio as well.

Art Wiederman:  I mean, a doctor, a doctor who I mean, I've had doctors come to me and say, Art, 80% of my patients come from X, Y, Z insurance plan.

Katie Fornelli: Right.

Art Wiederman:  That's a problem. That could be a problem.

Katie Fornelli: It's could be a problem. It depends on the patient demographics. If 80% of those patients have the income potential to go to to pay the difference between in network provider and an out-of-network provider for those services. And then then it may not be as big of a problem as a practice where the income potential does not support a patient's paying that difference.

Matt Nelson:  I like to share a story of like my I grew up in a little tiny, little tiny town. And I you know, I share this when I do this presentation to contract or not. But, you know, there was one major employer in our little tiny town. And, you know, we were a family of five. There was two dental practices in town, one that took the plan on the didn't take the plan. And, you know, the one that didn't take the plan had lower Yelp and Google review scores. So, you know, it really was just kind of common sense for my family of like, can we afford to pay, you know, the extra like five pro fees out of pocket, you know, for the for the whole family and go to an office with lower reviews. So it's like really understanding like what you're having to offer in your community and what's around and what the competition is. And, you know, for us, it was, you know, kind of a no brainer.

Katie Fornelli: Now and reputation plays a big part. I think what Nat is saying is repetition. So we can run the numbers all day long and we can tell you what the analytics say. But but reputation is going to make a significant difference. And also, your dental team is your dental team. What's the relationship that your dental team has with your patient base? And is that relationship going to help you build an out of network patient population in your practice?

Art Wiederman: Yeah, this is this might be the most important part of this conversation in this entire podcast today, guys, talk about how and why it's important for patient, for the doctor and the team to build trust. The word is trust to build trust with your patients so that when we get to the next part of this conversation is, okay, you've made the decision. Now how do we do it? When you go to tell the patients they don't go, Oh, well, you're a commodity and I'm going to go to the next guy down the street and go to them. So talk about how I mean, how to build trust with patients is a two day course, probably. But, you know, just just talk about why that's really important.

Katie Fornelli: Oh, Matt and I could talk trust and leadership. And we just did a webinar series actually, that's on our online learning platform for how to build trust with your dental team. So absolutely, this is this is going to be critical. And so when we give you that treatment plan, if you go through the service with us, that is one thing that we will it's a caveat to all of this. So the numbers might say one thing, but your relationship with your with your team. So I'm a strong believer in your dental team. I can walk into any dental practice and I can tell I can tell if the team trusts the leader, and if the team doesn't trust the leader, they're not going to convey that trust to your patients. So it is that trickle down effect. So it starts with your dental team. Do they trust you? Do they support you? Do you support them? Is that is there that mutual respect? And have you given your team the tools and the resources and the ability to convey to your patients why they should stay with your practice versus another practice regardless of your your contract with the plan? I think that that's just I think I see a lot of practice, a lot of patients who they don't care if the practice owner is in network or out of network. They just want somebody who they can trust. So yeah, it's it's it's number one, it's critical. It's it's the number one critical foundation to every system in the dental practice.

Art Wiederman:  And isn't it really important, guys, that the doctor doesn't just walk in one day and say, we're going out of network? I mean, you've got to have deep meetings with your team and say, hey, listen, I am really as the leader. I'm looking at changing. I call it changing our relationship with insurance plans and insurance companies. I'm looking at change in our relationship and I want to talk to you and make sure that we're all on the same page. What is your experience, guys, with teams? Do they say, Oh, no, no, no, we can't do that. Everybody leave. Or do they say, Halleluiah, Doctor, let's go. When do we start? How does that what do you see?

