Episode #350: Decoding Dental Payments: Mastering Payer Challenges and Creating a Seamless Patient Financial Experience

Michael Walker: Hello everyone. Welcome to the Less Insurance Dependence podcast, your trusted source for strategies, insights, and expert advice to help you build a more profitable, independent dental practice. I’m Michael Walker, your cohost, and I’m thrilled to bring you another value-packed episode featuring a leader who’s helping dental teams simplify operations and take control of their revenue.

On this show, we’re all about helping you reduce your reliance on insurance, whether through building a fee-for-service model, improving efficiency, or rethinking your financial systems.

But before we dive into today’s conversation, I want to tell you about an incredible opportunity that’s being brought to you today by our sponsor at Ekwa Marketing. Ekwa Marketing is offering you a complimentary marketing strategy meeting valued at over $900 to help your practice attract better-fit patients and reduce your reliance on insurance. This marketing strategy meeting will help you rank number one on Google in your area — that would be awesome — attract high-value new patients, and increase new patient calls month over month.

Michael Walker: You’re gonna be able to go ahead and book your complimentary marketing strategy meeting at the following link, which is lessinsurancedependence.com/marketing-strategy-meeting. And you’ll also be able to pick that link up where you picked up this podcast. That link will be there as well.

And if you’re looking for guidance on building a thriving insurance-independent practice, you can also go ahead and schedule a complimentary coaching meeting with Gary Takacs at thrivingdentist.com/csm. Again, that link will also be where you picked up this podcast.

In today’s episode, we’ll be discussing common reimbursement and payer challenges dental teams face, how automation simplifies both insurance and patient payments, strategies to support cash flow during the shift away from insurance, and what to look for when evaluating payment and claims automation tools.

Michelle, it is great to have you here, and I’d like to go ahead and start by looking at the landscape. What are some of the biggest challenges you see dental practices facing when it comes to pay reimbursements and insurance workflows?

So now, onto today’s episode. I’m excited to welcome Michelle Dowling, Executive Vice President of Marketing for Rectangle Health, a company that’s leading the way in healthcare payment and automation solutions. Michelle brings a wealth of experience in helping dental practices overcome payer challenges, streamline reimbursement, and improve the financial patient experience.

Michelle Dowling: Well, it’s great to be here, and thank you for the question. We think about this every day, all day long, and the first thing that we see is we consider the inefficiencies. And I think it’s really timely to talk about lessening the dependence on insurance, but more so, how do we create less manual processes? How do we reduce that?

So the first thing we see is the amount of time and resources spent on manual reconciliation, retouching, reassociating — when reimbursement claims actually do make it through to the practice — chasing outstanding balances, reconciling payments from multiple payers. This just keeps adding to the complexity of the payer rules and the rise of virtual credit cards, and it just creates a more complex administrative environment.

And when we’re thinking about overhead, we’re thinking about staff morale. These things contribute significantly, as does the loss of revenue. So as patient payments and the collection side continue to be a challenge, we see that we need financial help there to help people pay for their treatment.

Michelle Dowling: But then on the other side, we think about the payer side, and we figure if we’re automating and making it more convenient for patients, how can we do the same thing for the staff in the reimbursement side? So this is kind of the new landscape that we’re seeing. We see healthcare take such a big leap toward digital and making things a little bit more easy and streamlined for scheduling. Well, how do we continue down that same path and think about more and more ways to find automation and convenience, not only for the patient, but also for staff?

Michael Walker: Yeah, thank you, Michelle. And I can totally see that. It’s just like, it’s amazing how, you know, in the marketing world, as we both know — and we’re both in that realm — we know the funnel, the infamous term: funnel. The infamous funnel, yes. And it is all about how you bring this collection of information through. We, in the marketing side, and helping us get — just what I was talking about — what that Ekwa Marketing offer will bring to you: opportunities to fill that funnel with great paying customers and high-quality clients.

But it’s interesting when you think about this payment side and collection — we don’t think the same way. It feels like somebody’s just taken and put layers on top. It’s kinda like, you know, “We need that? We’ll put that there. And we need this? We’ll put that there.” Are they talking to each other? Do they relate to each other? We just created duplication. It just feels like there’s so much… it’s almost like the Wild West a bit.

Michelle Dowling: Yes. We say sometimes it’s like — imagine if you went to a brand new employer tomorrow and you said, "Well, how am I gonna get paid for my salary?" And they said to you, "Well, you can get a check or you can get direct deposit." No one would choose check. But yet, on the payer side in a healthcare office, they choose check every day.

