Breaking ties with insurers may be an enticing proposition, but before you do, you need to understand how patients view this transition.
So you want to break ties with some or all of the insurance plans with which you’re now a provider. Are you worried about what your patients will think? Concerned they may jump ship? Before you make any changes look long and hard at the issues, evaluate your patient base and insurance issues in your area and have a definite plan in place.

How patients perceive insurance
We wanted to find out what dental insurance meant to our target group—how much they depended on it, how much it influenced their choice of dentist and their habits. Here are some of the trends we observed:

• Insurance plans with low benefits make little difference in the "stay or leave" decisions. These patients have most likely already realized that the dental insurance has little value to them.

How to make a change with the least disruption
These are steps for an office that is considering moving from accepting assignment of benefits:

1. Notify patients of the intended change at least three months in advance. Notifying the patient of your decision in advance that you will drop insurance assignment is the most important step, and how you handle it will significantly influence patient retention.

" Mrs. Smith we want to continue to give our patients the best quality of care they deserve. To offer you the treatment that is best for you I need to do that without third party involvement. To provide the optimum care level and to offer you a wider range of treatment options with fewer restrictions we’ll be making a transition over the next year [or the time frame you determine in advance] in how we manage insurance issues. This will be a gradual transition and one that we’ll work closely with patients on. Your insurance [or plan] will continue to provide support toward treatment, but the way the insurance is processed will be different. I’ve asked "Nancy" [treatment coordinator or financial person] to step in to explain the details and to help answer the questions that you probably have. We want to make the transition one that everyone is comfortable with. [Nancy joins discussion at this point or their conversation may be continued in a consultation room.] Once Nancy has gone over this information with you we want to make sure we get your questions answered [optional …. and to ensure we have the best process in place for us to work with you]."

Nancy is now left with the patient to explain the transition and to give the patient printed matter that includes the details. It will be very important for Nancy to encourage the patient to verbalize questions, concerns or objections. This is a key reason that the face-to-face discussion is so meaningful … it is the only way that you will know where you stand with the patient.

2. For a six-month period following patient notification, continue to submit forms and accept limited assignment of benefit. Most patients are intimidated by the notion of completing insurance forms. In our poll, we were surprised to find that many were concerned about this task even more than they were concerned about the idea of accepting assignment. That’s why it is so meaningful to complete the forms during the transitional phase. This will help patients accept the change and recognize that you understand their concerns. During these six months you might also consider putting a monetary cap on acceptance of assignment. That is, you may indicate to the patient that you will continue to accept assignment of benefit up to a certain fee level or perhaps only beyond a certain fee level. Beyond that fee level, you might have in place other resources that will enable the patient to accept treatment, such as bank plans, dental payment plans, credit cards, etc. By doing so, you are showing the patient you understand the challenges they have and that you want to help them find a way to accept the treatment that they want or need.

3. For the next six-month period, continue to submit insurance forms, but shift reimbursement to the patient. During this phase, the patient is required to provide payment at the time of treatment. His or her compliance will be influenced by many factors, including dental IQ, income level, trust in the practice, desire for treatment and, of course, secondary payment plans or credit card options. During this period, there is the greatest likelihood of patient attrition, especially families with children.

4. On an ongoing basis, the patient submits insurance forms, and reimbursement is made to him or her. This may be the stage you are most eager to reach. But, it also can be the most intimidating to patients. If you go this route, bear in mind that many patients will want some "hand-holding" before they feel comfortable. Many patients perceive completion of insurance forms as "part of the service" so tread carefully here. In some cases you may opt to continue this "service" in order to maintain patient loyalty.

Direct reimbursement
From time to time, you may have a patient in your chair who is in a position of influence in his or her company. You may find it worthwhile to fill this person in on a different approach to "coverage." Because direct reimbursement (DR) is a relatively new approach, many companies may not be familiar with it. The ADA and many state associations offer assistance to companies who want to know how to implement DR. DR can benefit the patient, the practice and the employer. For more information, including the ADA’s Internet presentation on this, go to www.ada.org/prof/prac/manage/benefits/dr/index.html.

The Bottom Line
Once again, it was clear that TRUST is a key issue as it relates to patient retention.  If you and your team have not developed strong, trust-based relationships with patients, it is far riskier to move away from accepting assignment of benefit.  You will experience patient base shrinkage. The change may be the deciding factor for the patient who does not feel "connected" to your office.  Building trusting relationships with patients must be an on-going, never-ending process for ALL members of the team ... not just because trust can weather all kinds of storms, but because it's the right thing to do.  Even if these trusting patients do depart your practice, they may return when they don't feel faith or security in the new dental practice they went to.

Patients sound off on assignment of benefits
We presented the following scenarios to patients to gain some perspective on how they feel about accepting assignment of benefits. A word of caution: These responses may not represent the views of your own patients. It is important to keep an objective eye on how patients see you and the quality of the relationship with your practice.

Your dentist says he or she will assist in completing insurance forms but will no longer accept assignment of benefits.
43% I would accept this as a reality—I would stay with my present dentist.
57% I would leave the practice to find another dentist.

Your insurance company says the doctor’s fee is not UCR.
33% I would trust the dentist, stay with the dentist and pay the difference myself.
10% I would contact the insurance company for more information.
44% I would contact the dental practice and ask about the fee difference and UCR.
13% I would ask the dentist to lower his or her fee or ask for a discount.

If your dental practice says they will no longer accept assignment of benefit what will you do?
50% Stay with dentist who accepts assignment of benefit
50% Leave to find dentist who accepts assignment