Matt Nelson:  It really is a mix. I you know, there's some that are happy to not have to work with the plan as much. There's others that, you know, dental employees, dental staff tend to be probably some of the most empathetic people on Earth anyways. And so they're already thinking about like, yeah, we're going to lose everybody. They can't afford this. My family has this plan, whatever it may be, and it's critical to have those staff meetings to get your, you know, get your team in alignment and make sure they understand the whys behind it and get their buy in. Because if your team's not bought in, you're not going to succeed in this process. And, you know, I think I saw one doctor, you know, went up and in the staff meeting, you know, he was getting a lot of pushback from the team. And then, you know, the doctor said like, well, who wants to take a 30% pay cut? And, you know, everybody scoffed, you know, and he's like, I want to pay you what you deserve. And I can't do that if I'm taking this 30% pay cut. So all of a sudden the team rallied like, Heck, yeah, Doc, let's do it. Yeah.

Art Wiederman: Yeah. That got their attention.

Katie Fornelli: I you know, I approach it, too, that I've done a lot of change management training with dental teams over the years. And this is a big shift and it's a big change for a lot of staff who have worked in dentistry for their entire careers. And so there's a lot of fear that comes with change and a lot of uncertainty that comes with this process and it can feel really and. Certain and it can feel really scary. Both Matt and I have walked practices through the process of going out of network and and it's it can be uncertain. And there are days when you look at the reports and you look at the data and and and there can be some moments of panic. And so that's why it's really important to know the numbers going into this before you just make this decision. This is not a decision to take lightly.

Art Wiederman: No. And we're going to we're going to get into if you make the decision, what do you do? But I want to make one comment as the numbers guy here. Not that you're not, but I'm the C, I'm a I have these conversation doctors all the time. And you tell me if I'm wrong, if you're contracted with a an insurance plan and the let's just say the average discount of your your fees is 40%, which is not unusual. Is it a correct statement to say, okay, doctor, here's the worst thing that will happen if you lose 40% of these patients, if they go to other offices and 60% of those patients stay and they pay full fee, your full 100% fee, you will have the same revenues and have 40% less work to do. And you get to be on the golf course more. Is that and I know there's a lot that goes into it, but is that is that accurate?

Katie Fornelli: Pretty simple.

Matt Nelson:  It's a bad.

Art Wiederman: Problem.

Katie Fornelli: Yeah.

Matt Nelson:  Yeah. Yeah. My life was about 20 to 25%, but.

Art Wiederman: Yeah, well, whatever the number is. But that's where. That's where the evaluation goes. Yeah. And that's where when you do your evaluation, you say, Okay, doctor, this plan represents 7% of your revenues and you have X number of patients. And if you do go choose and again, you guys never say you should never say that, right? It's always if you choose to go out of network, this is the financial impact. And if you retain X number of patients at your normal fees, you will not have a loss of revenues. And in fact, you'll have more room and you'll have more time to spend with your patients and all this stuff. So yeah, so I want to.

Katie Fornelli: Go ahead and so we and we break it down. So I like we look at more than obviously just the fee schedule. So we're looking at the collections per patient with that plan. We're comparing it to the collections per patient for all other patients in the practice. So we're really comparing the how all patients in the practice are, how all other patients in the practice compare to patients with this particular plan so that you can as a as a doctor making this business decision, you can say, okay, is this plan performing similar to all other patients in my practice? Because I often see that you just look at the fee schedule, you see, Oh my gosh, I'm taking a 50% write off on on average for all procedure cuts. Well, what's the frequency of those procedure codes? If you look at the top 15 or 20 procedure codes, which is what you're really performing, does that ratio go up or down? If you look at the volume of those procedures for those patients on that plan compared to volume of those same procedures for all other patients? And you might see that there is a discrepancy or an opportunity where patients on that plan maybe are accepting treatment at a higher or a lower rate than all other patients. And those are important things to note. We look at your treatment acceptance percentage, we look at it for patients on that plan compared to all other patients. So we're looking at all of the metrics, not just the fee schedule.

Art Wiederman: Yeah, I mean, if you have a if you have a doctor who has challenges presenting cases in a team that has challenges, closing cases and and you're getting 60% of UCR and you have challenges, what's going to happen when you ask for 100% of UCR? Right.

Katie Fornelli: Right.

