As a practice management coach, I’ve spent the better part of a decade in the trenches: provider agreements, CMS guidelines, denials, and appeals. And after all that time, one truth keeps surfacing, and it isn’t a comfortable one. Insurance participation sits at the root of burnout in this profession. It shows up everywhere: in a team that no longer feels valued as wages stall against DSO offers, in a workforce shortage that COVID only deepened, and yes, even in coaches like me, who’ve spent years showing up to fight on behalf of clients who deserve better.
So I stopped staying quiet about it. It would have been easier to keep my head down, but I started naming the problem publicly, alongside helping my clients transition to fee-for-service and equipping their patients to understand what’s really happening with their benefits. That combination got the attention of the largest dental insurance company in the country. In March of 2023, Delta Dental sent me a cease-and-desist over my social media posts and the letters I’d shared publicly.
I share that not to boast, but because credibility matters here, and I want you to trust what I’m about to walk you through. If you’re looking for proof that this approach works, and that it’s defensible, take it from the fact that I pushed back and won.
What follows is the process I’ve used successfully to help practices transition to fee-for-service. One honest caveat before we go further, because I’d rather tell you the truth than make this sound easier than it is: this isn’t right for every practice. Your demographics, your over-the-counter collection rate, and your overall operations all need an honest look before you make this leap. Courage without preparation isn’t strategy. It’s just risk.
What Your Patients Actually Want to Know
Here’s the truth: your patient is not going to read a two-page letter. Thanks to social media, more doctors are dropping insurance every year, and patients are far less shocked by it than they were a decade ago. Even so, most will skim right past the bolded, all-caps line that says “YOU CAN STILL USE YOUR BENEFITS HERE.” Many don’t even realize dental and medical insurance work differently, so they’ll assume the letter doesn’t apply to them, or they’ll panic and call in a scramble.
Your letter needs to be short, direct, and centered on what actually matters to your patient, who, let’s be honest, already assumes you’re doing just fine financially. Cover only this:
- What’s actually changing
- Confirmation that you can still see them
- Confirmation that you’ll still handle their claims
- Why this change protects their care
- An invitation to call with questions
I recommend mailing it on the last business day of the week. It gives patients a moment to sit with it instead of skimming it, and by the time they call the following week, they’ve usually had a chance to feel it and calm down.
Show Them the Benefits, Don’t Just Tell Them
Most insurance companies let you pull benefit information online, so use that. Send patients their actual in- and out-of-network coverage details, not just your summary of it, and save a copy in their chart. You’ll want it later.
For any patient with an appointment already on the books, print their benefits alongside a copy of your letter, and save the conversation for checkout, not check-in. If your front desk brings it up too early, they’ll be the ones fielding every question for the rest of the day. At checkout, simply ask whether they received the letter, walk them through the benefits page, and meet whatever comes up with patience.
Track the Truth With Simple Codes
Create a few internal tracking codes, something like “Delta Plus” for patients who’ve said they’re staying, and “Delta Minus” for those requesting records to transfer out. Apply these to every patient, not just the subscriber, so your reporting reflects what’s actually happening. And for anyone who leaves, let them know the door stays open. People change their minds more often than you’d think, and there’s no shame in that.
When the Reimbursement Call Comes In
Two things tend to happen once a patient gets their reimbursement check: they deposit it without a second thought, or they call you upset that it’s less than expected. This is where the benefits summary you already reviewed with them earns its keep.
When that call comes in, resist the urge to apologize on their plan’s behalf. You didn’t promise them their benefits back at 100%, and you’re not the one who let them down. What they need from you in that moment isn’t sorry. It’s someone in their corner, something closer to “I get why this is frustrating. Let’s figure it out together.”
From there, go back to the prep work you already did together. Ask if they still have the benefits breakdown you shared before treatment, or better yet, have them email it straight over so you can pull it up side by side. Walk through it again, and this time don’t soften it: whatever percentage they were promised, it is definitely not landing at 100%. Many Delta Dental plans not only decline to pay providers directly, they reduce the reimbursement itself, even though most other plans manage to pay the provider’s usual and customary fee, or close to it, without asking the patient to front the entire cost. Let them be angry about that. It’s earned, and it’s exactly where this needs to start.
Anger on its own doesn’t change anything, though, and leaving them there wouldn’t be fair to them. Once you’ve sat with it together, give them somewhere real to put that energy.
Turn Your Patients Into Advocates, Not Adversaries
Give your patients everything they need to speak up: the insurer’s member services contact, their state insurance ombudsman, their Department of Insurance and Financial Services, and their state representative. Encourage them to call, write, and file grievances through their broker or HR department if that applies.
This only works because there’s strength in numbers. Patients standing beside their providers, rather than being caught in the middle, is what ultimately moves insurance companies toward fair reimbursement that actually keeps pace with inflation, and away from denying, downgrading, or bundling care based on a spreadsheet instead of a diagnosis. Dental plan holders deserve more than a maximum benefit frozen in time from fifty years ago, and their doctors deserve the ability to practice medicine, not policy.