When we have situations where we can create digitization — which is always the first step for automating anything — first you have to make it digital, then you can automate. But yet, we’re still sitting with stacks of checks, we’re still sitting with ACH, we’re still sitting with this paper-based environment, and we are not able to stretch ourselves to figure out a better way.

Michael Walker: Yeah, I totally can see that. And that’s a great way you just described that. And speaking on the automation, let’s head down that path a little bit. How can automation and digital payment solutions help simplify both claims processing and the overall patient financial experience?

Michelle Dowling: Sure. So we think about words — we hear, talking about marketing — we say things like “streamline your organization” or “streamline your workflow.” It doesn’t mean anything. So, in practical terms, when we say we want to use technology, what we’re doing is we’re not just replacing people— we’re not replacing people. We’re replacing processes.

So we’re creating a connection between systems to talk to each other, but most importantly — like underscore, highlight this — is you’ve gotta take both the patient information, the patient data, plus the payment data, and marry those two things up. Because if you came to the dentist and you said, “I’m gonna come in for my cleaning, my cleaning costs $500,” and you send that off, there’s two things that have to happen. You have to know who the patient is and what they experienced — what they came in for — but also, you have to know what the insurance side is going to cover and then the out-of-pocket.

Michelle Dowling: So the two things there are the financial piece and the patient data. So making sure everything is compliant and secure on the patient side is one thing, but you also need that payment to ride in together. So what happens when we are talking about how does technology help — it’s taking data and creating this pipe, if you will, between what I need and then what I’m being delivered and what systems are talking to each other.

So implementing these tools is why it’s so important and how it creates efficiencies. We think that it’s very difficult when you just add on more and more vendors, more and more systems, more and more technology, because oftentimes the biggest culprit is that they don’t talk to each other.

So we often talk about things like “vendor consolidation” — big words that don’t really mean anything — but what it really comes down to is, can I open up my laptop or my PC and get started on my day and not have to manually click around or search for things, or worse, not use something that has been vetted, paid for, implemented? Because we see that a lot of waste as well. What sounds good in theory actually doesn’t happen in real life.

So while we love technology and we love automation, and we think that it’s absolutely the path for better staff morale, reducing manual errors — there is a very big possibility that it is also not well adopted in the office, or they’re not trained as well, and people default to old methodology. So we need to change that perspective and offer things that are really valuable and meaningful.

Michael Walker: Yeah. I love — I was thinking as you were talking — part of my background, I’m a professional mediator. So what I do is I help people — in this case, two people speaking English — actually translate what they’re saying to each other, because it’s a communication thing. And what I just heard you say is, it’s a communication thing.

I mean, are we all speaking the same language? If we talk about payment, what does that mean? What are we really talking about? And having — I remember in the world of analog, you know, we used to have sliders on the soundboard and stuff like that where we could physically move things. And so we could see — well, now digital, we can do even more, but it’s not as evident. And we need an orchestra leader. We need a communicator to drive this, which is obviously — I’m sure we’ll probably get to a part of the conversation about Rectangle Health in that realm.

But I just — I think that’s so important. It’s not that technology’s the problem. It’s just like, it’s almost like a song that hasn’t been tuned in yet. That make sense?

Michelle Dowling: That’s right.

Michael Walker: That’s kind of what I feel like it is. It’s just about how — you need an orchestra leader to kind of bring all the instruments together to create this beautiful sound or this beautiful transactional methodology for you.

Michelle Dowling: That’s right. I think that’s a great analogy. If you think about — if everyone uses a smartphone, when you first got your smartphone, you probably used it for phone calls and for text messaging. Think about what you use your phone for now, today. And what was the biggest difference from moving toward messaging and phone? It was connectivity. Can I connect to my personal banking? Can I connect to the songs I want to listen to?

So the idea is — you could have 50 apps on your phone, but I guarantee you use five every day in and out. Why wouldn’t you use the other 40? Because they might not give you the same value, but they do serve a purpose.

So, same thing at the office — just making sure what systems matter and where can we solve the biggest problems. Where can we create those efficiencies — or saying it differently — where do we find the most value? And then where can we find the connection points to make it even work harder for us, rather than the person working harder?

Michael Walker: Yeah. The technology allowing the smartness of it to do the legwork, and we just simply have to wave the baton and keep—

Michelle Dowling: Exactly. Yeah.

Michael Walker: So you said something — solve, solve the biggest problem. So the next question I have for you speaks to that specifically. Many practices, as we would have on this podcast, want to reduce their dependence on insurance, but obviously, they’re gonna worry about cash flow during the transition to that. Just what we’re talking about — there’s a lot of moving parts. How can technology help ease that financial pressure?