Art Wiederman: So that's a there's more to this than just the numbers I want to get into. And again, this is a full day course again. So now you've done this analysis, the doctors, anything else and they say, okay, we're going to go out of network with a plan, all plans, you know, everything. We're going to do whatever we're going to do. All right? We don't just send a letter the next day and say, hey, 1500 active patients just want to let you know that we're no longer in-network with X, Y, Z insurance. We don't we don't do that that way. So let's spend the rest of our time. And this is really important talking about what is the process once you've made the decision. We've talked about how you make the decision. Now you've made the decision. How do we do this? So start that discussion with me.

Matt Nelson:  Yeah, and I'm glad you mentioned that, that you brought that up that way, because I think back to when I first started learning this process, there was this small community and this doctor decided that they were going to go out of network with a plan and they mailed a letter out to the patients, you know, and the patients read the letter and their thought process generally isn't I need to call my doctor and find out what this means. It's I need to call my plan and find out what this means. And, you know, those plan reps are trained.

Art Wiederman: Oh, yeah.

Matt Nelson:  Just to send the patient to an office that's, you know, a mile down the road and it's going to save them a bunch of money and that's all they're going to turn it to is money. It's just they're going to save you money. It's not you're going to go get better treatment. You're not going to get a better quality of care here. It's you're going to save a bunch of money if you go to this doctor down the route. So in that same community, you know, the doctor doctor called us and said like, hey, I also want to go out and network, but I don't want to do it the way this guy did because I got all of his patients.

Art Wiederman: So I learned something here.

Matt Nelson:  And so we've compiled, you know, the strategy for this, for this doctor to go out and network that was, you know, a 12 month process. But it really began with, you know, seven months. The record cycle was about seven months, seven months of communicating with. It's on. You know, they were going to break up with the plan and not the patient and why they were breaking up with the plan and what that meant and that the quality of care was important to them. And they wanted to be an unrestricted provider. And, you know, they followed that strategy. And, you know, the retention was closer to, you know, or attrition was closer to 20%. So, yeah.

Art Wiederman: Yes, much.

Matt Nelson:  Better than the letter.

Art Wiederman: So you're so you guys are going to do this in person face to face with every patient in this practice, Right? That's the goal.

Matt Nelson: Everybody with the plan and or plans that you want to.

Art Wiederman: Write, meaning Yeah, just post patients. Okay. And then and then give me an example, Matt and Katie of, you know, what would you do? You're going to start the conversation. Give me some tidbits. What would you say? By the way, Mrs. Smith, I want to talk to you about something.

Matt Nelson:  Yeah. Katie, you're so good at this.

Katie Fornelli: Well, so the messaging is is key to this. And it it one, like Matt said, having those staff meetings to prepare your team, multiple staff meetings to prepare your team and creating messaging that feels like your team are saying it not some consultant is saying it. You know, I, I can script a message all day long, but I tend to find that dental office staff, they don't want me telling them how to say something. They want to breathe their own life into the script. So it's really important that you take the messaging and then you say, okay, does this sound like something that that Kathy in the front office would say to our patients, who has known our patients for 25 years? Is this something that would come out of Kathy's mouth and not Katie? Katie The consultants mouth? So it's really important that you develop scripting and messaging that feels comfortable to your staff who are having these conversations. And so some of the key language though, that we use Matt mentioned already and it's an unrestricted provider versus we we don't take your plan any more in this office and it's it's messaging on the phone. When a patient calls and says, oh, do you take my PPO plan? And it's messaging to say, we accept all patients who have PPO benefits and we are happy to file the claim on your behalf and maximize your PPO benefits. So it's it's not saying, no, we don't take your plan when they call because the minute they hear no, all they heard was no, it doesn't matter what you say after the. No, it's it's just no, I can't come to this practice.

Art Wiederman: So I have a question. So what if what if the patient in this conversation says so? Please tell me, are you in-network provider or not? You can't be dishonest.

Katie Fornelli: No, you can't be dishonest. And so if they say, are you in network, the answer is we are not in network. We are an unrestricted provider, which means you can still come here. We can still maximize your your benefits and we will give you an estimate of what your portion is going to be prior to any treatment with our office.

Art Wiederman: And you're going to love our office. Do you ever get into saying, you know, we don't know what the difference is, but in many cases it is not substantial between whether we're in network or not. Do you ever say things like that or is that not a lot?

Katie Fornelli: You can, Yeah, we recommend giving percentages that typically we see this is the percentage and the patient portion percentage. And yes, it's an estimate. And our financial we have financial resources on CDA.org, we have a financial agreement. And in that financial agreement we have language that the office staff can read to the patient that basically explains the out of network relationship with the plan, meaning this is an estimate, these are percentages. And when we file the claim, it won't be until we receive the EOB that we understand what the plan is actually going to pay. So so it's, you know, it's all in the it's all in the financial documentation that you want to use to support your your conversations.

Art Wiederman: So, Matt, you were saying you mentioned a year. That's what I've heard. So we basically make the decision we're going to go out of network with this plan and let's just say it's a plan. Doesn't matter which one. It can be multiple plans, but let's say we do go to our network, we are then going to start the discussion with our team, were then going to start the discussion with all of the patients in our practice who are patients who are in network. And once we have finished the discussion with as many of them as can come in within a six month or nine month period, once we think we've talked to everybody, then is that when you send the letter out, is that when you contact the plan, give me the timeframe of how this all works?

Matt Nelson:  Yeah, You know, going back to the conversations to I just want to circle back, it should really understand who has the strongest relationship with the patient. That's the person that should be having the conversation. So most times that should be the clinician that has the actual face to face out of network conversation with the patient should be the doctor or the hygienist or. But in some cases it is going to be that front office person. They don't care what the doctor does. They just come to see the front office person because they love them. You know, there's those patients out there, but making sure that the right person is having a contact. The plan, as far as your question about when to send the letter, like you're going to have a target date set on when you want to be out of network. And you've probably been telling your patients like, hey, January 1st is my day, I'm going to be out of network. So you got to understand your contractual obligations of notification, notifying the plan of when you want to be out of networks. If your goal is January 1st and it's a 90 day, you know, 90 day notification period, then you're going to want to get that letter sent out or email sent out on January and September 1st to make sure that you fulfill that that time requirement.

Art Wiederman: Yeah. You want to make sure that you follow whatever the rules are of the contract that you signed. In other words, if you have to give 30 or 60 or 90 days notice, which is, isn't it most of the plans. That's pretty much what we're looking at here.

Matt Nelson:  90 days.

Art Wiederman: 90 days. So that gives you that gives you the time to plan and get your systems set up and all this stuff. But but again, it's a process. It's not you know, we want to we don't even think about giving notice probably until we've talked to as many patients as are affected in our active patient base. Right.

Matt Nelson:  Yeah. You should try some kind of, like a documentation process, because I'll tell you, what tends to happen is that you're going to talk to every patient you see face to face over whatever your recall cycle is, Right? So six or seven months. And what tends to happen is like everybody comes out of the gate, fired up month one or two and a month, three or four people start falling through the cracks. But you remember those patients that are coming in months three and four. This is their first time seeing you two. So they deserve that communication just as much as two people in months, one and two. So it's important to like really be thorough with your documentation on the schedule. Like this patient has this plan. Make sure you talk to them and then do some kind of an billable code to to try to track whether it was a positive or a negative conversation in the system. And what that does is one, like if you look at the schedule and say, like, okay, ten patients with that plan came in, I charge eight quotes, okay, I only talk to 80% of my patients. That's I let 20% fall through. I'm probably going to lose that 20% because they're the ones that are going to get the letter.