Michelle Dowling: Right. So this is probably the most important question. When we are okay with number of days in AR or number of days in outstanding balances, that is the biggest impact to cash flow. Why would it be okay for us to participate in services rendered, and then the practitioner not be able to get paid for 30, 60, 90 days?

So when we think about how we can leverage technology and shorten those days, that is a way to improve cash flow. Lessening the dependency on the payer or insurance is one part of it, and I think it’s probably a very smart thing to do. But if we had to stay in the lane where, in order to keep seeing patients and help them out financially, how do we ensure that that reimbursement cycle shortens so that we can actually get to the cash that you deserve because you’ve rendered services?

So where I think we can be very sensitive is — can we offer options to reduce our dependencies on insurance? Or can we maximize where we can and should be getting reimbursed faster in order to protect cash flow?

Michael Walker: Yeah. The term that jumps to mind from what you’re saying is “reverse engineering.”

Michelle Dowling: Exactly.

Michael Walker: I mean, obviously, we’ve got a problem here. And if we’re not getting paid in 90 days, it’s either something we can — if we reverse engineer it to where we want to get to, it’s like in my world — everybody, it’s called a BATNA in mediation: Best Alternative to a Negotiated Agreement. Everybody has a BATNA on something.

What’s your BATNA? Is it 30 days, 60 days? What’s the maximum you’re prepared to look at? And then how are you gonna redistribute the mix of your business so that you have stuff that’s coming in a timely way that brings balance?

There just might be — with some of this — it’s just not possible. But on the other hand, you can’t figure that out if you don’t have a system that’s doing the heavy lifting for you, because you’ll just drive yourself crazy with spreadsheets. And that’s not what — there’s nobody on this call that got up this morning passionate about wanting to work on a spreadsheet. Maybe a couple of people in this area.

Michelle Dowling: I think I have some folks who would love it. But the point you’re making is — there is balance. We might not be able to lessen the dependency 100%, but are there areas of opportunity where we know that maybe a particular patient demographic or just the type of procedures that we’re holding does require insurance help, per se?

And if we could start to make that better, and also lessen the dependency in other cases, that balance is probably a really nice way to improve overall revenue optimization — finding that cash flow, getting back to reducing administrative burden — and we can start to come at it from that perspective.

Michael Walker: Mm-hmm. Yeah, I think that’s really well put, Michelle. The reality is that some things just aren’t gonna change — or change fast enough — or be completely adoptable for what you need or want in this. And I think the other thing is: everything is a season. You know, in this season, what are you pointing at the top? Your cash drivers, right?

You’ve got accounts receivable. You’ve got inventory. Those are big, big users of cash. And, you know, you manage your inventory, you manage your receivables — but you know that they keep getting stretched out. Why? And what can you do differently?

And I think the important part of this is to say: are we — maybe I’m not ready, you can correct me, Michelle — but I feel like, have we really done the homework on knowing who our ideal customer is?

Michelle Dowling: Right. I do think that sometimes we are also, like you said, trying to solve things where there might be a better answer out there, and we don’t need to default to status quo or the way we’ve always done it. I think that absolutely things have changed tremendously. And I think in the vein of ICP — or your ideal customer — it’s also: what are the most important drivers for your practice or your organization?

And I think sometimes we’ve gone way too far in just accepting that, “Well, this is just how it works. This is just how we do it.” And I don’t mean that to say people aren’t working hard — they more than certainly are — but can we push that responsibility into places that can help us?

We talk a lot about AI, right? And we talk a lot about how we can see optimizations, can we see these enhancements? And I think the technology is out there, but someone needs to come along and architect — back to our earlier point — to make sure those systems are talking and working together. That is key. But it’s a challenge.

Michael Walker: Yeah. And again, the biggest step here being taken by any of our listeners is actually capturing something and saying, “Okay, where’s my starting point? What could I do?” Right?

Like, you know, often we get overwhelmed by this. And I always like to say — what’s the soundbite you’re hearing that you can capture, that you’re gonna be able to go back and say, “Hey Michelle, this is what I heard. Now this is where I think I want to understand this better. I want to start here.” Whatever that looks like.

And to that point, let’s just talk a bit about dental teams starting to explore payment automation. Let’s talk a bit about what should they look for in a solution to support long-term efficiency and profitability?