Art Wiederman: And doctors, I want to make 11.. You are going to lose patients. I don't know of anybody that I've heard of who has chosen to go the route of going out of network that they have retained 100%. There will be patients who just say, nope, I'm going to go to somebody who takes my insurance and I don't care. You could give me cookies and I'm not going to stay, right, guys? So they have to. And that's hard for some doctors. Oh, my God, I'm going to lose pay. Yeah, but you're at the end of the day, if you can keep your losses to 15 or 20%, which is a good statistic that I've heard. Yeah. You're going to be more profitable and you're going to move your practice more towards maybe what it is that you want, which may be a fee for service practice. So and then if there's a when ultimately you send, you will send a letter out once you've talked to everybody. And by the way, one more thing. That's why I think you guys, I'm sure, believe in morning huddles. Right. Right. So as part of a morning huddle, wouldn't it be a good idea to say, oh, by the way, since we've decided to go out of network with X, Y, Z insurance and Mrs. Jones at ten and Mrs. Williams at three, our two people, we have to talk to you. So the whole team knows that this is going on. That's a good idea, right?

Matt Nelson:  Yeah, absolutely.

Katie Fornelli: And this is why, like Matt said, it's a it's a practice system like any other system in your practice. So it's important that you have the communication documented, you have the plan documented. You add this to your morning huddle agenda as a standing morning huddle agenda item. You have monthly reports that you can run to track those positive, negative or conversations you missed. That didn't happen. You may have patients that say, I need you to follow up with with my spouse and we need you know, I'm not the only decision maker in my household. So there might be follow up conversations that you have to have and that needs to be tracked and noted. So it's a system and and it needs to be tracked and monitored on a daily basis.

Art Wiederman: All right. Well, go ahead, Matt. I'm sorry.

Matt Nelson:  The the when you were talking about notifying the plan to we have a resource called where you need to know about dropping dental, dental plan contracts that walks you through a lot of this process, but also has the sample letter that you can send out to patients. Oh, after you lost the conversation, hopefully. And also the the sample letter that you can send to the plan for the, you know, the breakup letter.

Katie Fornelli: The up a lot of breakup.

Matt Nelson:  A breakup.

Katie Fornelli: But it's not you. It's me.

Art Wiederman: Before I before I got married that I was in the dating world I got lots of breakup letter I just getting.

Matt Nelson: It is really important though, throughout this process that you stay adaptable and you know, I had mentioned earlier, like charging out like if the conversation goes negative or you feel like the patient didn't respond in a favorable manner and you charge that out as an under little code, it's going to give you a list that you can go back to at the end of this process. A patient that you talked to, you you can you can write a report on your practice management software and reach back out to these patients and say, Hey. Mr. Smith. I know when we talked about this, it didn't go very well. So I want to know what other questions you have. It's really important that I keep you and, you know, whatever it may be, that conversation.

Art Wiederman: Well, that comes back. And unfortunately, guys, we're about to the point where I'd love to sit here and talk to you for hours and hours because it's so much fun and it's really informative. But what it really comes back to is doctors. Unless you have a culture with your team and with your patients where there's trust and caring, this is not going to go as well if you don't have a culture in Europe. Let me say it again. If you don't have a culture in your practice where whatever your patients are told by you, they 100% trust you, you're not going to be as successful as chain in changing your relationship if you do. And guys, you've had doctors that you've probably had that conversation with and maybe you talk to them about their practice and you say, You know what, Doctor? Before you think about going out of network with insurance, you might need to take steps. ABC And to really solidify the trust you have. Have you had those conversations?

Matt Nelson:  ABC Yeah, yeah, absolutely. And we've also had the conversation where it's, you know, be adaptable. You don't have to stick to your guns. You made this decision. You get four or five months and it's not going as well as you thought. Be adaptable. You don't you don't have to stick with it because you want to do it. You can we work with your team some more and, you know, come back to it at another point.

Art Wiederman: But I'm going to go ahead.

Katie Fornelli: And we've also had a number of doctors who have gone through our consulting service and they realized that their practice isn't ready for this. And that's perfectly okay, too. They're not saying never ready. They're just saying right now maybe they're in a they're in a phase where their practice is ramping up still. I had a doctor who had recently gone through a practice transition, and the practice just wasn't ready for this. They didn't have the right systems in place. And so that's perfectly okay. It's something that you can work toward. And again, if it aligns with your practice model, I kind of go back to I keep going back to that.