And I think I’d like to expand that question out, Michelle, to really: what is the entry point? Like, what’s the best place to start? I think that’s, many people get paralyzed by trying to — well, I don’t know — as a man, we think we should solve everything in the next 24 hours. Where that comes from…

Michelle Dowling: Yeah, well, I think you hit it right on the head — identifying where the biggest points of friction are is a great place to start. So you can ask your team, “What is the thing that you are spending the most time on in your day?” or “Where is the most frustrating part of your day happening?”

“Well, I can’t get to the phone fast enough. I can’t keep up with voicemails.” They will tell you. Or, “I have to call a patient 14 times before they pay their outstanding bill.” Those will be the clues on what needs to get solved, because then you can also trace that back to productivity, cash flow, revenue, or other significant business impacts.

So if you ask the questions, and then you can look at it and say, “Okay, if you have to make 14 phone calls and send out five pieces of mail, that is a problem.”

Michelle Dowling: There’s an article — I think it’s from JAMA — that says, for every $100 that a practice looks to collect, it’s $20 of administrative costs. Twenty dollars on every hundred. And practices are doing thousands of these transactions, if not hundreds of thousands of them a month.

So imagine what that looks like. Imagine if we could get that down to 10%. What an increase in cash that would look like.

So looking at where are the main points of friction, or main points where people are predominantly spending their time — that can be a clue.

Then the next question I would ask out of that is: What systems are affected? And can you clearly see if it’s a systems disconnect? Or are there systems that may be able to connect those pieces?

Can you connect your text reminders when you’re trying to reschedule an appointment with, “By the way, you’ve got a $45 outstanding bill — click here to pay that before you come in”? That is efficient, and it’s closing a loop.

So when you can start to design that, and when you’re looking into a vendor — if you have found a particular service that you’d like to find out more about, or implement — I would look at the costs. Obviously, maintenance, setup, and support are always my top three.

Then, for healthcare, security: Are they HIPAA-compliant? Are they PCI-compliant? That data security is a non-negotiable. Do they require a business associate agreement? There are critical questions there.

And then I would — the next piece I would absolutely, hands down say, is my most important secret weapon when I’m hiring an outside vendor: talk to a client. Now of course, they’re going to give you a positive referral, but even that can be very telling. You just have to dig in to know what’s important to you.

Michelle Dowling: So finding the—getting your vendor or your service provider, you know, getting a couple of people who have used them would be key. Because there are hiccups. Every one of us has them. If it’s not in the setup process, it’s in getting started, it’s in maintenance. And it’s not just to say, “I don’t want to work with you,” it’s just to know ahead of time what to look out for.

And then probably the secondary most important thing is: What kind of training and onboarding support do you need? What will be critical for your team to effectively use any technology that you would want to bring into your practice?

Ease of use is probably one of the most important, but there’s also that ongoing touchpoint and support that’s important as well.

Michael Walker: You got a lot of favorites there, Michelle.

Michelle Dowling: I do. I know I did say a lot.

Michael Walker: No, it’s good.

Michelle Dowling: Gotta get through it. And I also sit on the side where I can sympathize with the folks that are trying to make these critical decisions. It’s a lot to consider. You know, we always say at Rectangle Health, we try to be the mechanism to help providers. We are not providing the clinical care — that is the most important. So as a supporting cast member, we do everything we can to make it easy. And these are just some of the things that have come up over the years — things that make it easy or are just things that we should look out for.

Michael Walker: Yeah, that’s beautiful. And I think that’s the—again, with Rectangle Health, who you are with, you know that this is a great place to start to have that conversation about what to do. It’s really hard, when you’re looking at something like this, to do the due diligence on your own — unless you’re a whiz in all this stuff, you’re an IT wiz and financial, then that might be a little… it might be fun. But if you’re not, then it’s about having somebody in your corner that can help you with the due diligence and ultimately how to execute and move forward.

I think that’s all—we have to, you know, my goal as a leadership coach is to help take 80% of you and focus on the 20% of what you’re great at. Right?

So, I think I see a lot in medical practice — the problem is we get focused on having to be jack-of-all-trades because we think we have to know everything. We think we have to be able to address areas and just do it because, “Who else is gonna do it?” And that’s just not true. It’s just not true.

You have a lawyer that does your legal stuff. You have an accountant that sends your stuff off to the government. In areas like this, it’s just such an important part. And same in marketing — having a partner in that.

And I think the one thing that you didn’t mention, and I was thinking about, was evolution capacity. I mean, that’s the thing. Stuff is moving so fast, Michelle. Everything moves so fast. And AI is able to gather such an incredible amount of information to say, “Here’s a whole bunch of stuff going on.”

It just makes due diligence—yes—faster in terms of data collection, but even more challenging to sort through to get down to what really is important to you and what you want to achieve.