Art Wiederman: So here's the last thing, and then we're going to have to call it a podcast that I want to share and I want to just quickly get your comments. Doctors, I have talked to numerous dead dentists who have done this, who have gone through and who have either dropped, gone out of network with a plan or have converted their practice over a period of time to fee for service. Not only have they been successful, if they've done it correctly, they are making a lot more money, they are much happier. They're spending more time with their patients and their whole practice experience is more enjoyable. Would you say, guys, in conclusion to this discussion that if you do make the decision and it's a difficult decision to change your relationship with an insurance plan or other or all insurance plans, that if done correctly, you can absolutely do this successfully?

Katie Fornelli: Loaded question are.

Art Wiederman: All my questions have loaded? We are.

Katie Fornelli: We are. We are very cautious in our in this in this approach. Right. And I think that you're but all the things you said, if you are looking at this as a long term strategy for your business. If you have evaluated your demographics, you've evaluated the practice model, you know that your practice model fits within the patient demographics, then yes, it's possible. And we have you know, we have consultants that we can refer you to, to use a consultant to walk you through the out of network process. And we obviously are highly supportive of consultants because we've been consultants ourselves. So it I think you need to decide, is this something you can do on your own? Do you have the dental team that can that can that can do this independent of a consultant? If not, there are experts out there. There are tons of consultants who are excellent at helping your practice navigate through the out of network process.

Art Wiederman: Katy for Nelly and Matthew Nelson from the California Dental Association. Incredibly valuable information. I love talking to you guys. I just I wish I could just like, sit here on the microphone, like, all day, every day and do this. That's what I want to do. But thank you, guys. You've been wonderful. Katie, Thank you for including me as part of what you're doing at CDA. Let's roll real quick again, June 10th in in the Bay Area, thinking we don't have a location at this moment, but probably.

Katie Fornelli: Better by the time this airs. We will. Yeah. Yeah.

Art Wiederman: So it'll be somewhere in the east, in the Bay Area somewhere. And then June 22nd is in Sacramento, right?

Katie Fornelli: Correct.

Art Wiederman: Yes. Okay. So go to Coorg. And again, where do they go to stay?

Katie Fornelli: Go to virtual and live events and we'll have a landing page there. It's called now and next in dentistry, mapping your career.

Art Wiederman: Okay. And guys, if you want to come and see me at the CDA, I am I am speaking, I think twice on Saturday, once at the spot and once to dentists who are looking at acquiring dental practices and then maybe a third time. Katie We're still working on that because I worked I worked for Katie that weekend.

Katie Fornelli: We keep you busy.

Art Wiederman: You keeping me busy, and then we are at Booth 1472. Please come by and say hi to us folks. Thank you again for the privilege and go stay on here until I take the podcast out. Thank you for the honor and privilege of your time for listening to my podcast. Some of you have been with me since December of 2018, I think it was. We've been doing this now for four years. I don't by 27, I don't even remember anymore. It we're coming up on four and a half years. I want to thank my partner again. Decisions in Dentistry magazine WWw.DecisionsinDentistry.com Great clinical content 140 Continuing education courses at a very, very reasonable price if you're looking for a dental CPA. I'm a member of the Academy of Dental CPAs, 25 CPA firms that represent over 10,000 dentists in the United States. We are at Eide Bailly, where I was one of the founding members of this group. If you have any questions or you're looking, we do take new clients. You have to be nice. That's the that's the requirement. You have to be nice. We want nice people. And 99.99% of our clients are super, super nice people. I mean, I have just some of my best friends in the world are private practice dentists, and I just played golf with one of them a couple of days ago. So, you know, give me a call. 6572793243 and email me if you need anything a Wiederman@EideBailly.com Katie Fanelli and Matthew Nelsen from the California Dental Association. Thank you for everything that you do to help our doctors and thank you for taking your time today.

Katie Fornelli: Thank you.

Art Wiederman: Thanks, Eric. Okay. And then with that, everyone, I want to again thank you for listening and let you know that that is it for this episode of The Art of Dental Finance and Management with Art Wiederman, CPA. And we'll see you next time. Bye bye.