Michelle Dowling: Absolutely. Yeah. Software is probably one of the most prime examples of that. You have to be far ahead of the industry that you’re working in. So I think, like what you said, was probably one of the things that resonates most here at Rectangle Health — because we exclusively work for the healthcare industry — we are always looking at the future for them and anticipating needs that are four to six months to a year out, minimally.

Right? So the idea is: can we look at trends that are happening outside of healthcare, knowing that they will affect healthcare, and make sure that we are already ahead of them so that we can continue to offer that down the road?

I’ll give you a great example. The recent legislation came down that the Treasury would be moving away from paper checks by September. That is a monumental possibility — I think, rather than reality — but if we can start to look at what’s happening, even in our own government, moving away from checks, we know that is on the horizon for healthcare. We’ve seen this happen many, many times over the years.

So to your point about evolution — we also have clues all around us. And a lot of good companies will start to look at those and then have that inform what they’re coming out with and what they’re creating in the backend.

Michael Walker: Yeah, absolutely. Yeah, I was thinking just something you mentioned too about reaching out, talking to a client — somebody who already is using it. I just want to encourage you: if you’re gonna do that, don’t just ask, “Hey, so how’s that working for you?”

Ask more. Here are two questions that I’ll pose, that I would suggest. This is what I’d use in a mediation setting — something like this. I’d say:

The first question would be: “What is something that has happened with this XYZ platform that has unexpectedly delighted you?” You’ll be amazed what will come out from that comment.

The other question would be: “What has happened that you had hoped to see but hasn’t materialized yet?”

Michelle Dowling: Those are great questions.

Michael Walker: And if you pose those questions, trust me, they will feed off in two different ways and you’ll get way more context. Because now, people don’t feel like they have to answer one way or the other — they can lean into it. And then you can do secondary questions and all that kind of stuff.

But, you know, as we kind of wrap up, I just wanted to — Michelle, thank you so much for joining us today and sharing your insights on simplifying dental payments and tackling payer challenges.

Closing Thoughts

Michelle Dowling: Absolutely, my pleasure. Thank you so much for having me.

Michael Walker: Yeah. Your expertise and the work you’re doing at Rectangle Health are clearly helping dental practices not only get paid faster — that’s a good thing — but also build a stronger foundation for long-term independence from insurance, giving practices a foundation that they are in charge of, not systems and bureaucracies and regulatory entities to this extent in this realm.

So we certainly hope today’s episode has given our listeners practical ideas — I know it has — for improving efficiency, reclaiming revenue, and providing a better financial experience for patients.

As always, this podcast is about taking action. So here are two steps you can take to move your practice forward. I’m actually going to have three — there are three things I want to put out today.

The first is: if you’re looking to attract high-quality new patients and grow beyond that PPO dependence, then, as I mentioned before, I just encourage you to schedule that marketing strategy meeting with Ekwa Marketing.

Their team will help you build an SEO strategy that will drive that consistent patient flow you’re looking for. It’s like what we’re talking about — if you’re already a super expert in this area, then this might not be of great value. But I can tell you, there’s no tricks or hooks. It’s free. I also know they spend about five to six hours in advance looking at all your online digital materials so that they will actually come back to you with a report that gives you a real good sense of what you could do — with no expectation. You don’t have to do anything with them.

They’re just providing that. That’s what this company is about — helping, just like this podcast, helping set each practice up for success together in a way that really brings great joy to the practice owners and every employee as part of the team.

So if you’d like to do that, I just encourage you to book — and I mentioned it before — at lessinsurancedependence.com/marketing-strategy-meeting. And again, that link will be where you picked up this podcast. You’ll be able to get that link right there.

The second, for strategic guidance on building a thriving insurance-independent practice, as mentioned before, you could schedule your complimentary coaching meeting with Gary Takacs. And Gary can be booked at thrivingdentist.com/csm to get that started.

And third, you guys have just met Michelle, and she has given you some great tips and thoughts and ideas. What a wonderful person to have in your corner as you start to consider looking at less insurance dependence. So I encourage you to reach out to her as well.

So certainly, as I mentioned, all three of these resources are here to help take you to the next step toward a more profitable and sustainable practice.

If you’ve found value in today’s episode, please share it with a colleague or a friend. The more we spread these conversations, the more we empower dental professionals to take control of their financial future.

And thanks for spending time with us today, and I look forward to connecting with you again on the next episode of the Less Insurance Dependence podcast.

And until then, and on behalf of Michelle — keep moving forward toward a thriving, independent practice. Mike Walker, till next time.